The procalcitonin-to-cortisol ratio is a potential prognostic predictor in sepsis with abdominal source: a retrospective observational study

doi:10.5847/wjem.j.1920-8642.2022.095

Abstract

Abstract:

BACKGROUND: The aim of the study was to investigate the procalcitonin-to-cortisol ratio (P/C ratio) as a prognostic predictor among septic patients with abdominal source.

METHODS: We retrospectively enrolled 132 post-surgery patients between 18 and 90 years old with sepsis of the abdominal source. On the second day of sepsis onset, cortisol, procalcitonin (PCT), Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, C-response protein (CRP), and other baseline characteristics were collected. In addition, the length of ICU stay, length of mechanical ventilation (MV) days, length of shock days, and 28-day mortality were also recorded. Univariate analysis was performed to screen potential risk factors. Stratified analysis was used to identify the interaction among the risk factors. Multivariate analysis was also utilized to demonstrate the relationship between the risk factors and mortality. The receiver operator characteristic (ROC) curve analysis was conducted to evaluate the risk factors. A restricted cubic spline (RCS) demonstrated the association between survival outcome and the P/C ratio variation.

RESULTS: A total of twenty-nine patients died, and 103 patients survived within 28 d. There were significant differences in cortisol, PCT, P/C ratio, interleukin (IL)-6, SOFA, and APACHE II scores between the survival and non-survival groups. No significant interaction was observed in the stratified analysis. Logistic regression analysis revealed that P/C ratio (P=0.033) was significantly related to 28-day mortality. Based on ROC curves, P/C ratio (AUC=0.919) had a higher AUC value than cortisol or PCT. RCS analysis depicted a positive relationship between survival possibility and P/C ratio decrement.

CONCLUSION: P/C ratio might be a potential prognostic predictor in septic patients with abdominal sources.

Key words: Sepsis, Cortisol, Procalcitonin, Procalcitonin-to-cortisol ratio, Adrenal insufficiency

Hui Liu, Jie Hu, Jian-guo Xiao, Hong-jun Kang, Fei-hu Zhou. The procalcitonin-to-cortisol ratio is a potential prognostic predictor in sepsis with abdominal source: a retrospective observational study[J]. World Journal of Emergency Medicine, 2022, 13(6): 441-447.

Figures/Tables 7

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Characteristics	All (n=132)	Survival (n=103)	Non-survival (n=29)	P-value
Age, year	70 (57-76)	67 (51-77)	71 (68-73)	0.116
Female/male	55/77	46/57	9/20	0.271
BMI, kg/m²	22.29 (20.59-24.31)	22.32 (20.64-24.75)	22.08 (19.66-23.31)	0.189
8 a.m. cortisol, nmol/L	789.4 (545.71-1257.58)	775.3 (562-1231.6)	855.3 (535.9-1461.9)	0.045*
PCT, ng/mL	5.01 (2.96-9.25)	3.67 (2.39-6.23)	12.46 (8.6-21.76)	<0.001*
P/C ratio, μg/nmol	6.14 (3.80-10.98)	4.65 (2.94-7.48)	18.83 (12.09-36.12)	<0.001*
IL-6, pg/mL	118.03 (39.76-258.60)	59.31 (33.96-179.46)	423.06 (257.04-545.94)	<0.001*
CRP, mg/dL	11.28 (6.96-15.16)	11.33 (6.90-14.17)	9.64 (7.21-20.39)	0.513
SOFA	8 (4-13)	6 (3-9)	16.00 (14-18)	<0.001*
APACHE II	19 (17-23)	19 (16-23)	20.00 (19-23)	<0.001*
Length of ICU stay, d	18.50 (8-37.5)	18 (8-38)	25 (8-37)	0.769
MV days	10 (5-17.25)	10 (5-17)	10 (6-26)	0.556
Shock days	8 (4.75-15)	7 (4-11.5)	22 (8-27)	<0.001*
Source of sepsis, n
Intestinal puncture	20	17	3	0.600
Colon obstruction or fistulation	34	28	6	0.641
Anastomotic fistulation	15	11	4	0.892
Retroperitoneal infection	13	9	4	0.650
Traumatic intestinal rupture	14	10	4	0.772
Bile duct infection or liver abscess	16	13	3	0.992
Antibiotics associated diarrhea	8	7	1	0.820
Seudomembranous enteritis	6	4	2	0.854
Spleen rupture and infection	6	4	2	0.854

Variables	β	OR	95% CI	Z-value	P-value
P/C ratio	0.349	1.874	1.260-2.183	2.132	0.033*
SOFA	0.375	1.455	1.164-1.955	2.915	0.004*
APACHE II	0.137	1.146	1.001-1.344	1.850	0.064

Characteristics	n	Death (related to P/C ratio) [OR(95% CI)]	P-value	P-value of interaction
Age				0.783
< 70 years	65	1.40 (1.16-1.82)	0.003*
≥ 70 years	67	1.29 (1.15-1.50)	<0.001*
IL-6 tertile				0.802
< 70 pg/mL	55	1.34 (0.77-2.39)	0.238
70-200 pg/mL	35	1.42 (1.15-2.01)	0.009*
> 200 pg/mL	42	1.17 (1.06-1.34)	0.009*
CRP				0.886
< 6 mg/dL	24	2.51 (1.37-11.42)	0.054
6-12 mg/dL	51	1.30 (1.09-1.69)	0.019*
> 12 mg/dL	57	1.55 (1.24-2.39)	0.005*
SOFA tertile				0.247
< 10	79	1.08 (0.60-1.54)	0.547
≥ 10	53	1.31 (1.15-1.58)	0.002*
APACHE II tertile				0.387
< 19	53	1.29 (1.11-1.78)	0.025*
19-26	62	1.89 (1.40-3.25)	0.002*
> 26	17	1.08 (0.79-1.49)	0.622

Variables	Cut-off value	AUC (95%CI)	P-value	Sensitivity (%)	Specificity (%)
Cortisol	838.96 nmol/L	0.506 (0.375-0.636)	0.465	55.2	58.3
PCT	7.44 ng/mL	0.876 (0.811-0.942)	<0.001*	86.2	82.5
P/C ratio	11.94	0.919 (0.870-0.970)	<0.001*	75.9	91.3
Cortisol vs. PCT			<0.001*
Cortisol vs. CPR			<0.001*
PCT vs. CPR			0.087

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