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Procalcitonin increase in early identification of critically ill patients at high risk of mortality.

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Jensen, Jens Ulrik ; Heslet, L ; Jensen, TH ; Espersen, K ; Steffensen, P ; Tvede, M. / Procalcitonin increase in early identification of critically ill patients at high risk of mortality. I: Critical Care Medicine. 2006 ; Bind 34, Nr. 10. s. 2596-602.

Bibtex

@article{70620d3983de47d79a9f655116a31339,
title = "Procalcitonin increase in early identification of critically ill patients at high risk of mortality.",
abstract = "OBJECTIVE: To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients. DESIGN: Prospective observational cohort study. SETTING:: Multidisciplinary intensive care unit at Rigshospitalet, Copenhagen University Hospital, a tertiary reference hospital in Denmark. PATIENTS: Four hundred seventy-two patients with diverse comorbidity and age admitted to this intensive care unit. INTERVENTIONS: Equal in all patient groups: antimicrobial treatment adjusted according to the procalcitonin level. MEASUREMENTS AND MAIN RESULTS: Daily procalcitonin measurements were carried out during the study period as well as measurements of white blood cell count and C-reactive protein and registration of comorbidity. The primary end point was all-cause mortality in a 90-day follow-up period. Secondary end points were mortality during the stay in the intensive care unit and in a 30-day follow-up period. A total of 3,642 procalcitonin measurements were evaluated in 472 critically ill patients. We found that a high maximum procalcitonin level and a procalcitonin increase for 1 day were independent predictors of 90-day all-cause mortality in the multivariate Cox regression analysis model. C-reactive protein and leukocyte increases did not show these qualities. The adjusted hazard ratio for procalcitonin increase for 1 day was 1.8 (95{\%} confidence interval 1.3-2.7). The relative risk for mortality in the intensive care unit for patients with an increasing procalcitonin was as follows: after 1 day increase, 1.8 (95{\%} confidence interval 1.4-2.4); after 2 days increase, 2.2 (95{\%} confidence interval 1.6-3.0); and after 3 days increase: 2.8 (95{\%} confidence interval 2.0-3.8). CONCLUSIONS: A high maximum procalcitonin level and a procalcitonin increase for 1 day are early independent predictors of all-cause mortality in a 90-day follow-up period after intensive care unit admission. Mortality risk increases for every day that procalcitonin increases. Levels or increases of C-reactive protein and white blood cell count do not seem to predict mortality. Comment in: Crit Care Med. 2006 Oct;34(10):2687-8.",
keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Biological Markers, C-Reactive Protein, Calcitonin, Child, Child, Preschool, Critical Illness, Denmark, Female, Humans, Infant, Leukocyte Count, Male, Middle Aged, Multiple Organ Failure, Multivariate Analysis, Prognosis, Proportional Hazards Models, Prospective Studies, Protein Precursors, Sensitivity and Specificity, Sepsis, Survival Analysis",
author = "Jensen, {Jens Ulrik} and L Heslet and TH Jensen and K Espersen and P Steffensen and M Tvede",
year = "2006",
doi = "10.1097/01.CCM.0000239116.01855.61",
language = "English",
volume = "34",
pages = "2596--602",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams & Wilkins",
number = "10",

}

RIS

TY - JOUR

T1 - Procalcitonin increase in early identification of critically ill patients at high risk of mortality.

