Usefulness of procalcitonin clearance to predict mortality in abdominal sepsis

To evaluate the plasma levels and clearance of procalcitonin (PCTc) as prognostic biomarkers for patients with abdominal sepsis. A retrospective study of 103 patients with abdominal sepsis was conducted in our intensive care unit (ICU) from 2016 to 2018. Procalcitonin (PCT) plasma levels were measured at the time of diagnosis of abdominal sepsis and daily over the next 5 days. PCTc was calculated from day 3 to day 5. The prognostic accuracy of PCTc was expressed as the area under the receiver operating characteristic curve (AUROC). The Kaplan-Meier method was used to compare the survival curves by log-rank test. Logistic regression analysis was used to predict the 28-day mortality. The primary outcome was 28-day mortality since admission to ICU. Serum PCT levels from day 1 to day 5 did not differ significantly between survivors and non-survivors, while PCTc on day 5 was statistically significantly higher in survivors than that in non-survivors (86.4% vs 38.7%, P<0.001). The cutoff value for PCTc-day 5 was 70%, with AUROC of 0.726, sensitivity of 64.6%, and specificity of 78.3%. The 28-day mortality was significantly lower among those with PCTc-day 5 >70% compared with those with PCTc-day 5 <70% (9.1% vs 38.3%, log-rank test, P<0.001), and odds ratio (OR) was 0.16 (95% confidence interval (CI): 0.05-0.48, P<0.001). The ability to decrease PCT by at least 70% on day 5 was an independent predictor of 28-day mortality after admission to ICU with moderate accuracy.