Serial procalcitonin predicts mortality in severe sepsis patients: Results from the multicenter procalcitonin monitoring SEpsis (MOSES) Study

Philipp Schuetz, Robert Birkhahn, Robert Sherwin, Alan E. Jones, Adam Singer, Jeffrey A. Kline, Michael S. Runyon, Wesley H. Self, D. Mark Courtney, Richard M. Nowak, David F. Gaieski, Stefan Ebmeyer, Sascha Johannes, Jan C. Wiemer, Andrej Schwabe, Nathan I. Shapiro

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Objectives: To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. Design: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-Approved protocol. Setting: Thirteen U.S.-based emergency departments and ICUs. Patients: Consecutive patients meeting criteria for severe sepsis or septic shock who were admitted to the ICU from the emergency department, other wards, or directly from out of hospital were included. Interventions: Procalcitonin was measured daily over the first 5 days. Measurements and Main Results: The primary analysis of interest was the relationship between a procalcitonin decrease of more than 80% from baseline to day 4 and 28-day mortality using Cox proportional hazards regression. Among 858 enrolled patients, 646 patients were alive and in the hospital on day 4 and included in the main intention-To-diagnose analysis. The 28-day all-cause mortality was two-fold higher when procalcitonin did not show a decrease of more than 80% from baseline to day 4 (20% vs 10%; p = 0.001). This was confirmed as an independent predictor in Cox regression analysis (hazard ratio, 1.97 [95% CI, 1.18-3.30; p < 0.009]) after adjusting for demographics, Acute Physiology and Chronic Health Evaluation II, ICU residence on day 4, sepsis syndrome severity, antibiotic administration time, and other relevant confounders. Conclusions: Results of this large, prospective multicenter U.S. study indicate that inability to decrease procalcitonin by more than 80% is a significant independent predictor of mortality and may aid in sepsis care.

Original languageEnglish (US)
Pages (from-to)781-789
Number of pages9
JournalCritical care medicine
Volume45
Issue number5
DOIs
StatePublished - May 1 2017
Externally publishedYes

Fingerprint

Calcitonin
Sepsis
Mortality
Hospital Emergency Service
Systemic Inflammatory Response Syndrome
APACHE
United States Food and Drug Administration
Septic Shock
Multicenter Studies
Regression Analysis
Demography
Clinical Trials
Anti-Bacterial Agents
Population

Keywords

  • Biomarker
  • Emergency services
  • Intensive care units
  • Procalcitonin
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Serial procalcitonin predicts mortality in severe sepsis patients : Results from the multicenter procalcitonin monitoring SEpsis (MOSES) Study. / Schuetz, Philipp; Birkhahn, Robert; Sherwin, Robert; Jones, Alan E.; Singer, Adam; Kline, Jeffrey A.; Runyon, Michael S.; Self, Wesley H.; Courtney, D. Mark; Nowak, Richard M.; Gaieski, David F.; Ebmeyer, Stefan; Johannes, Sascha; Wiemer, Jan C.; Schwabe, Andrej; Shapiro, Nathan I.

In: Critical care medicine, Vol. 45, No. 5, 01.05.2017, p. 781-789.

