Key result
Serum procalcitonin level, albumin level, and SOFA score at ICU discharge independently predicted 90-day post-ICU mortality, yielding a combined area under the curve of 0.913.
Observational (n=218)
No
Odds Ratio: 6.47 (95% CI 2.22–18.9)
p-value: p=0.001
The combination of serum procalcitonin, albumin, and SOFA score at ICU discharge accurately predicts 90-day post-ICU mortality and may aid in objective discharge decision-making.
May inform post-ICU risk stratification in observational cohorts; leaves open prospective validation before guiding discharge decisions.
PURPOSE: The final decision for discharge from the intensive care unit (ICU) is uncertain because it is made according to various patient parameters; however, it should be made on an objective evaluation. Previous reports have been inconsistent and unreliable in predicting post-ICU mortality. To identify predictive factors associated with post-ICU mortality, we analyzed physiological and laboratory data at ICU discharge. METHODS: Patients admitted to our ICU between September 2012 and August 2013 and staying for critical care>2 days were included. Sequential Organ Failure Assessment (SOFA) score; systemic inflammatory response syndrome score; white blood cell count; and serum C reactive protein, procalcitonin (PCT), interleukin-6 (IL-6), lactate, albumin, and hemoglobin levels were recorded. The primary end point was 90-day mortality after ICU discharge. Two hundred eighteen patients were enrolled (195 survivors, 23 non-survivors). RESULTS: Non-survivors presented a higher SOFA score and serum PCT, and IL-6 levels, as well as lower serum albumin and hemoglobin levels. Serum PCT, albumin, and SOFA score were associated with 90-day mortality in multiple logistic regression analysis. Hosmer-Lemeshow test showed chi-square value of 6.96, and P value of 0.54. The area under the curve (95% confidence interval) was 0.830 (0.771-0.890) for PCT, 0.688 (0.566-0.810) for albumin, 0.861 (0.796-0.927) for SOFA score, and increased to 0.913 (0.858-0.969) when these were combined. Serum PCT level at 0.57 ng/mL, serum albumin at 2.5 g/dL and SOFA score at 5.5 predict 90-day mortality, and high PCT, low albumin and high SOFA groups had significantly higher mortality. Serum PCT and SOFA score were significantly associated with survival days after ICU discharge in Cox regression analysis. CONCLUSIONS: Serum PCT level and SOFA score at ICU discharge predict post-ICU mortality and survival days after ICU discharge. The combination of these two and albumin level might enable accurate prediction.
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Matsumura et al. (2014) conducted an observational in Critical illness requiring ICU admission (n=218). Serum procalcitonin (PCT) level at ICU discharge vs. Lower PCT levels was evaluated on 90-day mortality after ICU discharge (OR 6.47, 95% CI 2.22-18.9, p=0.001). Serum procalcitonin level, albumin level, and SOFA score at ICU discharge independently predicted 90-day post-ICU mortality, yielding a combined area under the curve of 0.913.
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