The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review

Abstract

BackgroundMajor trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD), which markedly influence the outcome of injured patients. Early identification of patients at risk of developing posttraumatic complications is crucial to provide early treatment and improve outcomes. We sought to evaluate the prognostic value of serum procalcitonin (PCT) levels after trauma as related to severity of injury, sepsis, organ dysfunction, and mortality.MethodsWe searched PubMed, MEDLINE, EMBASE, the Cochrane Database, and references of included articles. Two investigators independently identified eligible studies and extracted data. We included original studies that assessed the prognostic value of serum PCT levels in predicting severity of injury, sepsis, organ dysfunction, and mortality among critically injured adult patients.ResultsAmong 2015 citations, 19 studies (17 prospective; 2 retrospective) met inclusion criteria. Methodological quality of included studies was moderate. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Twelve out of 16 studies demonstrated significant elevation of initial PCT levels in patients who later developed sepsis after trauma. PCT level appeared a strong predictor of MOD in seven out of nine studies. While two studies did not show association between PCT levels and mortality, four studies demonstrated significant elevation of PCT levels in non-survivors versus survivors. One study reported that the PCT level of ≥ 5 ng/mL was associated with significantly increased mortality (OR 3.65; 95% CI 1.03–12.9; p = 0.04).ConclusionPCT appears promising as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.

Composite bioscore is superior to routine biomarkers and established scoring systems in predicting mortality in adult critically ill patients with secondary sepsis

“…Roughly, one third of our patient population was group of trauma critically ill patients, who developed secondary sepsis. In a recent systematic review, prognostic value of serum procalcitonin in critically ill trauma patients was investigated with conflicting results: out of six studies regarding procalcitonin outcome prediction ability, four found significantly higher levels of procalcitonin in nonsurvivors, which is in contrast to our results, while two demonstrated no association between procalcitonin levels and lethal outcome, which is in accordance with our data (26). In our present study, C-reactive protein levels showed statistically significant difference between survivors and nonsurvivors only on the 5 th day, which is, from the clinical point of view, rather late predictor of lethal outcome with AUC of 0.64.…”

Physiologic risk factors for early acute kidney injury in severely injured patients

“…PCT is a marker of bacterial infection, but it is also rapidly elevated in various non-infectious forms of systemic infl ammation including injury. Elevated PCT levels immediately after trauma are predictive of both infectious and noninfectious complications and correlate with the development of organ dysfunctions and increased mortality (34,35). We found a signifi cant difference between the AKI-group and non-AKI group in serum PCT at all of T1, T2, and T3.…”

MR‐ proADM to detect specific types of organ failure in infection

“…PCT was able to detect the presence of cardiovascular and renal failure, with AUROCs > 0.80, but exhibited lower ORs in the multivariate analysis than those shown by MR‐proADM. Some authors have studied the prognostic value of serum PCT levels in predicting sepsis, organ dysfunction and mortality among adults critically ill patients 32 with discordant results 33,34 . However, none of these studies analysed the relationship between PCT and specific organ failure.…”