Yonsei Med J.  2004 Feb;45(1):29-37. 10.3349/ymj.2004.45.1.29.

Predictive Comparisons of Procalcitonin (PCT) Level, Arterial Ketone Body Ratio (AKBR), APACHE III Score and Multiple Organ Dysfunction Score (MODS) in Systemic Inflammatory Response Syndrome (SIRS)

• Lee YJ
• Park CH
• Yun JW
• Lee YS

• KMID: 1734089
• DOI: http://doi.org/10.3349/ymj.2004.45.1.29

Abstract

Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.

Keyword

Arterial ketone body ratio; acute physiology; age; chronic health evaluation III score; mortality prediction; multiple organ dysfunction score; procalcitonin; receiver operating characteristic curve; systemic inflammatory response syndrome

MeSH Terms

*APACHE
Adolescent
Adult
Aged
Aged, 80 and over
Biological Markers
Calcitonin/*blood
Comparative Study
Female
Human
Ketone Bodies/*blood
Male
Middle Aged
Multiple Organ Failure/blood/diagnosis/*mortality
Predictive Value of Tests
Protein Precursors/*blood
Sepsis Syndrome/blood/diagnosis/*mortality
Survival Analysis