Department of Intensive Care Medicine, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland.
Crit Care. 2010;14(6):R205. doi: 10.1186/cc9327. Epub 2010 Nov 15.
This prospective study investigated the predictive value of procalcitonin (PCT) for survival in 242 adult patients with severe sepsis and septic shock treated in intensive care.
PCT was analyzed from blood samples of all patients at baseline, and 155 patients 72 hours later.
The median PCT serum concentration on day 0 was 5.0 ng/ml (interquartile range (IQR) 1.0 and 20.1 ng/ml) and 1.3 ng/ml (IQR 0.5 and 5.8 ng/ml) 72 hours later. Hospital mortality was 25.6% (62/242). Median PCT concentrations in patients with community-acquired infections were higher than with nosocomial infections (P = 0.001). Blood cultures were positive in 28.5% of patients (n = 69), and severe sepsis with positive blood cultures was associated with higher PCT levels than with negative cultures (P = < 0.001). Patients with septic shock had higher PCT concentrations than patients without (P = 0.02). PCT concentrations did not differ between hospital survivors and nonsurvivors (P = 0.64 and P = 0.99, respectively), but mortality was lower in patients whose PCT concentration decreased > 50% (by 72 hours) compared to those with a < 50% decrease (12.2% vs. 29.8%, P = 0.007).
PCT concentrations were higher in more severe forms of severe sepsis, but a substantial concentration decrease was more important for survival than absolute values.
本前瞻性研究调查了降钙素原 (PCT) 对 242 例重症脓毒症和感染性休克成年患者在重症监护治疗中的生存预测价值。
对所有患者的基线血样和 155 例患者的 72 小时血样进行 PCT 分析。
第 0 天的中位数 PCT 血清浓度为 5.0ng/ml（四分位距 (IQR) 1.0 和 20.1ng/ml）和 72 小时后为 1.3ng/ml（IQR 0.5 和 5.8ng/ml）。医院死亡率为 25.6%（62/242）。社区获得性感染患者的 PCT 浓度中位数高于医院获得性感染患者（P = 0.001）。28.5%的患者（n = 69）血培养阳性，且严重脓毒症伴阳性血培养患者的 PCT 水平高于阴性血培养患者（P = <0.001）。感染性休克患者的 PCT 浓度高于无感染性休克患者（P = 0.02）。PCT 浓度在医院存活者和非存活者之间无差异（P = 0.64 和 P = 0.99），但与 PCT 浓度降低 >50%（72 小时）的患者相比，浓度降低 <50%的患者死亡率更低（12.2%比 29.8%，P = 0.007）。
PCT 浓度在更严重的严重脓毒症形式中更高，但浓度的大幅下降对生存比绝对值更重要。
