Prognostic evaluation of severe sepsis and septic shock: Procalcitonin clearance vs Δ Sequential Organ Failure Assessment

Purpose: The purpose of the study is to compare the clearance of procalcitonin (PCT-c) in the first 24 and 48 hours of treatment of severe sepsis and septic shock with another early prognostic marker represented by the 48-hour. Sequential Organ Failure Assessment (SOFA). Materials and methods: Prospective, observational cohort study conducted in a general intensive care unit including patients with severe sepsis and septic shock. The PCT-c was determined at the diagnosis of sepsis and after 24 and 48 hours. The SOFA score was determined at the time of intensive care unit admission and after 48 hours. Results: One hundred thirty adult patients with severe sepsis and septic shock were studied over an 18-month period. The 24-and 48-hour PTC-c scores were significantly higher in survivors (P < .0001). In nonsurvivors, the initial SOFA was significantly higher, and the 48-hour Delta SOFA was significantly smaller (P = .01). The area under the receiver operating characteristic curve was 0.68 for Delta SOFA and 0.76 for 24-and 48-hour PCT-c. Conclusions: The 48-hour Delta SOFA score and the clearance of 24-and 48-hour PCT are useful markers of prognosis in patients with severe sepsis and septic shock. A decrease in PCT-c in the first 24 hours of treatment should prompt the reassessment of the appropriateness and adequacy of treatment. (C) 2014 Elsevier Inc. All rights reserved.