Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients: A prospective observational study.
The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients.



This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups.



Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P< .05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P< .05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P< .001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P< .001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017).



Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: trasydom@gmail.com.
Domonkos
D
Trásy
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: tkrisztian78@gmail.com.
Krisztián
K
Tánczos
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: nemethmarton85@gmail.com.
Márton
M
Németh
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: hankovszky@gmail.com.
Péter
P
Hankovszky
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: anlovas@gmail.com.
András
A
Lovas
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: andrasmikor@gmail.com.
András
A
Mikor
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: ildiko.laszlo88@gmail.com.
Ildikó
I
László
University of Szeged, Faculty of Medicine, Division of Infectious Diseases, First Department of Internal Medicine, Szeged, Hungary. Electronic address: horvathne.hajdu.edit@med.u-szeged.hu.
Edit
E
Hajdú
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: oszang78@gmail.com.
Angelika
A
Osztroluczki
Semmelweis University, Faculty of Medicine, Department of Transplantation and Surgery, Budapest, Hungary. Electronic address: jancsidora@gmail.com.
János
J
Fazakas
University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: zsoltmolna@gmail.com.
Zsolt
Z
Molnár
D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D002116:Calcitonin / Q000097:blood* / Q000187:drug effects; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve
D000890:Anti-Infective Agents; D011498:Protein Precursors; D002116:Calcitonin
Appropriate antimicrobial therapy; Biomarkers; Empirical antimicrobial therapy; Infection; Procalcitonin; Sepsis