title: Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis.
abstract: 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.
authors.affiliation: 2nd Department of Internal Medicine, Sismanogleion Athens Hospital, Athens 15126, Greece.
authors.forename: Antonia-Panagiota
authors.initials: AP
authors.lastname: Georgopoulou
authors.forename: Athina
authors.initials: A
authors.lastname: Savva
authors.forename: Evangelos J
authors.initials: EJ
authors.lastname: Giamarellos-Bourboulis
authors.forename: Marianna
authors.initials: M
authors.lastname: Georgitsi
authors.forename: Maria
authors.initials: M
authors.lastname: Raftogiannis
authors.forename: Nicolaos
authors.initials: N
authors.lastname: Antonakos
authors.forename: Efterpi
authors.initials: E
authors.lastname: Apostolidou
authors.forename: Dionyssia-Pinelopi
authors.initials: DP
authors.lastname: Carrer
authors.forename: George
authors.initials: G
authors.lastname: Dimopoulos
authors.forename: Aggelos
authors.initials: A
authors.lastname: Economou
authors.forename: George
authors.initials: G
authors.lastname: Efthymiou
authors.forename: Nearchos
authors.initials: N
authors.lastname: Galanakis
authors.forename: Labrini
authors.initials: L
authors.lastname: Galani
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Gargalianos
authors.forename: Ilias
authors.initials: I
authors.lastname: Karaiskos
authors.forename: Chrisostomos
authors.initials: C
authors.lastname: Katsenos
authors.forename: Dimitra
authors.initials: D
authors.lastname: Kavatha
authors.forename: Evangelos
authors.initials: E
authors.lastname: Koratzanis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Labropoulos
authors.forename: Malvina
authors.initials: M
authors.lastname: Lada
authors.forename: George
authors.initials: G
authors.lastname: Nakos
authors.forename: Evgenia
authors.initials: E
authors.lastname: Paggalou
authors.forename: George
authors.initials: G
authors.lastname: Panoutsopoulos
authors.forename: Michael
authors.initials: M
authors.lastname: Paraschos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pavleas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Pontikis
authors.forename: Garyfallia
authors.initials: G
authors.lastname: Poulakou
authors.forename: Athanassios
authors.initials: A
authors.lastname: Prekates
authors.forename: Styliani
authors.initials: S
authors.lastname: Sybardi
authors.forename: Maria
authors.initials: M
authors.lastname: Theodorakopoulou
authors.forename: Christina
authors.initials: C
authors.lastname: Trakatelli
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsiaoussis
authors.forename: Charalambos
authors.initials: C
authors.lastname: Gogos
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.forename: Michael
authors.initials: M
authors.lastname: Meisner
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide