engleski

Utility of procalcitonin in a medical intensive care unit in Croatia

AimsTo investigate the clinical benefit of routine pro-calcitonin (PCT) measurement in the medical inten-sive care unit (ICU) of a tertiary referral hospital.MethodsAdult patients with suspected infectionswere included. White blood cells, C- reactive protein(CRP), and PCT were measured.ResultsIn this study 129 patients of median age 64years (interquartile range 39–89years) were prospec-tively included. The Acute Physiology And ChronicHealth Evaluation II (APACHE II) and Sequential Or-gan Failure Assessment (SOFA) scores were 21±14and 7± 6, respectively. Intensive care unit (ICU)mortality was 22.5%. Immunocompromised patientsconstituted 39.5%. A significant correlation was ob-served between PCT and APACHE II (Spearman’srho 0.461, p< 0.01), PCT and SOFA (Spearman’s rho0.494, p< 0.01) and PCT and CRP (Spearman’s rho0.403, p< 0.01). Most patients (n= 83, 64.3%) re-ceived antibiotics before admission. No differencein PCT (1.56± 8μg/L vs. 1.44± 13μg/L, p=0.6) wasobserved with respect to previous antibiotic ther-apy. Levels of PCT and CRP were significantly in-creased in patients with positive blood cultures, the infection caused by Gram-negative microorganismregardless of disease severity and pneumonia withcomplications. PCT did not differ among patientswith positive vs negative urine culture (4.6± 16μg/Lvs. 1.76± 11.9μg/L) or positive vs. negative endotra-cheal aspirate (1.93± 11.4μg/L vs. 1.76± 1.11μg/L).PCT-guided stewardship was applied in 36 patients(28%).ConclusionIncreased initial PCT levels might pointto the development of more severe disease caused byGram-negative bacteria, regardless of previous antibi-otic treatment. The results pertain to immunocompe-tent and immunocompromised patients. Implemen-tation of PCT-guided stewardship in those patients ispossible and relies on experience as well as knowl-edge of reference change value for a marker withinthe specific setting.

Biomarker · Procalcitonin · Sepsis ·Pneumonia · Critical illness

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