Predictive Value of Combination of Procalcitonin and Predisposition, Infection, Response, and Organ Dysfunction (PIRO) System in Septic Patients with Positive Blood Cultures in the Emergency Department

Abstract

Purpose

Procalcitonin and predisposition, infection, response, and organ dysfunction (PIRO) system have high predictive value for the prognosis of critically ill patients. There are few studies on the predictive value of patients with positive blood cultures. The aim of the study was to evaluate risk stratification and sepsis-related mortality in patients with positive blood cultures via procalcitonin (PCT) combined with the PIRO system in emergency departments (ED).

Methods

A total of 1074 patients with positive blood cultures were admitted to Beijing Chao-Yang Hospital ED from December 2017 to October 2020. Their serum PCT was recorded, along with a Sequential Organ Failure Assessment (SOFA) score, Mortality in Emergency Department Sepsis (MEDS) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and PIRO score to predict the prognosis of septic patients with positive blood culture in terms of ICU (intensive care unit) admission, multiple organ dysfunction syndrome (MODS) development, and 28-day mortality. Receiver operating characteristic (ROC) curves and logistic regression analysis were used to assess the prognostic value of the scoring systems.

Results

A total of 978 patients met the inclusion criteria. PCT, MEDS, APACHE II, and PIRO scores were found to independently predict ICU-admission, MODS development, and 28-day mortality (P<0.05), whereas SOFA did not. The AUC values of the PCT, MEDS, APACHE II, and PIRO scores for ICU-admission were 0.620, 0.740, 0.780, and 0.751, respectively. In the prediction of 28-day mortality, the AUC values of PCT, MEDS, APACHE II, and PIRO were 0.782, 0.745, 0.805, and 0.831, respectively. The AUC values combined PCT and PIRO system in predicting MODS and 28-day mortality were better than when predicting ICU-admission.

Conclusion

This study indicates that PCT combined with the PIRO scoring system has a higher predictive value and is superior in predicting MODS and 28-day mortality in septic patients with positive blood cultures.

Keywords:

• procalcitonin
• PIRO scoring system
• positive blood culture
• 28-day mortality

Abbreviations

ICU, Intensive care unit; MODS, multiple organ dysfunction syndrome; COPD, chronic obstructive pulmonary disease; CVD, cerebrovascular disease; CHF, congestive heart failure; CRD, chronic renal disease; DM, diabetes mellitus; MAP, mean arterial pressure; WBC, white blood cell; PCT, procalcitonin; Lac, lactate; CRP, C-reactive protein; ALB, albumin; NLR, neutrophils and lymphocytes ratio; SOFA, Sequential Organ Failure Assessment; APACHE II, Acute Physiology and Chronic Health Evaluation II; MEDS, Mortality in emergency department sepsis; PIRO, Predisposition, Infection, Response, and Organ dysfunction.

Data Sharing Statement

The dataset that was used to support the finding of this study will be made available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participant

All procedures performed in studies involving human participant were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by Beijing Chao-Yang Hospital Ethics Committee. Written informed consent was obtained from all participants.

Acknowledgments

We would like to thank Beijing Chao-Yang Hospital for facilitating the study and covering the data collection costs. We would also like to acknowledge all data collectors, supervisors, and respondents without whom this research would not have been realized.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest regarding this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for- profit sectors.