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Critical Care
Published in: Critical Care 1/2019

Open Access 01-12-2019 | Septicemia | Research

The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review

Authors: Aziza N. AlRawahi, Fatma A. AlHinai, Christopher J. Doig, Chad G. Ball, Elijah Dixon, Zhengwen Xiao, Andrew W. Kirkpatrick

Published in: Critical Care | Issue 1/2019

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Abstract

Background

Major trauma is associated with high incidence of septic complications and multiple organ dysfunction (MOD), which markedly influence the outcome of injured patients. Early identification of patients at risk of developing posttraumatic complications is crucial to provide early treatment and improve outcomes. We sought to evaluate the prognostic value of serum procalcitonin (PCT) levels after trauma as related to severity of injury, sepsis, organ dysfunction, and mortality.

Methods

We searched PubMed, MEDLINE, EMBASE, the Cochrane Database, and references of included articles. Two investigators independently identified eligible studies and extracted data. We included original studies that assessed the prognostic value of serum PCT levels in predicting severity of injury, sepsis, organ dysfunction, and mortality among critically injured adult patients.

Results

Among 2015 citations, 19 studies (17 prospective; 2 retrospective) met inclusion criteria. Methodological quality of included studies was moderate. All studies showed a strong correlation between initial PCT levels and Injury Severity Score (ISS). Twelve out of 16 studies demonstrated significant elevation of initial PCT levels in patients who later developed sepsis after trauma. PCT level appeared a strong predictor of MOD in seven out of nine studies. While two studies did not show association between PCT levels and mortality, four studies demonstrated significant elevation of PCT levels in non-survivors versus survivors. One study reported that the PCT level of ≥ 5 ng/mL was associated with significantly increased mortality (OR 3.65; 95% CI 1.03–12.9; p = 0.04).

