title: The utility of procalcitonin in critically ill trauma patients.
abstract: BACKGROUND
  Procalcitonin (PCT), the prohormone of calcitonin, has an early and highly specific increase in response to systemic bacterial infection. The objectives of this study were to determine the natural history of PCT for patients with critical illness and trauma, the utility of PCT as a marker of sepsis versus systemic inflammatory response syndrome (SIRS), and the association of PCT level with mortality.
  
  
  METHODS
  PCT assays were done on eligible patients with trauma admitted to the trauma intensive care unit (ICU) of a Level I trauma center from June 2009 to June 2010, at hours 0, 6, 12, 24, and daily until discharge from ICU or death. Patients were retrospectively diagnosed with SIRS or sepsis by researchers blinded to PCT results.
  
  
  RESULTS
  A total of 856 PCT levels from 102 patients were analyzed, with mean age of 49 years, 63% male, 89% blunt trauma, mean Injury Severity Score of 21, and hospital mortality of 13%. PCT concentration for patients with sepsis, SIRS, and neither were evaluated. Mean PCT levels were higher for patients with sepsis versus SIRS (p < 0.0001). Patients with a PCT concentration of 5 ng/mL or higher had an increased mortality when compared with those with a PCT of less than 5 ng/mL in a univariate analysis (odds ratio, 3.65; 95% confidence interval, 1.03-12.9; p = 0.04). In a multivariate logistic analysis, PCT was found to be the only significant predictor for sepsis (odds ratio, 2.37; 95% confidence interval,1.23-4.61, p = 0.01).
  
  
  CONCLUSIONS
  PCT levels are significantly higher in ICU patients with trauma and sepsis and may help differentiate sepsis from SIRS in critical illness. An elevated PCT level was associated with increased mortality.
authors: Inova Regional Trauma Center, Falls Church, Virginia, USA. Joseph.Sakran@uphs.upenn.edu
authors: Joseph V
authors: JV
authors: Sakran
authors: Christopher P
authors: CP
authors: Michetti
authors: Michael J
authors: MJ
authors: Sheridan
authors: Robyn
authors: R
authors: Richmond
authors: Tarek
authors: T
authors: Waked
authors: Tayseer
authors: T
authors: Aldaghlas
authors: Anne
authors: A
authors: Rizzo
authors: Margaret
authors: M
authors: Griffen
authors: Samir M
authors: SM
authors: Fakhry
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood* / Q000378:metabolism; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D016001:Confidence Intervals; D003422:Critical Care; D016638:Critical Illness; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood* / Q000378:metabolism; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000097:blood* / Q000401:mortality / Q000628:therapy
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide