Abstract
Purpose: It has been reported that the serum procalcitonin (PCT) levels increase in patients with systemic infections, especially bacterial infections. On the other hand, there are also some reports of increase of the serum PCT levels after injuries, e.g., in trauma patients. In this study, we investigated the changes in the serum PCT levels in emergency trauma patients to determine if there might be correlations between the serum PCT levels and the site of injury, severity of injury and outcome of the patients.
Objectives and Methods: Trauma patients admitted to 11 participating emergency and critical care centers affliated to the National Hospital Organization, Japan, from April 1, 2010 to February 28, 2012 were registered for this study. Data on the severity of the injuries, vital signs, serum CRP and PCT levels at admission (Day0) and at 12-24 hours after admission (Day1) were recorded. The outcome of the patients were reviewed, and the relationships between the site of injury/ severity of injuries and the serum levels of PCT were determined by univariate analysis, and the relationship between the in-hospital outcomes and serum PCT levels was evaluated by multivariate analysis.
Results: A total of 218 patients were enrolled. Comparison of the serum CRP and PCT levels between Day0 and Day1, revealed significantly higher values of these parameters on Day1, irrespective of the site of injury. Serum PCT levels on Day1 increased as the ISS (injury severity score) increased. In the ISS>20 group, the serum PCT levels on Day1 were significantly higher in the patients with head injuries, extremity injuries and multiple injuries. A comparison of the variables in relation to the in-hospital outcome revealed significant differences in the GCS on Day0 and Day1, and in the serum PCT levels on Day1. A logistic regression analysis focusing on head trauma patients, identified serum PCT levels on Day1 and the GCS scores on Day0 and 1 as predictors of the in-hospital prognosis, and the area under the ROC curve for the GCS score and serum PCT levels on Day1 was 0.98309.
Conclusion: Our results indicate that the serum PCT levels on Day1 increase in proportion to the trauma severity in patients with head, extremity and multiple injuries. A combination of the GCS score and serum PCT levels on Day 1 may be useful for prediction of prognosis in these patients.
