Procalcitonin Clearance at 24,48,72,and 96 Hours and Mortality in Patients With Cancer and Sepsis: A Retrospective Cohort Study

Abstract

Introduction:

Previous studies have evaluated procalcitonin clearance (PCTc) as a marker of sepsis severity but at different time points and cutoffs. We aimed to assess the predictive performance of PCTc at different time points of sepsis management in patients with cancer.

Methods:

This retrospective cohort study included patients with cancer admitted to an intensive care unit between 2013 and 2016. We calculated PCTc at 24, 48, 72, and 96 hours after admission. Its predictive performance for hospital and 90-day mortality was analyzed with receiver operating characteristic curves and areas under the curves (AUCs). Sensitivity and specificity were calculated for different time points using different cutoffs.

Results:

We included 301 patients. Areas under the curves ranged from 0.62 for PCTc at 24 hours to 0.68 for PCTc at 72 and 96 hours for hospital mortality prediction, and from 0.61 for PCTc at 24 hours to 0.68 for PCTc at 72 hours for 90-day mortality prediction. For hospital mortality prediction, PCTc at 72 hours ≤80% showed the best sensitivity (96.0%; 95% confidence interval [CI]: 90.8%-98.7%), and PCTc at 96 hours ≤50% showed the best specificity (70.7%; 95% CI: 54.5%-83.9%).

Conclusions:

Procalcitonin clearance at 24, 48, 72, and 96 hours poorly predicted hospital and 90-day mortality. Therefore, daily PCT measurement should not be used to predict mortality for patients with cancer and sepsis.

Keywords

cancer critical care procalcitonin prognosis sepsis

Get full access to this article

View all access options for this article.

References

Rosolem

Rabello

Lisboa

, et al. Critically ill patients with cancer and sepsis: clinical course and prognostic factors. J Crit Care. 2012;27(3):301–307.

Torres

Azevedo

Silva

, et al. Sepsis-associated outcomes in critically ill patients with malignancies. Ann Am Thorac Soc. 2015;12(8):1185–1192.

Costa

Nassar

Jr Caruso

. Accuracy of SOFA, qSOFA, and SIRS scores for mortality in cancer patients admitted to an intensive care unit with suspected infection. J Crit Care. 2018;45:52–57.

Arora

Singh

Trikha

. Procalcitonin levels in survivors and nonsurvivors of sepsis: systematic review and meta-analysis. Shock. 2015;43(3):212–221.

Liu

Han

Yan

Xie

. Prognostic value of procalcitonin in adult patients with sepsis: a systematic review and meta-analysis. PLoS One. 2015;10(6):e0129450.

Wirz

Meier

Bouadma

, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care. 2018;22(1):191.

Suberviola

Castellanos-Ortega

Gonzalez-Castro

Garcia-Astudillo

Fernandez-Miret

. Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock. Med Intensiva. 2012;36(3):177–184.

Schuetz

Maurer

Punjabi

Desai

Amin

Gluck

. Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients. Crit Care. 2013;17(3):R115.

Schuetz

Birkhahn

Sherwin

, et al. Serial procalcitonin predicts mortality in severe sepsis patients: results from the multicenter procalcitonin monitoring sepsis (MOSES) Study. Crit Care Med. May 2017;45(5):781–789.

10.

Poddar

Gurjar

Singh

, et al. Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock. Indian J Crit Care Med. 2015;19(3):140–146.

11.

de Azevedo

Torres

Beraldi

Ribas

Malafaia

. Prognostic evaluation of severe sepsis and septic shock: procalcitonin clearance vs delta sequential organ failure assessment. J Crit Care. 2015;30(1):219.e9–219.e12.

12.

Aziz

Nelwan

Sukrisman

Suhendro

. Higher cut-off serum procalcitonin level for sepsis diagnosis in metastatic solid tumor patients. BMC Res Notes. 2018;11(1):84.

13.

Chaftari

Hachem

Reitzel

, et al. Role of procalcitonin and interleukin-6 in predicting cancer, and its progression independent of infection. PLoS One. 2015;10(7):e0130999.

14.

Durnas

Watek

Wollny

, et al. Utility of blood procalcitonin concentration in the management of cancer patients with infections. Onco Targets Ther. 2016;9:469–475.

15.

Patout

Salaun

Brunel

Bota

Cauliez

Thiberville

. Diagnostic and prognostic value of serum procalcitonin concentrations in primary lung cancers. Clin Biochem. 2014;47(18):263–267.

16.

Bone

Balk

Cerra

, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–1655.

17.

Singer

Deutschman

Seymour

, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–810.

18.

Davies

. Procalcitonin. J Clin Pathol. 2015;68(9):675–679.

19.

Ruiz-Rodriguez

Caballero

Ruiz-Sanmartin

, et al. Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study. Med Intensiva. 2012;36(7):475–480. Spain: S.L. y SEMICYUC.

20.

Schuetz

Ebmeyer

Johannes

Wiemer

Schwabe

Shapiro

. The authors reply. Crit Care Med. 2017;45(10):e1098–e1099.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.21 MB