Is PCT a marker of infection and/or mortality?

Introduction

There is much evidence to suggest that increased, early induction of PCT following varying incidents is suggestive of subsequent potential complications. This applies to the postoperative period and multiple trauma, as well as other diseases.

Aim of the study

In our study, the purpose was to examine the PCT fluctuation in relation to the early signs of infection, to find out whether PCT indicates a significant predictive value of infection.

Materials and methods

Between 1 January 2001 and 31 December 2001, 248 patients were studied (among the 347 patients who were admitted in our general ICU). Finally, 125 patients were stratified in our study. The rest of the patients were excluded because the length stay in ICU was limited (< 5 days). All patients were divided into four groups according to the reason for admission.

Group A

56 multiple trauma (43 men, 13 women, mean age 49.2 years, mean ICU stay 13.4 days, APACHE II score 17–22).

Group B

19 postoperative (10 men, nine women, mean age 49.5 years, mean ICU stay 11.7 days, APACHE II score 20–24).

Group C

19 pathologic (12 men, seven women, mean age 50.7 years, mean ICU stay 14.8 days, APACHE II score 22–25).

Group D

31 cerebral stroke (18 men, 13 women, mean age 49.5 years, mean ICU stay 14.2 days, APACHE II score 18–23). Each group was divided in two subgroups: (I) patients possessing early (days 0–2) signs of infection (elevated WBC, CRP, temperature/reduced platelets, fibrinogen/positive cultures); (II) patients free of early signs of infection.

Results

In group A, 32 patients had positive signs of infection, but PCT had no parallel fluctuation with the other markers of inflammation, whereas mortality (30%) was related to high PCT levels (> 2 ng/ dl). In group B, seven patients had positive signs of infection, mortality was 31% and similar results with group A were noted. In group C, nine patients had positive signs of infection and mortality was 47%, while PCT levels indicated promptly the fatal outcome. Finally, in group D, only 14 patients had positive signs of infection, mortality was 32% and PCT levels were slightly higher in those who did not survive.

Conclusion

Numerous triggers can induce PCT and it has no significant predictive value as the only marker of inflammation. In our study, mortality was directly related to high PCT levels (> 2 ng/dl), while values more than 30 ng/dl were absolutely related to fatal outcome.