title: Procalcitonin variations after Emergency Department admission are highly predictive of hospital mortality in patients with acute infectious diseases.
abstract: OBJECTIVE
  To evaluate the diagnostic and prognostic usefulness of procalcitonin (PCT) in patients admitted to the Emergency Department (ED) with signs of infections and to assess the prognostic value of repeated measurements in predicting hospital mortality.
  
  
  METHODS
  A prospective, observational study was conducted in our 400-bed General Teaching Hospital. 261 patients arriving in ED with signs/symptoms of infection were enrolled. PCT was performed upon arrival in the ED (T0), and 5 days after antibiotic therapy (T5). Blood cultures were performed in all patients upon arrival in the ED.
  
  
  RESULTS
  Mean T0 PCT value was 7.1±17.9 ng/ml, and at T5 3±9.1 ng/ml (p < 0.0001). Mean PCT in septic non-survivors was increased at T5 compared to T0 but not significantly. The PCT increase at T5 was an independent factor of mortality (OR = 1.29, p < 0.02) in septic patients. Compared to baseline mean delta % PCT decrease at T5 was 28%. Patients with a decrease delta % PCT > 28% showed a lower number of deaths, with a statistical significant difference if compared to those patients with a < 28% decrease (p < 0.004). ROC curve of delta % PCT for prediction of death has an AUC = 0.82 (p < 0.03).
  
  
  CONCLUSIONS
  PCT is a useful marker for diagnosis of systemic and local infections, and for prognostic stratification in patients with acute infectious diseases at their arrival in ED. PCT variations after antibiotic therapy are highly predictive for in-hospital mortality. PCT normalization during antibiotic therapy suggests a good response to infection possibly leading to less infection-related deaths.
authors: Emergency Medicine Department, Sapienza University, Rome, Italy.
authors: L
authors: L
authors: Magrini
authors: F
authors: F
authors: Travaglino
authors: R
authors: R
authors: Marino
authors: E
authors: E
authors: Ferri
authors: B
authors: B
authors: De Berardinis
authors: P
authors: P
authors: Cardelli
authors: G
authors: G
authors: Salerno
authors: S
authors: S
authors: Di Somma
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D003141:Communicable Diseases / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D004636:Emergency Service, Hospital; D005260:Female; D017052:Hospital Mortality; D006769:Hospitals, General; D006784:Hospitals, Teaching; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012307:Risk Factors; D012384:Rome; D018805:Sepsis / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide