Procalcitonin Variations Are Highly Predictive Of Hospital Mortality In Patients With Bloodstream Infection In Intensive Care Unit

Background and objective：The value of PCT had been studied sufficiently as a diagnostic,antibiotic therapy guiding marker of sepsis. PCT is superior to othermarkers in diagnosis of bloodstream infection，while the value of PCT inpredicting the mortality of patients with bloodstream infection remainsuncertain. The differences in absolute PCT values and their variationsbetween survival group and death group were compared, to evaluate theprognostic value of PCT in patients admitted to the ICU with bloodstreaminfection.Materials and Methods：In this study, we retrospectively analyzed the data of56patients withbloodstream infection admitted to Jilin university Bethune First hospitalfrom June1,2012to May1,2014. Those patients showed positive bloodcultures, and received repeated PCT measurements on the1,4,7, and10thday of hospitalization. The patients were divided into two groupsaccording to their28-day survival result: survival group（n=37）and deathgroup（n=19）. Differences in parameters of PCT value and its variationsbetween two groups were compared, to evaluate the prognostic value ofPCT in patients admitted to the ICU with bloodstream infection. Results：1.There was no significant difference in patients characteristics: age,gender, length of ICU stay, length of fever,24-hour APACHE II score,characteristics and laboratory tests at admission, and main complications.The fungal blood stream infections percent was higher in death groupthan in survival group(P<0.05).While the Gram-negative (G-) andGram-positive (G+) infections percent were not significantly differentbetween survival group and death group (P>0.05for both).2. PCT declined as the use of antibiotics. PCT levels at admission toICU in survivors were significantly higher than those in death group,while they decreased more slowly in death group than in survival group.There was no significant differences in PCT1、PCT4、PCT7、PCT10between survival group and death group. However, the PCTT7-T1wassignificantly higher in survival group. The area under the ROC curve ofPCTT7-T1was better for predicting mortality than others. The best cut-offvalue for PCTT7-T1was-0.11ng/ml, with AUC of0.738and a sensitivityof70.0%and a specificity of71.4%. The best cut-off value for PCTT10-T1was-2.71ng/ml, with AUC of0.833and a sensitivity of100%and aspecificity of71.4%. Other parameters were not significantly different.3. WBC and PON were not significantly different (P>0.05).Conclusion：1. PCTT7-T1and PCTT10-T1are highly predictive of hospital mortality in patients with bloodstream infection in intensive care unit.2.The value of PCT1、PCT4、PCT7、PCT10and other parameters oughtto be tested in larger studies.