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Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From
the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study
#MMPMID28257335
Schuetz P
; Birkhahn R
; Sherwin R
; Jones AE
; Singer A
; Kline JA
; Runyon MS
; Self WH
; Courtney DM
; Nowak RM
; Gaieski DF
; Ebmeyer S
; Johannes S
; Wiemer JC
; Schwabe A
; Shapiro NI
Crit Care Med
2017[May]; 45
(5
): 781-789
PMID28257335
show ga
OBJECTIVES: To prospectively validate that the inability to decrease
procalcitonin levels by more than 80% between baseline and day 4 is associated
with increased 28-day all-cause mortality in a large sepsis patient population
recruited across the United States. DESIGN: Blinded, prospective multicenter
observational clinical trial following an Food and Drug Administration-approved
protocol. SETTING: Thirteen U.S.-based emergency departments and ICUs. PATIENTS:
Consecutive patients meeting criteria for severe sepsis or septic shock who were
admitted to the ICU from the emergency department, other wards, or directly from
out of hospital were included. INTERVENTIONS: Procalcitonin was measured daily
over the first 5 days. MEASUREMENTS AND MAIN RESULTS: The primary analysis of
interest was the relationship between a procalcitonin decrease of more than 80%
from baseline to day 4 and 28-day mortality using Cox proportional hazards
regression. Among 858 enrolled patients, 646 patients were alive and in the
hospital on day 4 and included in the main intention-to-diagnose analysis. The
28-day all-cause mortality was two-fold higher when procalcitonin did not show a
decrease of more than 80% from baseline to day 4 (20% vs 10%; p = 0.001). This
was confirmed as an independent predictor in Cox regression analysis (hazard
ratio, 1.97 [95% CI, 1.18-3.30; p < 0.009]) after adjusting for demographics,
Acute Physiology and Chronic Health Evaluation II, ICU residence on day 4, sepsis
syndrome severity, antibiotic administration time, and other relevant
confounders. CONCLUSIONS: Results of this large, prospective multicenter U.S.
study indicate that inability to decrease procalcitonin by more than 80% is a
significant independent predictor of mortality and may aid in sepsis care.
|APACHE
[MESH]
|Aged
[MESH]
|Aged, 80 and over
[MESH]
|Calcitonin/*blood/metabolism
[MESH]
|Comorbidity
[MESH]
|Female
[MESH]
|Hospital Mortality
[MESH]
|Humans
[MESH]
|Intensive Care Units/*statistics & numerical data
[MESH]
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