Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients: A prospective observational study

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• 作者：Domonkos Trá ; sy ; MD^a ; ^{trasydom@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Krisztiá ; n Tá ; nczos ; MD^a ; ^{tkrisztian78@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Má ; rton Né ; meth ; MD^a ; ^{nemethmarton85@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Pé ; ter Hankovszky ; MD^a ; ^{hankovszky@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Andrá ; s Lovas ; MD^a ; ^{anlovas@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Andrá ; s Mikor ; MD^a ; ^{andrasmikor@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Ildikó ; Lá ; szló ; MD^a ; ^{ildiko.laszlo88@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Edit Hajdú ; MD^b ; ^{horvathne.hajdu.edit@med.u-szeged.hu" class="auth_mail" title="E-mail the corresponding author} ; Angelika Osztroluczki^a ; ^{oszang78@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Já ; nos Fazakas ; MD^c ; ^{jancsidora@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Zsolt Molná ; r ; MD^a ; ^{zsoltmolna@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; The EProK study group
• 关键词：Infection ; Empirical antimicrobial therapy ; Appropriate antimicrobial therapy ; Procalcitonin ; Biomarkers ; Sepsis
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：34
• 期：Complete
• 页码：50-55
• 全文大小：486 K

文摘

The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients.

Materials and methods

This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t₀), 8 hourly (t₈, t₁₆, t₂₄), and then daily (day_2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups.

Results

Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t₀= 2.8 (1.2-7.4), t₁₆= 8.6 (4.8-22.1), t₂₄= 14.5 (4.9-36.1), P< .05. In the A group, PCT peaked at t₁₆ and started to decrease by t₂₄: t₀= 4.2 (1.9-12.8), t₁₆= 6.99 (3.4-29.1), t₂₄= 5.2 (2.0-16.7), P< .05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t₀ to t₁₆ had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P< .001; from t₀ to t₂₄, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P< .001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017).

Conclusions

Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.