Ratio of serum procalcitonin to monocytic HLA-DR as a reliable parameter in prognosis prediction of sepsis

Abstract

Background: We evaluated the prognostic potential of the ratio of serum procalcitonin to monocytic HLA-DR for 28-day mortality in sepsis.

Methods: In this retrospective study, a total of 91 patients with sepsis were enrolled. Clinical and laboratory data detected on admission (D0) and 7 days thereafter (D7) including the Acute Physiology and Chronic Health Evaluation II (APACHE II), the Sequential Organ Failure Assessment (admission SOFA), serum lactate, D-dimer, mHLA-DR, procalcitonin, platelet and white blood cell count, neutrophil-to-lymphocyte ratio were collected. The PCT/mHLA-DR ratio, the changes in mHLA-DR and WBC on day 7 compared with those on the day of admission and PCT clearance were calculated. Receiver operating characteristic curves, Kaplan-Meier survival curves, DeLong test and Cox regression analyses were used to assess and compare their predictive values.

Results: Among all studied parameters, D₇-PCT/mHLA-DR showed the best discriminatory property to differentiate survivors from non-survivors and was identified as an independent predictor of 28-day mortality.

Conclusion: The D₇-PCT/mHLA-DR ratio was more sensitive than either biomarker alone in predicting fatal outcome in septic patients. Combining pro-inflammatory and immunosuppression biomarkers might improve the prognostic accuracy in sepsis.

Keywords: Monocytic HLA-DR; Procalcitonin; Prognosis; Sepsis.