INTRODUCTION. Procalcitonin (PCT) has been studied as sepsis marker in different clinical scenarios and its values are higher in gram-negative infections compared to gram-positive ones. PCT raise is more evident in bacterial then in invasive fungal infec- tions. PCT values were higher in surgical than in medical patients, and in abdominal and urinary infections than others. OBJECTIVES. The aim of our study was to identify the most import- ant clinical determinant that influences PCT values in a population of medico-sukrgical ICU patients. METHODS. Retrospective analisi of a prospective 4 year-data col- lection. 927 consecutive patients were analyzed and we collected clinical parameters, laboratory, microbiological and radiographicexams, antibiotics and vasopressors administration, C-Reactive Protein (CRP) and PCT values, in order to recognize etiology and site of infections. We daily classified the clinical states of patients into six diagnostic classes and the intensive care admission as medical or surgical. An optimal scaling analysis was performed in order to assess the most important clinical determinant of PCT. RESULTS. PCT values were lower in fungal sepsis than in gram- negative and gram-positive ones (p< 0.05). We analyzed peak values of PCT during septic events: gram-negative sepsis have higher mean peak value than gram-positive and fungal ones (p< 0.05). PCT values of abdominal (3.84 ng/ml - IC95% 3.35-4.36) and urinary tract (6.63 ng/ml - IC95% 4.71-11.52) septic events were higher than in soft tissues (4,03 ng/ml - IC95% 3.42-4.81), lung (2.31 ng/ml - IC95% 2.09-2.68), and BSI (1.78 ng/ml - IC95%1.22 -2.35) ones (p< 0.05). PCT mean peak value was higher in abdominal than in lung sepsis (p< 0.05). There was no statis- tical significance for the other sites of infection in PCT peak means values.We found higher PCT values in surgical patients than in medical ones, anyway there's a difference due to the site of infection: actually there is prevalence of abdominal infection in surgical patients (61.6%), and prevalence of lung infection (73.2%) in medical patients. At optimal scaling analysis we found that septic events were the strongest determinant of PCT values (par- tial correlation=0.432 and importance=0.702), site of infection pre- sents a high importance (=0.22), while type of patient (medical/ surgical) (=0.08) and etiology (=0.02) importance were similar. Analyzing PCT peak values we found that the septic event was the most important clinical factor of the septic events PCT peak value (partial correlation=0.28, importance=0.8) than other ones. CONCLUSIONS. Our study identified that PCT moves in different ways according to etiology, site of infection and type of patient admission (medical/surgical), anyway the most important clinical determinant factor of PCT peak value during a septic event is etiology.
What is the most important clinical determinant of procalcitonin?
Zampieri Silvia;Donadello Katia;Schweiger Vittorio;Gottin Leonardo;Polati Enrico
2018-01-01
Abstract
INTRODUCTION. Procalcitonin (PCT) has been studied as sepsis marker in different clinical scenarios and its values are higher in gram-negative infections compared to gram-positive ones. PCT raise is more evident in bacterial then in invasive fungal infec- tions. PCT values were higher in surgical than in medical patients, and in abdominal and urinary infections than others. OBJECTIVES. The aim of our study was to identify the most import- ant clinical determinant that influences PCT values in a population of medico-sukrgical ICU patients. METHODS. Retrospective analisi of a prospective 4 year-data col- lection. 927 consecutive patients were analyzed and we collected clinical parameters, laboratory, microbiological and radiographicexams, antibiotics and vasopressors administration, C-Reactive Protein (CRP) and PCT values, in order to recognize etiology and site of infections. We daily classified the clinical states of patients into six diagnostic classes and the intensive care admission as medical or surgical. An optimal scaling analysis was performed in order to assess the most important clinical determinant of PCT. RESULTS. PCT values were lower in fungal sepsis than in gram- negative and gram-positive ones (p< 0.05). We analyzed peak values of PCT during septic events: gram-negative sepsis have higher mean peak value than gram-positive and fungal ones (p< 0.05). PCT values of abdominal (3.84 ng/ml - IC95% 3.35-4.36) and urinary tract (6.63 ng/ml - IC95% 4.71-11.52) septic events were higher than in soft tissues (4,03 ng/ml - IC95% 3.42-4.81), lung (2.31 ng/ml - IC95% 2.09-2.68), and BSI (1.78 ng/ml - IC95%1.22 -2.35) ones (p< 0.05). PCT mean peak value was higher in abdominal than in lung sepsis (p< 0.05). There was no statis- tical significance for the other sites of infection in PCT peak means values.We found higher PCT values in surgical patients than in medical ones, anyway there's a difference due to the site of infection: actually there is prevalence of abdominal infection in surgical patients (61.6%), and prevalence of lung infection (73.2%) in medical patients. At optimal scaling analysis we found that septic events were the strongest determinant of PCT values (par- tial correlation=0.432 and importance=0.702), site of infection pre- sents a high importance (=0.22), while type of patient (medical/ surgical) (=0.08) and etiology (=0.02) importance were similar. Analyzing PCT peak values we found that the septic event was the most important clinical factor of the septic events PCT peak value (partial correlation=0.28, importance=0.8) than other ones. CONCLUSIONS. Our study identified that PCT moves in different ways according to etiology, site of infection and type of patient admission (medical/surgical), anyway the most important clinical determinant factor of PCT peak value during a septic event is etiology.
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