Aims To investigate the clinical benefit of routine procalcitonin (PCT) measurement in the medical intensive care unit (ICU) of a tertiary referral hospital. Methods Adult patients with suspected infections were included. White blood cells, C-reactive protein (CRP), and PCT were measured. Results In this study 129 patients of median age 64 years (interquartile range 39-89 years) were prospectively included. The Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 21 ± 14 and 7 ± 6, respectively. Intensive care unit (ICU) mortality was 22.5%. Immunocompromised patients constituted 39.5%. A significant correlation was observed between PCT and APACHE II (Spearman's rho 0.461, p < 0.01), PCT and SOFA (Spearman's rho 0.494, p < 0.01) and PCT and CRP (Spearman's rho 0.403, p < 0.01). Most patients (n = 83, 64.3%) received antibiotics before admission. No difference in PCT (1.56 ± 8 µg/L vs. 1.44 ± 13 µg/L, p = 0.6) was observed with respect to previous antibiotic therapy. Levels of PCT and CRP were significantly increased in patients with positive blood cultures, the
response (Mandard score 1 and 2). Variables which met the cut-off criteria were used to fit multivariate logistic regression models combining clinical variables (age, gender, T-stage and N-stage) with imaging features. Performance of the combined models was compared with that of baseline clinical model and the area under the curve (AUC), and two-tailed p values were reported.Results: 37 patients (6 female, 31 male, median 65 years, range 41-80) were included in this analysis. 13/37 patients achieved a pathological response. Diffusion-weighted MTD at Timepoint_1 (OR 0.33, 95%CI 0.14-0.81, p 0.02) and T2-weighted kurtosis at Timepoint_2 (OR 0.09, 95%CI 0.01-0.91, p 0.04) were associated with pathological response. These statistically improved the predictive performance of the clinical model (AUC 0.88 and 0.94, respectively versus 0.75 for baseline clinical model).Conclusions: Diffusion-weighted maximal tumour dimension at week-3 and T2weighted kurtosis on neoadjuvant treatment completion have the potential to improve the predictive value of clinical models for response to treatment, but would require external validation in subsequent studies.
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