Yao Liu,1 Shuangping Zhao,2 Zixi Qin,3 Xun Huang3 

1Department of Hepatopathy, The Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, People’s Republic of China; 2Department of Critical Care Medicine, Xiangya Hospital, Central South University, Changsha, People’s Republic of China; 3Department of Infection Control Center, Xiangya Hospital, Central South University, Changsha, People’s Republic of China

Correspondence: Xun Huang, Department of Infection Control Center, Xiangya Hospital, Central South University, Changsha, People’s Republic of China, Email huangxun@mail.csu.edu.cn

Objective: This study aimed to evaluate the potential prognostic value of procalcitonin (PCT) and procalcitonin clearance (PCTc) among patients with septic shock.
Methods: We conducted a prospective single-center observational study of septic shock patients admitted to the adult intensive care unit (ICU) of a tertiary teaching hospital in Southern China between January and December 2015. Serum PCT levels of surviving patients were measured at the onset of septic shock and subsequently on days 2 (24 h), 3 (48 h), 4 (72 h), and 5 (96 h), respectively. Similarly, PCTc on Days 2, 3, 4, and 5 were calculated to evaluate their prognostic performance.
Results: One hundred and twenty-eight adult patients with septic shock were included in the study. There was no significant difference between PCT concentrations measured at a single time point in survivors and non-survivors. However, PCTc on Day 2, 3, and 5 were significantly higher in survivors than in non-survivors. The best area under the receiver operating characteristic curve (AUC) values for prognosis were 0.74 (95% CI, 0.59– 0.88), 0.74 (95% CI, 0.61– 0.86), and 0.72 (95% CI, 0.54– 0.90), respectively. In the logistic regression analysis, PCTc-day 2 > 12.7% and PCTc-day 3 > 49.6% were identified as independent predictors of survival for patients with septic shock. However, PCTc-day 5 was not independently associated with survival. The best cutoff for PCTc-day 2 and day 3 were 12.7% and 49.6%, respectively.
Conclusion: Compared with PCTc, PCT demonstrated lower prognostic performance for the survival of patients with septic shock. However, PCTc on Day 2 and 3 were significantly associated with survival in patients with septic shock and may serve as valuable prognostic indicators.

Keywords: procalcitonin, procalcitonin clearance, septic shock, prognosis, biomarker