title: Prognostic value of PCT in septic emergency patients.
abstract: BACKGROUND
  An accurate assessment of septic patients at risk for poor clinical outcomes is challenging for clinicians in the emergency department (ED).
  
  
  OBJECTIVE
  We aimed to evaluate the prognostic value of procalcitonin (PCT) in septic patients in the ED for predicting death.
  
  
  RESULTS
  In a retrospective study, 188 septic patients (median age 63 [IQR 51-80]) of two French university hospitals were included. Patients who deceased within 30 days (20 %, n = 37) presented higher PCT value at admission (median 34.0 µg/L [5.0-71.9]) in comparison with the survivals (median 6.4 µg/L [4.1-13.1], p = 0.0005). ROC curve analysis indicated a moderate AUC of 0.686 [95 % CI 0.613-0.752] and an optimal PCT threshold value at 32.5 [95 % CI 21.8-43.3] µg/L that was associated with a 51 % [34-67] sensitivity, a 96 % [90-98] specificity, a 73 % [52-88] positive predictive value, and a 89 % [83-93] negative predictive value for death. Only 26 patients (14 %) had PCT values above this threshold (19 in the deceased group vs 7 in survival group, p < 0.0001). By multivariate analysis, only three variables remained significantly predictive of the death: personal history of cardiovascular disease (OR 3.1 [1.0-9.4], p = 0.046), the presence of severe sepsis/septic shock in the ER (OR 4.4 [1.3-12.3], p = 0.013), and a PCT level >32.5 µg/L (OR 36.0 [10.0-128.4], p < 0.0001). Similar results were obtained when considering the combined outcome death and/or admission in ICU.
  
  
  CONCLUSIONS
  Elevated value of PCT at admission has moderate accuracy to identify poor outcome in ED septic patients in daily practice.
authors.affiliation: Department of Emergency Medicine, Centre Hospitalo-universitaire de Rouen, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Peschanski
authors.affiliation: Department of Automated Biological Diagnosis, Hôpitaux Universitaires Paris Centre (HUPC) - Hôpital Cochin, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France. camille.gobeaux@cch.aphp.fr.
authors.forename: Camille
authors.initials: C
authors.lastname: Chenevier-Gobeaux
authors.affiliation: Department of Emergency Medicine, Hôpitaux Universitaires Est Parisien - Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 rue de la Chine, 75020, Paris, France.
authors.forename: Lynda
authors.initials: L
authors.lastname: Mzabi
authors.affiliation: Department of Emergency Medicine, Centre Hospitalo-universitaire de Rouen, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Rémy
authors.initials: R
authors.lastname: Lucas
authors.affiliation: Department of Biochemistry and Hormonology, Hôpitaux Universitaires Est Parisien - Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 rue de la Chine, 75020, Paris, France.
authors.forename: Siham
authors.initials: S
authors.lastname: Ouahabi
authors.affiliation: Department of Emergency Medicine, Centre Hospitalo-universitaire de Rouen, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Vianney
authors.initials: V
authors.lastname: Aquilina
authors.affiliation: Department of Biochemistry, Clinical Biology Institut, Centre Hospitalo-universitaire de Rouen, 1 rue de Germont, 76000, Rouen, France.
authors.forename: Valéry
authors.initials: V
authors.lastname: Brunel
authors.affiliation: Department of Biochemistry and Hormonology, Hôpitaux Universitaires Est Parisien - Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 rue de la Chine, 75020, Paris, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lefevre
authors.affiliation: Department of Emergency Medicine, Hôpitaux Universitaires Est Parisien - Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), 4 rue de la Chine, 75020, Paris, France.|Sorbonne Universités UMPC Université Paris 06, DHU Fighting Aging and Stress (FAST), Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Ray
keywords: Emergency department; Procalcitonin; Prognostic; Sepsis