Survival in septic shock patients with extreme high concentration procalcitonin: its relationship with dynamic change of procalcitonin concentration

管军¹
上海长征医院急救科

Objectives：To investigate whether procalcitonin concentration itself or dynamic change is still predictive of hospital survival when greater than 10ng/mL and to further evaluate the correlation between dynamic procalcitonin with dynamic change of sequential organ failure assessment (SOFA) score. Methods: Thirty seven septic shock patients with PCT concentration greater than 10ng/mL were enrolled in this study. Second PCT measurements were taken 5 days after enrollment and initial measurements. SOFA score were recorded simultaneously. Dynamic change of procalcitonin and SOFA score were defined as the difference between the second and initial measurement. Patients were divided into survivors(N=25) and non-survivors(N=12) based on 28-day outcome.Results: All survivors had a decrease of PCT concentration, from 4.15ng/mL to 43.51ng/mL, median decrease was 9.73ng/mL. All nonsurvivors had an increase of PCT concentration, from 1.39ng/mL to 439.27ng/mL, median increase was 5.95ng/mL. Significant decrease of PCT concentration (>25%) was observed in all the 25 survivors while none of the 12 nonsurvivors had a significant decrease of PCT concentration after 5 days’ management, p=0.000. Among patients whose PCT concentration were above 10ng/mL, procalcitonin concentration of initial measurement, second measurements, and dynamics were all significantly correlated with their counterparts of SOFA score, p=0.026, 0.000 and 0.000, respectively.Conclusions：Significant decrease of PCT concentration, rather than PCT concentration itself, is a perfect indicator of survival in septic shock patients when PCT concentration is greater than 10ng/mL. PCT concentration is highly correlated with SOFA score in septic shock patients even when PCT concentration is above 10ng/mL.