Is procalcitonin a reliable prognostic indicator in patients that undergo therapeutic hypothermia

Purpose: Procalcitonin (PCT) has been shown to aid in predicting outcome after cardiac arrest in patients with return of spontaneous circulation. However, PCT alone has been found to be a weak predictor of outcome in the setting of sepsis. We aimed to determine if PCT had any prognostic value in critically ill patients who underwent therapeutic hypothermia (TH). Materials and methods: We retrospectively reviewed all patients that underwent TH between February and May 2013 in a single institution and that had recorded serial PCT levels. Using these criteria we selected those patients with different outcomes (discharge fromhospital neurologically intact and death).We compared PCT levels, APACHE II and SOFA scores. Results: 2 diametrically opposite cases were recognized. One patient was discharged from the hospital neurologically intact and another one expired. Admission PCT levels were 11.53 and 31.29, APACHE II scores 20 and 25, SOFA scores 13 and 15. PCT levels prior to TH were 1.19 and 9.89. After TH concluded PCT was 0.6 and 3.8. For the patient who died, the PCT level had decreased 76%, the APACHE II score increased 20%, and the SOFA score increased 25%. For the patient who was discharged neurologically intact, the PCT level decreased by 95%, APACHE II score decreased 35% and the SOFA score by 69%. Conclusions: In our small cohort, APACHE II and SOFA scores had direct correlationwith the outcome of the patients that underwent TH, while PCT levels decreased irrespective of their ultimate outcome. Further studies are needed to fully ascertain the value of PCT in the context of TH for selected clinical conditions.