Schuetz et al identified risk factors for mortality in a patient with severe sepsis. This can help to identify patients who may require more aggressive management. The authors are from the University of Basel and multiple institutions in the United States who participated in the MOSES Study.
Patient selection: adult with severe sepsis or septic shock, over 90% community-acquired
Outcome: 28-day all-cause mortality
Parameters:
(1) serum procalcitonin (PCT) on admission (day 0) in µg/L (B•R•A•H•M•S GmbH)
(2) serum procaclitonin (PCT) on day 4 in µg/L
(3) location on day 4 after admission
decrease in serum procalcitonin =
= ((baseline PCT) - (day 4 PCT)) / (baseline PCT) * 100%
Alternatively:
ratio of day 4 procalcitonin to admission procalcitonin =
= (day 4 PCT) / (admission PCT)
|
Parameter
|
Finding
|
Points
|
|
decrease in PCT
|
<= 80%
|
1
|
|
|
> 80%
|
0
|
|
location on day 4
|
in ICU
|
1
|
|
|
not in ICU
|
0
|
A decrease in serum procalcitonin > 80% is equivalent to day 4 to admission PCT ratio < 20%.
number of risk factors for all-cause mortality =
= SUM(points for the 2 parameters)
Interpretation:
• minimum score: 0
• maximum score: 2
• The greater the score the greater the all-cause mortality.