Research output: Contribution to journalArticle

Schuetz, P, Birkhahn, R, Sherwin, R, Jones, AE, Singer, A, Kline, JA, Runyon, MS, Self, WH, Courtney, DM, Nowak, RM, Gaieski, DF, Ebmeyer, S, Johannes, S, Wiemer, JC, Schwabe, A & Shapiro, NI 2017, 'Serial procalcitonin predicts mortality in severe sepsis patients: Results from the multicenter procalcitonin monitoring SEpsis (MOSES) Study', Critical care medicine, vol. 45, no. 5, pp. 781-789. https://doi.org/10.1097/CCM.0000000000002321
Schuetz, Philipp ; Birkhahn, Robert ; Sherwin, Robert ; Jones, Alan E. ; Singer, Adam ; Kline, Jeffrey A. ; Runyon, Michael S. ; Self, Wesley H. ; Courtney, D. Mark ; Nowak, Richard M. ; Gaieski, David F. ; Ebmeyer, Stefan ; Johannes, Sascha ; Wiemer, Jan C. ; Schwabe, Andrej ; Shapiro, Nathan I. / Serial procalcitonin predicts mortality in severe sepsis patients : Results from the multicenter procalcitonin monitoring SEpsis (MOSES) Study. In: Critical care medicine. 2017 ; Vol. 45, No. 5. pp. 781-789.
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abstract = "Objectives: To prospectively validate that the inability to decrease procalcitonin levels by more than 80{\%} between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. Design: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-Approved protocol. Setting: Thirteen U.S.-based emergency departments and ICUs. Patients: Consecutive patients meeting criteria for severe sepsis or septic shock who were admitted to the ICU from the emergency department, other wards, or directly from out of hospital were included. Interventions: Procalcitonin was measured daily over the first 5 days. Measurements and Main Results: The primary analysis of interest was the relationship between a procalcitonin decrease of more than 80{\%} from baseline to day 4 and 28-day mortality using Cox proportional hazards regression. Among 858 enrolled patients, 646 patients were alive and in the hospital on day 4 and included in the main intention-To-diagnose analysis. The 28-day all-cause mortality was two-fold higher when procalcitonin did not show a decrease of more than 80{\%} from baseline to day 4 (20{\%} vs 10{\%}; p = 0.001). This was confirmed as an independent predictor in Cox regression analysis (hazard ratio, 1.97 [95{\%} CI, 1.18-3.30; p < 0.009]) after adjusting for demographics, Acute Physiology and Chronic Health Evaluation II, ICU residence on day 4, sepsis syndrome severity, antibiotic administration time, and other relevant confounders. Conclusions: Results of this large, prospective multicenter U.S. study indicate that inability to decrease procalcitonin by more than 80{\%} is a significant independent predictor of mortality and may aid in sepsis care.",
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AU - Schuetz, Philipp

AU - Birkhahn, Robert

AU - Sherwin, Robert

AU - Jones, Alan E.

AU - Singer, Adam

AU - Kline, Jeffrey A.

AU - Runyon, Michael S.

AU - Self, Wesley H.

AU - Courtney, D. Mark

AU - Nowak, Richard M.

AU - Gaieski, David F.

AU - Ebmeyer, Stefan

AU - Johannes, Sascha

AU - Wiemer, Jan C.

AU - Schwabe, Andrej

AU - Shapiro, Nathan I.

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N2 - Objectives: To prospectively validate that the inability to decrease procalcitonin levels by more than 80% between baseline and day 4 is associated with increased 28-day all-cause mortality in a large sepsis patient population recruited across the United States. Design: Blinded, prospective multicenter observational clinical trial following an Food and Drug Administration-Approved protocol. Setting: Thirteen U.S.-based emergency departments and ICUs. Patients: Consecutive patients meeting criteria for severe sepsis or septic shock who were admitted to the ICU from the emergency department, other wards, or directly from out of hospital were included. Interventions: Procalcitonin was measured daily over the first 5 days. Measurements and Main Results: The primary analysis of interest was the relationship between a procalcitonin decrease of more than 80% from baseline to day 4 and 28-day mortality using Cox proportional hazards regression. Among 858 enrolled patients, 646 patients were alive and in the hospital on day 4 and included in the main intention-To-diagnose analysis. The 28-day all-cause mortality was two-fold higher when procalcitonin did not show a decrease of more than 80% from baseline to day 4 (20% vs 10%; p = 0.001). This was confirmed as an independent predictor in Cox regression analysis (hazard ratio, 1.97 [95% CI, 1.18-3.30; p < 0.009]) after adjusting for demographics, Acute Physiology and Chronic Health Evaluation II, ICU residence on day 4, sepsis syndrome severity, antibiotic administration time, and other relevant confounders. Conclusions: Results of this large, prospective multicenter U.S. study indicate that inability to decrease procalcitonin by more than 80% is a significant independent predictor of mortality and may aid in sepsis care.

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KW - Emergency services

KW - Intensive care units

KW - Procalcitonin

KW - Sepsis

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