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BJA Advance Access published online on July 18, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael181
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted June 14, 2006

Clinical Investigation

Procalcitonin for early prediction of survival outcome in postoperative critically ill patients with severe sepsis

A. A. Dahaba 1 *, B. Hagara 1, A. Fall 1, P. H. Rehak 2, W. F. List 1, and H. Metzler 1

1 Department of Anaesthesiology and Intensive Care Medicine, Graz Medical University, Graz, Austria
2 Biomedical Engineering and Computing Unit of the Department of Surgery, Graz Medical University, Graz, Austria

* To whom correspondence should be addressed.
A. A. Dahaba, E-mail: ashraf.dahaba{at}meduni-graz.at


  Abstract

Background. Identification of postoperative patients at high risk of dying early after intensive care unit (ICU) admission through a fast and readily available parameter may help in determining therapeutic interventions or further diagnostic procedures that could have an impact on patients' outcome. The aim of our study was to assess the utility of procalcitonin (PCT) and other readily available parameters, as useful early (days 1-3) predictors of mortality in postoperative patients diagnosed with severe sepsis within 24 h preceding their operation.

Methods. More than a period of 2 yr, subsets of 69 postoperative patients admitted with severe sepsis and 890 non-septic ICU patients were investigated. PCT, C-reactive protein (CRP) and sequential organ failure assessment (SOFA) score were recorded over the duration of ICU stay.

Results. PCT area under receiver operating characteristic (ROC) curve was 0.78 on day 3 and was highly predictive of fatal outcome (0.90) at day 6. Area under ROC curve of SOFA score was 0.85 on day 3 and remained in this range until day 6. Area under ROC curves on day 3 of CRP (0.61) was non-predictive and remained non-predictive over the duration of ICU stay.

Conclusions. PCT exhibited no discriminative power early after ICU admission for prediction of mortality in critically ill patients with severe sepsis, compared with a high predictive power of SOFA score on day 3. However, using PCT could still serve as a useful complementary comparator for prediction of survival outcome using the SOFA score.

Keywords: complications, sepsis; protein, C-reactive; statistics, receiver operating characteristic; survival, outcome.
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