• Sari Karlsson, Milja Heikkinen, Ville Pettilä, Seija Alila, Sari Väisänen, Kari Pulkki, Elina Kolho, Esko Ruokonen, and Finnsepsis Study Group.
• Department of Intensive Care Medicine, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland. sari.karlsson@pshp.fi
• Crit Care. 2010 Jan 1;14(6):R205.

IntroductionThis prospective study investigated the predictive value of procalcitonin (PCT) for survival in 242 adult patients with severe sepsis and septic shock treated in intensive care.MethodsPCT was analyzed from blood samples of all patients at baseline, and 155 patients 72 hours later.ResultsThe median PCT serum concentration on day 0 was 5.0 ng/ml (interquartile range (IQR) 1.0 and 20.1 ng/ml) and 1.3 ng/ml (IQR 0.5 and 5.8 ng/ml) 72 hours later. Hospital mortality was 25.6% (62/242). Median PCT concentrations in patients with community-acquired infections were higher than with nosocomial infections (P = 0.001). Blood cultures were positive in 28.5% of patients (n = 69), and severe sepsis with positive blood cultures was associated with higher PCT levels than with negative cultures (P = < 0.001). Patients with septic shock had higher PCT concentrations than patients without (P = 0.02). PCT concentrations did not differ between hospital survivors and nonsurvivors (P = 0.64 and P = 0.99, respectively), but mortality was lower in patients whose PCT concentration decreased > 50% (by 72 hours) compared to those with a < 50% decrease (12.2% vs. 29.8%, P = 0.007).ConclusionsPCT concentrations were higher in more severe forms of severe sepsis, but a substantial concentration decrease was more important for survival than absolute values.

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