Procalcitonin as a predictor of survival in patients with sepsis: A study on diagnostic accuracy.

Objective: Role of serum procalcitonin (PCT) in critically ill patients is well defined for identification of bacterial infection but it’s role in prediction of survival is not well established. We studied plasma kinetics of PCT, over the first three critical care days to validate its role in prediction of survival of patients with sepsis according to plasma level. Methods: A prospective observational study was conducted in CCU (KGMU). Total 53 consecutive patients either sex were recruited. Patients with systemic inflammatory response syndrome (SIRS) were recruited. PCT was measured on 1st and 3rd days. We studied 50 days survival using Kaplan-Meier analysis and diagnostic accuracy of PCT using ROC analysis. Results: In our study, PCT was statistically significantly higher in non-survivor patients compared to survivor patients (p<0.05). ROC curve was made with PCT based on culture at both time intervals. On the basis of ROC curve, we determined a cut-off value as 12.21 ng/ml of PCT on day 3 to predict sepsis with high sensitivity (93.7%) and specificity (71.4%). Area under curve (AUC) was also higher observed at day 3 (AUC=0.864, p<0.001) compared to day 1 (AUC=0.658, p<0.05). According to Kaplan-Meier curve, risk of mortality was by 83% (HR 0.17(95% 0.07-0.44)) lower in low sepsis category group (≤12.21 ng/ml) compared to high sepsis category group (>12.21 ng/ml). Conclusion: According to our study results, we conclude that serum PCT has good clinical diagnostic and prognostic values in prediction of survival in patients with sepsis. Kinetic studies of PCT can improve sensitivity and accuracy when evaluating the prognosis of patients with sepsis as well as survival rate. [ABSTRACT FROM AUTHOR]