Abstract:

Objective To investigate the predictive value of procalcitonin (PCT), and procalcitonin clearance (PCTc) and the dynamic changes of sequential organ failure assessment (SOFA) score on the prognosis of patients with severe sepsis. Methods The clinical data of 60 patients with severe sepsis were analyzed using a retrospective study. The PCTc were calculated based on the PCT at 0 h, 24 h, 48 h, 72 h and 120 h of enrollment, and the SOFA scores at 0 h and 48 h of enrollment were recorded, and the △SOFA at 48 h was figured out. The patients were divided into survival (n=44) and death group (n=16) according to whether they died at 28 d, and the interclass differences of PCT and PCTc at different time points were analyzed. Multivariate Cox regression analysis was used to explore the influencing factors of the prognosis of these patients, and the receiver operating characteristic (ROC) curve was used to verify the assessment ability of different indicators for the prognosis. Results There were statistically significant differences in PCT between groups, and the interaction between time and treatment factors was statistically significant (all P<0.05), but there was no significant difference between different time points (P>0.05). Compared with the death group, the PCT at 120 h in the survival group was significantly lower (P<0.05). The differences in PCTc between groups were statistically significant, the differences between different time points were statistically significant, and the interaction between time and treatment factors was statistically significant (all P<0.05). PCTc at 24 h, 48 h, 72 h, 120 h in the survival group were significantly higher (all P<0.05). Compared with the death group, the SOFA score of the survival group at enrollment was lower, and the△SOFA score at 48 h was significantly higher (all P<0.05). Multivariate Cox regression analysis showed that age>65 years old, PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h was an independent factor for the 28-day death of sepsis patients. The ROC curve results showed that the area under the curve (AUC) of PCTc at 120 h was 0.958, which could be used as a prognostic indicator. Conclusion Compared with the absolute value of PCT, PCTc is an indicator for judging the prognosis of sepsis. PCTc at 24 h, PCTc at 120 h, SOFA score at enrollment and △SOFA at 48 h are the independent influencing factors for the 28 d-death of sepsis patients. PCTc at 120 h can be used as an assessment tool for the prognosis of sepsis patients.

Key words: sepsis, prognosis, calcitonin, SOFA score