Procalcitonin to Albumin Ratio as a Predictor of Intensive Care Unit Mortality in Sepsis
1Department of Anaesthesiology and Critical Care, Universiti Sains Malaysia, Kubang Kerian, Malaysia
J Crit Intensive Care 2024; 15(1): 23-29 DOI: 10.14744/dcybd.2024.3689
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Aim: High procalcitonin (PCT) and low albumin (ALB) concentrations have been associated with mortality in sepsis. This study aimed to investigate the prognostic value of the PCT/ALB ratio for intensive care unit (ICU) mortality in patients with sepsis.
Study Design: A retrospective cohort study was conducted in a mixed ICU at a university-affiliated hospital in Malaysia over a 3-year period. Consecutive adult patients admitted to the ICU, who underwent simultaneous measurements of PCT and ALB and fulfilled the Sepsis-3 Criteria, were recruited. Serum PCT was measured in the ICU using a point-of-care analyzer (Finecare™ PCT Rapid Test, Guangzhou, China). The predictive performance of the PCT/ALB ratio was assessed by analysis of a receiver-operating characteristic (ROC) curve.
Results: A total of 185 patients diagnosed with sepsis were recruited. The primary outcome (i.e., all-cause ICU mortality) was 35.1%. Baseline PCT was significantly higher, and baseline ALB was significantly lower in non-survivors compared to survivors (25.4 [standard deviation, SD=31.2] vs. 9.8 [SD=20.0] ng/mL and 26.1 [SD=5.4] vs. 30.6 [SD=6.5] g/dL, respectively; P<0.001). The computed PCT/ALB ratio was significantly higher in non-survivors compared to survivors (1.04 [SD=1.29] vs. 0.36 [SD=0.72]; P<0.001). The area under the ROC curve (AUC) for the PCT/ALB ratio in discriminating ICU mortality was 0.731 (95% confidence interval [CI]: 0.658-0.804), which was higher than the AUC of PCT alone (AUC: 0.721, 95% CI: 0.647-0.796). The optimal cut-off value for the PCT/ALB ratio was > 0.15, with a sensitivity of 70.8% and a specificity of 63.3%.
Conclusions: The PCT/ALB ratio slightly improved the prediction of ICU mortality compared to the use of PCT alone. Thus, it may aid in the prognostication of sepsis, although further validation in a prospective multicenter study is required.