title: Prognostic evaluation of severe sepsis and septic shock: procalcitonin clearance vs Δ Sequential Organ Failure Assessment.
abstract: OBJECTIVE
  The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour Δ Sequential Organ Failure Assessment (SOFA).
  
  
  METHODS
  Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours.
  
  
  RESULTS
  One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24- and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Δ SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Δ SOFA and 0.76 for 24- and 48-hour PCT-c.
  
  
  CONCLUSIONS
  The 48-hour Δ SOFA score and the clearance of 24- and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment.
authors.affiliation: Intensive Care Unit, São Domingos Hospital, Maranhao, Brazil. Electronic address: jrazevedo47@gmail.com.
authors.forename: José R A
authors.initials: JR
authors.lastname: de Azevedo
authors.affiliation: Intensive Care Unit, São Domingos Hospital, Maranhao, Brazil.
authors.forename: Orlando J M
authors.initials: OJ
authors.lastname: Torres
authors.affiliation: Department of Surgery, Evangelic University Hospital of Curitiba, Curitiba, PR, Brazil.
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Beraldi
authors.affiliation: Department of Internal Medicine, Evangelic University Hospital of Curitiba, Curitiba, PR, Brazil.
authors.forename: Carmen A P M
authors.initials: CA
authors.lastname: Ribas
authors.affiliation: Department of Surgery, Evangelic University Hospital of Curitiba, Curitiba, PR, Brazil.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Malafaia
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism*; D012372:ROC Curve; D018805:Sepsis / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality; D012772:Shock, Septic / Q000175:diagnosis / Q000378:metabolism / Q000401:mortality; D017741:Survivors; D013997:Time Factors
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
keywords: Biomarker; Procalcitonin; Prognosis; SOFA score; Septic shock; Severe sepsis