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dc.contributor.authorSchuetz, Philippen_US
dc.contributor.authorMaurer, Paulaen_US
dc.contributor.authorPunjabi, Vikasen_US
dc.contributor.authorDesai, Amien_US
dc.contributor.authorAmin, Devendra Nen_US
dc.contributor.authorGluck, Ericen_US
dc.date.accessioned2014-07-07T17:02:18Z
dc.date.issued2013en_US
dc.identifier.citationSchuetz, Philipp, Paula Maurer, Vikas Punjabi, Ami Desai, Devendra N Amin, and Eric Gluck. 2013. “Procalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patients.” Critical Care 17 (3): R115. doi:10.1186/cc12787. http://dx.doi.org/10.1186/cc12787.en
dc.identifier.issn1364-8535en
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:12406608
dc.description.abstractIntroduction: Close monitoring and repeated risk assessment of sepsis patients in the intensive care unit (ICU) is important for decisions regarding care intensification or early discharge to the ward. We studied whether considering plasma kinetics of procalcitonin, a biomarker of systemic bacterial infection, over the first 72 critical care hours improved mortality prognostication of septic patients from two US settings. Methods: This retrospective analysis included consecutively treated eligible adults with a diagnosis of sepsis from critical care units in two independent institutions in Clearwater, FL and Chicago, IL. Cohorts were used for derivation or validation to study the association between procalcitonin change over the first 72 critical care hours and mortality. Results: ICU/in-hospital mortality rates were 29.2%/31.8% in the derivation cohort (n = 154) and 17.6%/29.4% in the validation cohort (n = 102). In logistic regression analysis of both cohorts, procalcitonin change was strongly associated with ICU and in-hospital mortality independent of clinical risk scores (Acute Physiology, Age and Chronic Health Evaluation IV or Simplified Acute Physiology Score II), with area under the curve (AUC) from 0.67 to 0.71. When procalcitonin decreased by at least 80%, the negative predictive value for ICU/in-hospital mortality was 90%/90% in the derivation cohort, and 91%/79% in the validation cohort. When procalcitonin showed no decrease or increased, the respective positive predictive values were 48%/48% and 36%/52%. Discussion In septic patients, procalcitonin kinetics over the first 72 critical care hours provide prognostic information beyond that available from clinical risk scores. If these observations are confirmed, procalcitonin monitoring may assist physician decision-making regarding care intensification or early transfer from the ICU to the floor.en
dc.language.isoen_USen
dc.publisherBioMed Centralen
dc.relation.isversionofdoi:10.1186/cc12787en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057444/pdf/en
dash.licenseLAAen_US
dc.subjectSepsisen
dc.subjectSevere sepsisen
dc.subjectSeptic shocken
dc.subjectBiomarkeren
dc.subjectProcalcitoninen
dc.subjectProcalcitonin kineticsen
dc.subjectProcalcitonin changeen
dc.subjectMortalityen
dc.subjectMortality predictionen
dc.subjectAPACHE IVen
dc.subjectSAPS IIen
dc.subjectClinical risk scoreen
dc.titleProcalcitonin decrease over 72 hours in US critical care units predicts fatal outcome in sepsis patientsen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalCritical Careen
dc.date.available2014-07-07T17:02:18Z
dc.identifier.doi10.1186/cc12787*


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