Multinational, observational study of procalcitonin in ICU patients with presumed or confirmed pneumonia and requiring mechanical ventilation

Objectives

Respiratory tract infections requiring mechanical ventilation account for more than 50% of all infections treated in the ICU and prolonged hospital stay and high ICU mortality [1–3]. Procalcitonin (PCT) may help to identify patients at increased risk of worsening organ dysfunction associated with severe sepsis. The goal of this study was to assess whether maximum PCT concentrations are associated with deterioration of organ function.

Method

PCT-7 is a multicenter, multinational, observational study of the association of PCT levels with acute organ dysfunction and 28-day outcome in ICU patients with presumed or confirmed pneumonia and requiring mechanical ventilation. Procalcitonin was determined daily by LUMItest^® (BRAHMS AG, Germany)

Results

One hundred and ninety-seven patients (62.4% males) were enrolled from January 2003 to November 2004 in eight centers in Europe, the USA, and Canada. The mean age was 61.4 years (range 19–99); the mean APACHE II score was 23.7. Patients with high PCT levels had higher mortality rates (PCT cutoff: 2 ng/ml: odds ratio: 3.0 [95% CI: 1.4–6.4], P = 0.006; PCT cutoff: 4 ng/ml: odds ratio: 3.7 [95% CI: 1.8–7.8], P < 0.001). There was a significant correlation between the maximum SOFA score and the maximum PCT during the ICU stay (r = 0.57; 95% CI: [0.45–0.66]; P < 0.001; n = 175). Both SOFA score and PCT elevations at any day had an area under the curve >0.7 in the receiver operator characteristic curve.

Conclusion

In this first multicenter study on patients with pneumonia, high levels of PCT identify patients with organ dysfunction and a high risk of death.