Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis.
OBJECTIVE
The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis.


METHODS
A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%.


RESULTS
Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003).


CONCLUSIONS
Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
Georgopoulou
Antonia-Panagiota
AP
2nd Department of Internal Medicine, Sismanogleion Athens Hospital, Athens 15126, Greece.
Savva
Athina
A
Giamarellos-Bourboulis
Evangelos J
EJ
Georgitsi
Marianna
M
Raftogiannis
Maria
M
Antonakos
Nicolaos
N
Apostolidou
Efterpi
E
Carrer
Dionyssia-Pinelopi
DP
Dimopoulos
George
G
Economou
Aggelos
A
Efthymiou
George
G
Galanakis
Nearchos
N
Galani
Labrini
L
Gargalianos
Panagiotis
P
Karaiskos
Ilias
I
Katsenos
Chrisostomos
C
Kavatha
Dimitra
D
Koratzanis
Evangelos
E
Labropoulos
Panagiotis
P
Lada
Malvina
M
Nakos
George
G
Paggalou
Evgenia
E
Panoutsopoulos
George
G
Paraschos
Michael
M
Pavleas
Ioannis
I
Pontikis
Konstantinos
K
Poulakou
Garyfallia
G
Prekates
Athanassios
A
Sybardi
Styliani
S
Theodorakopoulou
Maria
M
Trakatelli
Christina
C
Tsiaoussis
Panagiotis
P
Gogos
Charalambos
C
Giamarellou
Helen
H
Armaganidis
Apostolos
A
Meisner
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000188:drug therapy* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
D000890:Anti-Infective Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide