Clinical Analysis Of Serum Procalcitonin In The Evaluation Of Severity And Prognosis Of Severe Burn Patients

Objective1.To analyze the level of serum procalcitonin in severe burn patients during shock period,and to evaluate its clinical significance.2.To evaluated the prognostic value of serum PCT and PCT clearance in burn patients with sepsis by dynamic monitoring the tendency of PCT serum concentration.Methods1.Correlation study of serum procalcitonin levels with severity and prognosis in severe burn patients duringshock period.This was a retrospective cohort study of total 201 severe burn patients admitted to the burn center of the First Hospital Affiliated to the Chinese PLA General Hospital from January 2014 to January 2017.The basic data of patients' age,gender,cause of injury,area of burn and prognosis were collected,and the laboratory examination results of serum PCT,routine blood test,liver and kidney function and blood gas analysis were recorded during shock period.Spearman rank correlation were used to analyze the relationship between PCT level and clinical parameters.The difference of PCT level between survivors and non-survivors was evaluated among the subgroups divided by burn size.Data were processed with t test and Mann-Whitney U test.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic value of PCT level for predicting mortality in burn patients.The Kaplan-Meier method and Log bank test was used for survival analysis.2.Usefulness of Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Burn Patients with Sepsis.From January 2014 to September 2017,we retrospectively analyzed 109 burn patients with sepsis admitted to the burn center of the First Hospital Affiliated to the Chinese PLA General Hospital.Patient's basic conditions,vital signs,laboratory test results and other baseline data were collected.Daily PCT were measured for 7 days after the time of sepsis diagnosis and then PCT clearance was calculated.According to 90-day prognosis,patients were separated into survival group and death group,all indexes in two groups were compared and their effect on prognosis was evaluated.Results1.Correlation study of serum procalcitonin levels with severity and prognosis in severe burn patients during shock periodThere were significant correlations between burn index(r=0.693,P<0.01),leucocyte count(r=0.350,P<0.01),blood glucose(r=0.258,P<0.01),creatinine(r=0.284,P<0.01),urea nitrogen(r =0.216,P<0.01),total bilirubin(r =0.372,P<0.01),sequential organ failure assessment score(r=0.681,P<0.01),albumin(r=-0.154,P=0.029),brain natriuretic peptide(r=0.151,P=0.032),oxygenation index(r=0.173,P=0.014)and PCT level during shock period.Only 1 patient died of burn index less than 60.The area under the ROC curve of PCT level for predicting death for 54 patients with burn index more than 60 was 0.844(95%CI,0.637-0.927,P<0.01),and the best threshold value was 2.394 ng/mL,with sensitivity of 85.0%and specificity of 79.4%.Survival analysis revealed that the survival rates were 90%and 29%,after 90 days in the patients with PCT levels ?2.394 ng/mL and in those with>2.394 ng/mL,respectively(Log Rank=23.95,P<0.01).2.Usefulness of procalcitonin and procalcitonin clearance as a prognostic biomarker in burn patients with sepsis.Baseline data of the two groups were compared.The death group has larger burn area(90.17±8.45 vs 71.18± 15.54,P<0.10),higher APACHE II score(27.2±5.8 vs 22.8±6.7,P=0.018)and SOFA score(12.5±3.6 vs 10.4±3.2,P=0.042).PCTc was higher in survivors than in non-survivors,with significant differences on day 3,day 5 and day 7(P= 0.032,P<0.01,P<0.01);however,serum PCT levels on day 1 and day 2 were not significant prognostic factors for survival(P=0.096,P=0.211).The AUC-ROC was 0.621(95%Cl,0.479-0.763,P=0.073)for PCTc-3,0.832(95%CI,0.790-0.994,P<0.01)for PCTc-5 and 0.794(95%CI,0.768-0.948,P<0.01)for PCTc-7.Conclusions1.PCT level during shock period can be a useful biomarker for predicting severity and prognosis in severe burn patients.2.Dynamic changes of PCT reflected as PCTc on day 5 and day 7 can serve as a predictor of survival in severe burn patients with sepsis;however,serum PCT levels on day 1 and day 2 were not significant prognostic factors for survival.