Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.
*APACHE ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological Markers ; Calcitonin/*blood ; Comparative Study ; Female ; Human ; Ketone Bodies/*blood ; Male ; Middle Aged ; Multiple Organ Failure/blood/diagnosis/*mortality ; Predictive Value of Tests ; Protein Precursors/*blood ; Sepsis Syndrome/blood/diagnosis/*mortality ; Survival Analysis

Biomarkers ; blood ; Child ; Child, Preschool ; Critical Illness ; Early Diagnosis ; Heart Failure ; blood ; diagnosis ; mortality ; Humans ; Infant ; Intensive Care Units ; Mucocutaneous Lymph Node Syndrome ; blood ; diagnosis ; Natriuretic Peptide, Brain ; blood ; Peptide Fragments ; blood ; Predictive Value of Tests ; Prognosis ; Pulmonary Heart Disease ; blood ; diagnosis ; Risk Assessment ; Sepsis ; blood ; diagnosis ; Ventricular Dysfunction, Left ; blood ; diagnosis

BACKGROUND: Aortic dissection is an uncommon disease but early mortality is as high as 1 percent per hour if untreated. However, major advances in the prompt noninvasive diagnosis and in the medical and surgical treatment of aortic dissection now improve the survival rate to an 75~82% of 5-year survival rate. In order to determine clinical features and long-term follow up results of patients with aortic dissection in Korea, we present a retrospective review of 54 patients with aortic dissection at our institute. METHODS: We review the medical records, echocardiograms and computed tomogram(CT) or magnetic resonance imaging(MRI) of 54 patients(mean age: 59+/-12 years, male: 27) who had aortic dissection between September 1991 and July 1997. Patients were classified according to DeBakey type. Clinical features were evaluated in relation to type. Long-term survival rate using Kaplan-Meier method were also evaluated in relation to type, sex and presence of undertaking operation. RESULTS: Of the 54 patients with aortic dissection, twenty two(41%) were classified to type I, eight(15%) to type II and twenty four(44%) to type III. Age(type I: 60 yrs, type II: 60 yrs, type III: 57 yrs), sex(male in type I: 10(45%)type II: 4(50% ), type III: 13(54%)) and pulse rate(type I: 84, type II: 75, type III: 78) according to the type of aortic dissection show no signifiant difference. In regarding to predisposing factors, hypertension was found in 40(74%) overall, Marfan syndrome 1(2%), bicuspid aortic valve 4(7%), and iatrogenic vascular injury 3(6%). Four-year survival rate was 48% in all patients who were followed for 28+/-26 months(1-168 months), 61% in type I, 44% in type II and 44% in the III. But, there are no statistically significant difference in 4-year survival rate according to type and sex or presence of undertaking operation(data not shown). There are many kinds of cause of death; multi-organ failure, renal failure, congestive heart failure, sepsis, ruptured aortic dissection, gastrointestinal bleeding, cerebrovascular disease and postoperative weaning failure in the dead patients from aortic dissection. And also we found that there are some kinds of cause of death not directly related with aortic dissection(sepsis, gastrointestinal bleeding and cerebrovascular disease) in patients, especially in type III. CONCLUSION: Overall four-year survival rate in patients with aortic dissection was 48% and there were no significant differences in survival rate accoring to type, sex and presence of undertaking operation. There were many kinds of cause of death in patients with aortic dissection and some causes of death was not directly related with aortic dissection. The survival rate in patients with aortic dissection will be increased by strict control of blood pressure and optimal timing of operation before development of aortic rupture.
Aortic Rupture ; Aortic Valve ; Bicuspid ; Blood Pressure ; Causality ; Cause of Death ; Diagnosis ; Follow-Up Studies* ; Heart Failure ; Hemorrhage ; Humans ; Hypertension ; Korea ; Male ; Marfan Syndrome ; Medical Records ; Mortality ; Mortuary Practice ; Renal Insufficiency ; Retrospective Studies ; Sepsis ; Survival Rate ; Vascular System Injuries ; Weaning