Procalcitonin as a Prognosis Marker for the Severe Sepsis and Septic Shock Patients in Emergency Department
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Advance in sepsis management has increased the survival of patients with sepsis. However, severe sepsis and septic shock patients still have high mortality. We intend to verify the use of the procalcitonin (PCT) level as a prognosis marker in patients with severe sepsis or septic shock in the emergency department (ED). Methods: ED Patients with severe sepsis or septic shock were enrolled in our study. We used mortality and Intensive Care Unit (ICU) days as a prognosis index, and compared the PCT level in survivors and non-survivors. We introduced the simplified acute physiology score 3(SAPS3) to assess the severity of the patients and analyzed whether or not the PCT level correlated with the severity index. Results: The PCT level in septic shock patients [7.36 (0.92−33.69, IQR)] was higher than that in severe sepsis patients [3.24 (0.36−10.53, IQR)] (p = 0.04). However, there was no significant PCT level difference between survivors [median (IQR), 6.59 (0.60−29.25)] and non-survivors [median (IQR), 3.49 (0.40−20.41)] (p = 0.293). The SAPS3 score was higher in the non-survivor group [median (IQR), 64 (59.0−71.5)] than in the survivor group [median (IQR), 77 (68.5−82.0)] (p = 0.001). The PCT level did not correlate with either ICU days or hospital days. Conclusions: Using the PCT level as a prognosis factor in severe sepsis and septic shock patients in ED has little value.
Abstract
Background: Advance in sepsis management has increased the survival of patients with sepsis. However, severe sepsis and septic shock patients still have high mortality. We intend to verify the use of the procalcitonin (PCT) level as a prognosis marker in patients with severe sepsis or septic shock in the emergency department (ED). Methods: ED Patients with severe sepsis or septic shock were enrolled in our study. We used mortality and Intensive Care Unit (ICU) days as a prognosis index, and compared the PCT level in survivors and non-survivors. We introduced the simplified acute physiology score 3(SAPS3) to assess the severity of the patients and analyzed whether or not the PCT level correlated with the severity index. Results: The PCT level in septic shock patients [7.36 (0.92−33.69, IQR)] was higher than that in severe sepsis patients [3.24 (0.36−10.53, IQR)] (p = 0.04). However, there was no significant PCT level difference between survivors [median (IQR), 6.59 (0.60−29.25)] and non-survivors [median (IQR), 3.49 (0.40−20.41)] (p = 0.293). The SAPS3 score was higher in the non-survivor group [median (IQR), 64 (59.0−71.5)] than in the survivor group [median (IQR), 77 (68.5−82.0)] (p = 0.001). The PCT level did not correlate with either ICU days or hospital days. Conclusions: Using the PCT level as a prognosis factor in severe sepsis and septic shock patients in ED has little value.
참고문헌 (27)
- Angus DC, "Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care", Crit Care Med, 29, pp.1303~1310 (2001)
- Friedman G, "Has the mortality of septic shock changed with time", Crit Care Med, 26, pp.2078~2086 (1998)
- Georgopoulou AP, "Hellenic Sepsis Study Group: Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis", J Crit Care, 26(331), pp.e1~7 (2011)
- Rangel-Frausto MS, "The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study", JAMA, 273, pp.117~123 (1995)
- Nguyen HB, "Critical care in the emergency department: A physiologic assessment and outcome evaluation", Acad Emerg Med, 7, pp.1354~1361 (2000)
- 허미나, "혈액 배양 양성 패혈증 환자에서 프로칼시토닌과 C-반응성 단백의 진단 유용성 비교 분석", Annals of Laboratory Medicine, 29(6), pp.529~535 (2009), 대한진단검사의학회
- Reinhart K, "Markers for sepsis diagnosis: what is useful", Crit Care Clin, 22, pp.503~519 (2006)
- Bone RC, "Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis", Chest, 101, pp.1644~1655 (1992), The ACCP[DOI]
- Moreno RP, "SAPS 3 Investigators: SAPS 3--from evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission", Intensive Care Med, 31, pp.1345~1355 (2005)
- "SAPS 3 Software"[URL]
- Kibe S, "Diagnostic and prognostic biomarkers of sepsis in critical care", J Antimicrob Chemother, 66(2), pp.ii33~40 (2011)
- Hochreiter M, "Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial", Crit Care, 13, pp.R83~ (2009)
- Nobre V, "Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial", Am J Respir Crit Care Med, 177, pp.498~505 (2008)
- Nijsten MW, "Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro", Crit Care Med, 28, pp.458~461 (2000)
- 박태진, "혈청 프로칼시토닌(serum procalcitonin) 측정을 통한 패혈증 진단 및 중등도 평가의 유용성", Tuberculosis and Respiratory Diseases, 70(1), pp.51~57 (2011), 대한결핵및호흡기학회
- Kim SI, "Clinical usefulness of procalcitonin in febrile patients; comparison with erythrocyte sedimentation rate and c-reactive protein", Korean J Infect Dis, 32, pp.129~134 (2000)
- 최준철, "응급실로 내원한 패혈증 환자에서 프로칼시토닌과 Abbreviated Mortality in Emergency Department Sepsis 점수체계의 예후 예측도구로서의 유용성", 대한응급의학회지, 22(1), pp.50~58 (2011), 대한응급의학회
- 전은주, "The Value of Procalcitonin and the SAPS II and APACHE III Scores in the Differentiation of Infectious and Non-infectious Fever in the ICU: A Prospective, Cohort Study", Journal of Korean Medical Science, 25(11), pp.1633~1637 (2010), 대한의학회
- Claeys R, , Crit Care Med, 30, pp.757~762 (2002)
- Müller B, "Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit", Crit Care Med, 28, pp.977~983 (2000)
- Simon L, "Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis", Clin Infect Dis, 39, pp.206~217 (2004)
- Suprin E, "Procalcitonin: a valuable indicator of infection in a medical ICU", Intensive Care Med, 26, pp.1232~1238 (2000)
- Giamarellos-Bourboulis EJ, "Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient", Intensive Care Med, 28, pp.1351~1356 (2002)
- Tang BM, "Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis", Lancet Infect Dis, 7, pp.210~217 (2007)
- Jensen JU, "Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial", Crit Care Med, 39, pp.2048~2058 (2011)
- 이영주, "Predictive Comparisons of Procalcitonin (PCT) Level, Arterial Ketone Body Ratio (AKBR), APACHE III Score and Multiple Organ Dysfunction Score (MODS) in Systemic Inflammatory Response Syndrome (SIRS)", Yonsei Medical Journal, 45(1), pp.29~37 (2004), 연세대학교의과대학
- Heffner AC, "Etiology of illness in patients with severe sepsis admitted to the hospital from the emergency department", Clin Infect Dis, 50, pp.814~820 (2010)