Conclusion

PCT appears promising as a surrogate biomarker for trauma. Initial peak PCT level may be used as an early predictor of sepsis, MOD, and mortality in trauma population.
Appendix
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Literature
1.
Rhee P, Joseph B, Pandit V, et al. Increasing trauma deaths in the United States. Ann Surg. 2014;260(1):13–21.PubMedCrossRef
2.
3.
Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am. 1983;249(2):28–35.PubMedCrossRef
4.
Baker CC, Oppenheimer L, Stephens B, et al. Epidemiology of trauma deaths. Am J Surg. 1980;140(1):144–50.PubMedCrossRef
5.
Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–223.PubMedCrossRef
6.
Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–128.PubMedCrossRef
7.
Mann EA, Baun MM, Meininger JC, et al. Comparison of mortality associated with sepsis in the burn, trauma, and general intensive care unit patient: a systematic review of the literature. Shock. 2012;37(1):4–16.PubMedCrossRef
8.
Moore FA, Moore EE. Evolving concepts in the pathogenesis of postinjury multiple organ failure. Surg Clin North Am. 1995;75(2):257–77.PubMedCrossRef
9.
10.
Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: what we do and do not know about cytokine regulation. Crit Care Med. 1996;24(1):163–72.PubMedCrossRef
11.
Talmor M, Hydo L, Barie PS. Relationship of systemic inflammatory response syndrome to organ dysfunction, length of stay, and mortality in critical surgical illness: effect of intensive care unit resuscitation. Arch Surg. 1999;134(1):81–7.PubMedCrossRef
12.
13.
Pfeifer R, Tarkin IS, Rocos B, et al. Patterns of mortality and causes of death in polytrauma patients--has anything changed? Injury. 2009;40(9):907–11.PubMedCrossRef
14.
Balci C, Sungurtekin H, Gürses E, et al. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care. 2003;7(1):85–90.PubMedCrossRef
15.
Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013;41(2):580–637.CrossRefPubMed
16.
Xiao Z, Wilson C, Robertson HL, Roberts DJ, Ball CG, Jenne CN, Kirkpatrick AW. Inflammatory mediators in intra-abdominal sepsis or injury - a scoping review. Crit Care. 2015;19(1):373.PubMedPubMedCentralCrossRef
17.
18.
Ciriello V, Gudipati S, Stavrou PZ, Kanakaris NK, Bellamy MC, Giannoudis PV. Biomarkers predicting sepsis in polytrauma patients: current evidence. Injury. 2013;44(12):1680–92.PubMedCrossRef
19.
Schneider HG, Lam QT. Procalcitonin for the clinical laboratory: a review. Pathology. 2007;39(4):383–90.PubMedCrossRef
20.
Benoist JF, Mimoz O, Assicot M, et al. Serum procalcitonin, but not C-reactive protein, identifies sepsis in trauma patients. Clin Chem. 1998;44(8 Pt 1):1778–9.PubMedCrossRef
21.
Kafetzis DA, Velissariou IM, Nikolaides P, et al. Procalcitonin as a predictor of severe appendicitis in children. Eur J Clin Microbiol Infect Dis. 2005;24:484–7.PubMedCrossRef
22.
Nylén ES, Snider RH, Thompson BS, et al. Pneumonitis-associated hyperprocalcitonemia. Am J Med Sci. 1996;312:12–8.PubMedCrossRef
23.
Meisner M, Tschaikowsky K, Hutzler A, et al. Postoperative plasma concentration of procalcitonin after different types of surgery. Intensive Care Med. 1998;24:680–4.PubMedCrossRef
24.
25.
Uzzan B, Cohen R, Nicolas P, et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med. 2006;34(7):1996–2003.PubMedCrossRef
26.
Sridharan P, Chamberlain RS. The efficacy of procalcitonin as a biomarker in the management of sepsis: slaying dragons or tilting at windmills? Surg Infect. 2013;14(6):489–511.CrossRef
27.
Jensen JU, Hein L, Lundgren B, et al. Procalcitonin And Survival Study (PASS) Group. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med. 2011;39(9):2048–58.PubMedCrossRef
28.
Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.PubMedCrossRef
29.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.PubMedCrossRef
30.
American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20(6):864–74.
31.
Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10.PubMedPubMedCentralCrossRef
32.
Hayden JA, Côté P, Bombardier C. Evaluation of the quality of prognosis studies in systematic reviews. Ann Intern Med. 2006;144(6):427–37.PubMedCrossRef
33.
Ren B, Zou G, Huang Y, et al. Serum levels of HSP70 and other DAMP proteins can aid in patient diagnosis after traumatic injury. Cell Stress Chaperones. 2016;21(4):677–86.PubMedPubMedCentralCrossRef
34.
Wojtaszek M, Staśkiewicz G, Torres K, et al. Changes of procalcitonin level in multiple trauma patients. Anaesthesiol Intensive Ther. 2014;46(2):78–82.PubMedCrossRef
35.
Rajkumari N, Mathur P, Sharma S, et al. Procalcitonin as a predictor of sepsis and outcome in severe trauma patients: a prospective study. J Lab Physicians. 2013;5(2):100–8.PubMedPubMedCentralCrossRef
36.
Sakran JV, Michetti CP, Sheridan MJ, et al. The utility of procalcitonin in critically ill trauma patients. J Trauma Acute Care Surg. 2012;73(2):413–8.PubMedCrossRef
37.
Haasper C, Kalmbach M, Dikos GD, et al. Prognostic value of procalcitonin (PCT) and/or interleukin-6 (IL-6) plasma levels after multiple trauma for the development of multi organ dysfunction syndrome (MODS) or sepsis. Technol Health Care. 2010;18(2):89–100.PubMedCrossRef
38.
Keel M, Härter L, Reding T, et al. Pancreatic stone protein is highly increased during posttraumatic sepsis and activates neutrophil granulocytes. Crit Care Med. 2009;37(5):1642–8.PubMedCrossRef
39.
Castelli GP, Pognani C, Cita M, et al. Procalcitonin as a prognostic and diagnostic tool for septic complications after major trauma. Crit Care Med. 2009;37(6):1845–9.PubMedCrossRef
