Abstract 231 Poster Session III, Monday, 5/3 (poster 97)

Introduction: Recent laboratory experiments on sepsis showed procalcitonin (PCT) had detrimental effects on host survival by a yet, unknown mechanism1. We hypothesized that increasing PCT levels from severe sepsis are associated with persistent multiple organ failure (PMOF) and increased mortality.

Methods: Plasma from critically ill children admitted to a tertiary-care PICU with severe sepsis was collected on days one (D1) and three (D3) and stored at -70°C until time of analysis. Organ Failure Index (OFI) scores (1 point for each failed organ system) were determined, and multiple organ failure (MOF) was defined as OFI≥3. MOF on D3=persistent MOF (PMOF); MOF on D1 or D2 but not D3=resolving MOF (RMOF); and no MOF on D1, D2, or D3=no MOF (NMOF). Children who did not survive to D3 were excluded from the study. Critically ill children (n=12) admitted with non-infectious issues served as controls. Values are presented as [median (25%ile-75%ile)] in ng/ml.

Results: PCT was elevated in patients with severe sepsis on D1 [2.695 (0.190-24.230)] but not on D3 [0.820 (0.100-8.090)] when compared with controls [0.200 (0.085-0.515)] (p<0.05) [1F-ANOVA]. Patients with PMOF had higher PCT levels compared with patients with NMOF (p<0.05), and increasing PCT over time was associated with the development of PMOF (p<0.05) and nonsurvival (p=0.083) [2F-ANOVA] (table).

Table 1 No caption available
Full size table

Conclusions: As predicted by the experimental sepsis model, increasing PCT was associated with worse outcomes in our sepsis population. Further studies are warranted to characterize any mechanistic role of PCT in sepsis induced MOF.

This study was funded in part by Brahms Diagnostica GmbH and NIH grant 3M01RR0056GCRC.