The impact of procalcitonin to C-reactive protein ratio (PCR) kinetics as a predictor of mortality in nosocomial bloodstream infections

Abstract

Purpose: To investigate the combination of serum C-reactive protein (CRP) and procalcitonin (PCT) kinetics in predicting mortality in nosocomial blood stream infections (BSIs).Materials and Methods: We retrospectively reviewed the medical records of patients ≥ 18 years of age with nosocomial BSIs hospitalized in intensive care units (ICU). Clinical, microbiological and biochemical data were compared in patients who survivors and deaths. Binary logistic regression analyses were used to identify independent risk factors. The kinetic changes were defined the as difference between level on 5th day and level at 1st day of BSI.Results: Of the 84 included patients, 49 (58.4%) had survivors and 35 (41.6%) had deaths. In univariate analysis, renal disease (p=0.007), cardiac disease (p=0.042), septic shock (p=<0.001), SOFA (p=<0.001) and APACHE-II (p <0.001), ΔCRP (p=0.004), ΔPCT (p=<0.001), and ΔPCR (p=0.025) were significantly higher in non-survivors. In the logistic regression analysis, APACHE-II score (OR=1.46, 95% CI=1.20-1.78, p <0.001), ΔCRP (OR=1.18, %95 CI =1.04-1.34, p=0.009), ΔPCT (OR=0.87, 95% CI=0.79-0.95, p=0.001), and ∆PCR (OR=36.78, 95%C = 4.52-299.01, p=0.001) were independent predictors of 28-day mortality.Conclusions: The ∆PCR kinetic was a strong independent predictor of mortality in nosocomial BSIs in ICUs.