AU - Jensen, Jens Ulrik

AU - Heslet, L

AU - Jensen, TH

AU - Espersen, K

AU - Steffensen, P

AU - Tvede, M

PY - 2006

Y1 - 2006

N2 - OBJECTIVE: To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients. DESIGN: Prospective observational cohort study. SETTING:: Multidisciplinary intensive care unit at Rigshospitalet, Copenhagen University Hospital, a tertiary reference hospital in Denmark. PATIENTS: Four hundred seventy-two patients with diverse comorbidity and age admitted to this intensive care unit. INTERVENTIONS: Equal in all patient groups: antimicrobial treatment adjusted according to the procalcitonin level. MEASUREMENTS AND MAIN RESULTS: Daily procalcitonin measurements were carried out during the study period as well as measurements of white blood cell count and C-reactive protein and registration of comorbidity. The primary end point was all-cause mortality in a 90-day follow-up period. Secondary end points were mortality during the stay in the intensive care unit and in a 30-day follow-up period. A total of 3,642 procalcitonin measurements were evaluated in 472 critically ill patients. We found that a high maximum procalcitonin level and a procalcitonin increase for 1 day were independent predictors of 90-day all-cause mortality in the multivariate Cox regression analysis model. C-reactive protein and leukocyte increases did not show these qualities. The adjusted hazard ratio for procalcitonin increase for 1 day was 1.8 (95% confidence interval 1.3-2.7). The relative risk for mortality in the intensive care unit for patients with an increasing procalcitonin was as follows: after 1 day increase, 1.8 (95% confidence interval 1.4-2.4); after 2 days increase, 2.2 (95% confidence interval 1.6-3.0); and after 3 days increase: 2.8 (95% confidence interval 2.0-3.8). CONCLUSIONS: A high maximum procalcitonin level and a procalcitonin increase for 1 day are early independent predictors of all-cause mortality in a 90-day follow-up period after intensive care unit admission. Mortality risk increases for every day that procalcitonin increases. Levels or increases of C-reactive protein and white blood cell count do not seem to predict mortality. Comment in: Crit Care Med. 2006 Oct;34(10):2687-8.

AB - OBJECTIVE: To investigate day-by-day changes in procalcitonin and maximum obtained levels as predictors of mortality in critically ill patients. DESIGN: Prospective observational cohort study. SETTING:: Multidisciplinary intensive care unit at Rigshospitalet, Copenhagen University Hospital, a tertiary reference hospital in Denmark. PATIENTS: Four hundred seventy-two patients with diverse comorbidity and age admitted to this intensive care unit. INTERVENTIONS: Equal in all patient groups: antimicrobial treatment adjusted according to the procalcitonin level. MEASUREMENTS AND MAIN RESULTS: Daily procalcitonin measurements were carried out during the study period as well as measurements of white blood cell count and C-reactive protein and registration of comorbidity. The primary end point was all-cause mortality in a 90-day follow-up period. Secondary end points were mortality during the stay in the intensive care unit and in a 30-day follow-up period. A total of 3,642 procalcitonin measurements were evaluated in 472 critically ill patients. We found that a high maximum procalcitonin level and a procalcitonin increase for 1 day were independent predictors of 90-day all-cause mortality in the multivariate Cox regression analysis model. C-reactive protein and leukocyte increases did not show these qualities. The adjusted hazard ratio for procalcitonin increase for 1 day was 1.8 (95% confidence interval 1.3-2.7). The relative risk for mortality in the intensive care unit for patients with an increasing procalcitonin was as follows: after 1 day increase, 1.8 (95% confidence interval 1.4-2.4); after 2 days increase, 2.2 (95% confidence interval 1.6-3.0); and after 3 days increase: 2.8 (95% confidence interval 2.0-3.8). CONCLUSIONS: A high maximum procalcitonin level and a procalcitonin increase for 1 day are early independent predictors of all-cause mortality in a 90-day follow-up period after intensive care unit admission. Mortality risk increases for every day that procalcitonin increases. Levels or increases of C-reactive protein and white blood cell count do not seem to predict mortality. Comment in: Crit Care Med. 2006 Oct;34(10):2687-8.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Biological Markers

KW - C-Reactive Protein

KW - Calcitonin

KW - Child

KW - Child, Preschool

KW - Critical Illness

KW - Denmark

KW - Female

KW - Humans

KW - Infant

KW - Leukocyte Count

KW - Male

KW - Middle Aged

KW - Multiple Organ Failure

KW - Multivariate Analysis

KW - Prognosis

KW - Proportional Hazards Models

KW - Prospective Studies

KW - Protein Precursors

KW - Sensitivity and Specificity

KW - Sepsis

KW - Survival Analysis

U2 - 10.1097/01.CCM.0000239116.01855.61

DO - 10.1097/01.CCM.0000239116.01855.61

M3 - Journal article

VL - 34

SP - 2596

EP - 2602

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 10

ER -

ID: 32535862