40.
Billeter A, Turina M, Seifert B, et al. Early serum procalcitonin, interleukin-6, and 24-hour lactate clearance: useful indicators of septic infections in severely traumatized patients. World J Surg. 2009;33(3):558–66.PubMedCrossRef
41.
Maier M, Wutzler S, Lehnert M, et al. Serum procalcitonin levels in patients with multiple injuries including visceral trauma. J Trauma. 2009;66(1):243–9.PubMed
42.
Balci C, Sivaci R, Akbulut G, et al. Procalcitonin levels as an early marker in patients with multiple trauma under intensive care. J Int Med Res. 2009;37(6):1709–17.PubMedCrossRef
43.
Castelli GP, Pognani C, Cita M, et al. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol. 2006;72(1–2):69–80.PubMed
44.
Ertugrul BM, Yilmabasar A, Ertugrul O, et al. Do C-reactive protein and procalcitonin predict hospital-acquired infection in patients with trauma? Saudi Med J. 2006;27(4):560–2.PubMed
45.
Meisner M, Adina H, Schmidt J. Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patients. Crit Care. 2006;10(1):R1.PubMedCrossRef
46.
Egger G, Aigner R, Glasner A, et al. Blood polymorphonuclear leukocyte migration as a predictive marker for infections in severe trauma: comparison with various inflammation parameters. Intensive Care Med. 2004;30(2):331–4.PubMedCrossRef
47.
Hensler T, Sauerland S, Lefering R, et al. The clinical value of procalcitonin and neopterin in predicting sepsis and organ failure after major trauma. Shock. 2003;20(5):420–6.PubMedCrossRef
48.
Andermahr J, Greb A, Hensler T, et al. Pneumonia in multiple injured patients: a prospective controlled trial on early prediction using clinical and immunological parameters. Inflamm Res. 2002;51(5):265–72.PubMedCrossRef
49.
Oberholzer A, Keel M, Zellweger R, et al. Incidence of septic complications and multiple organ failure in severely injured patients is sex specific. J Trauma. 2000;48(5):932–7.PubMedCrossRef
50.
Wanner GA, Keel M, Steckholzer U, et al. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med. 2000;28(4):950–7.PubMedCrossRef
51.
Mimoz O, Benoist JF, Edouard AR, et al. Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Med. 1998;24(2):185–8.PubMedCrossRef
52.
Civil ID, Schwab CW. The Abbreviated Injury Scale, 1985 revision: a condensed chart for clinical use. J Trauma. 1988;28(1):87–90.PubMedCrossRef
53.
Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707–10.PubMedCrossRef
54.
Goris RJ, te Boekhorst TP, Nuytinck JK, et al. Multiple-organ failure. Generalized autodestructive inflammation? Arch Surg. 1985;120(10):1109–15.PubMedCrossRef
55.
Lefering R, Goris RJ, van Nieuwenhoven EJ, et al. Revision of the multiple organ failure score. Langenbeck's Arch Surg. 2002;387(1):14–20.CrossRef
56.
Levy MM, Dellinger RP, Townsend SR, et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367–74.PubMedCrossRef
57.
Nakajima A, Yazawa J, Sugiki D, et al. Clinical utility of procalcitonin as a marker of sepsis: a potential predictor of causative pathogens. Intern Med. 2014;53:1497–503.PubMedCrossRef
58.
Castelli GP, Pognani C, Meisner M, et al. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care. 2004;8:R234–42.PubMedPubMedCentralCrossRef
59.
Meynaar I, Droog W, Batstra M, et al. In critically ill patients, serum procalcitonin is more useful in differentiating between sepsis and SIRS than CRP, Il-6, or LBP. Crit Care Res Pract. 2011;2011:594–645.
60.
Deng S, Zhu H, Wang K, et al. Procalcitonin as a marker of sepsis and outcome in patients with neurotrauma: an observation study. BMC Anesthesiol. 2013;13:48–51.PubMedPubMedCentralCrossRef
61.
Nobre V, Harbarth S, Jean-Daniel G, et al. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177:498–505.PubMedCrossRef
62.
Schroeder S, Hochreiter M, Koehler T, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Arch Surg. 2009;394:221–6.CrossRef
63.
Hochreiter M, Kohler T, Schweiger AM, et al. Procalcitonin to guide duration of antibiotic therapy in intensive care patients: a randomized prospective controlled trial. Crit Care. 2009;13(R83):1–7.
64.
Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicenter randomized controlled trial. Lancet. 2010;375:463–74.PubMedCrossRef
65.
Mitaka C. Clinical laboratory differentiation of infectious versus non-infectious systemic inflammatory response syndrome. Clin Chim Acta. 2005;351(1–2):17–29.PubMedCrossRef
66.
Meynaar IA, Droog W, Batstra M, et al. In critically ill patients, serum procalcitonin is more useful in differentiating between sepsis and SIRS than CRP, Il-6, or LBP. Crit Care Res Pract. 2011;2011:594645.PubMedPubMedCentral
67.
68.
Osborn TM, Tracy JK, Dunne JR, et al. Epidemiology of sepsis in patients with traumatic injury. Crit Care Med. 2004;32(11):2234–40.PubMedCrossRef
69.
Plurad DS, Lustenberger T, Kilday P, et al. The association of race and survival from sepsis after injury. Am Surg. 2010;76(1):43Y47.
70.
Svoboda P, Kantorová I, Scheer P, Radvanova J, Radvan M. Can procalcitonin help us in timing of re-intervention in septic patients after multiple trauma or major surgery? Hepatogastroenterology. 2007;54(74):359–63.PubMed
Metadata
Title
The prognostic value of serum procalcitonin measurements in critically injured patients: a systematic review
Authors
Aziza N. AlRawahi
Fatma A. AlHinai
Christopher J. Doig
Chad G. Ball
Elijah Dixon
Zhengwen Xiao
Andrew W. Kirkpatrick
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2019
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-019-2669-1

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