Impact of Procalcitonin Kinetics on Mortality in Intensive Care Patients with Sepsis
MEDICINA-LITHUANIA, vol.62, no.3, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 62 Issue: 3
- Publication Date: 2026
- Doi Number: 10.3390/medicina62030487
- Journal Name: MEDICINA-LITHUANIA
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
- Keywords: sepsis, procalcitonin kinetics, delta procalcitonin, kinetic eGFR, acute kidney injury, mortality prediction
- Dokuz Eylül University Affiliated: Yes
Abstract
Background and Objectives: Procalcitonin (PCT) kinetics are increasingly used as prognostic markers in sepsis, but their interpretation is confounded by dynamic changes in renal function during acute illness. This study evaluated the prognostic value of Delta PCT for 30-day mortality in critically ill patients with either sepsis or septic shock by incorporating serial kinetic eGFR measurements and renal function-adjusted Delta PCT cut-off values based on the mean kinetic eGFR during the first 48-72 h of ICU admission. Materials and Methods: This retrospective cohort study included 106 adult ICU patients with either sepsis or septic shock. Serial procalcitonin measurements were used to calculate Delta PCT as a ratio of follow-up to baseline values, while renal function was assessed using mean kinetic eGFR over the first 72 h of ICU admission. Results: Thirty-day mortality was 43.4%. Delta PCT was a strong independent predictor of mortality across all models. At 48 h, Delta PCT2 was independently associated with 30-day mortality in the overall cohort (AUC 0.793) and demonstrated independent prognostic significance only in patients with preserved renal function (GFR >= 30 mL/min/1.73 m(2)). The optimal Delta PCT2 cut-off corresponded to a 56% reduction in procalcitonin levels. At 72 h, Delta PCT3 emerged as an independent predictor of mortality regardless of renal function. ROC analysis identified an optimal Delta PCT3 cut-off corresponding to 62% procalcitonin reduction in the overall cohort, with renal function-specific thresholds of similar to 50% for patients with GFR < 30 mL/min/1.73 m(2) and similar to 73% for those with preserved renal function. The combination of APACHE II score and Delta PCT3 demonstrated the highest discriminative performance for mortality prediction (AUC 0.948). Conclusions: Procalcitonin kinetics provide clinically meaningful prognostic information in sepsis when interpreted alongside dynamic renal function. While 48 h procalcitonin kinetics offer prognostic value primarily in patients with preserved renal function, 72 h Delta PCT provides renal function-independent and superior mortality discrimination. Integrating serial kinetic eGFR measurements enables renal function-adapted Delta PCT threshold determination and may improve risk stratification in critically ill septic patients.