Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

Abstract

Background: Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.

Methods: Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38 degrees C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.

Results: Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).

Conclusion: The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients.

Figure 1

ROC curves for PCT, CRP and WBC count for differentiation between proven and not-proven infections. ROC: receiver operator characteristics, PCT: Procalcitonin, CRP: C- reactive protein, WBC: White Blood Cells.

Figure 2

Trend of PCT concentrations on sequential daily measurements between days 1 and 4 in patients with and without favorable outcome at 28 days. PCT: Procalcitonin.

Figure 3

PCT values for patients with (constant line) and without (dotted line) proven infection before and after the onset of fever (D1). PCT: Procalcitonin, D1: Day1 (day of fever onset).