{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:12Z","timestamp":1787028912508,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background: The management of septic patients hospitalized in Internal Medicine wards represents a challenge due to their complexity and heterogeneity, and a high mortality rate. Among the available prognostic tools, procalcitonin (PCT) is considered a marker of bacterial infection. Furthermore, an association between vitamin D deficiency and poor sepsis-related outcomes has been described. Objectives: To evaluate the prognostic accuracy of two consecutive PCT determinations (Delta-PCT) and of vitamin D levels in predicting mortality in a population of patients with microbiological identified sepsis admitted to Internal Medicine wards. Methods: This is a sub-analysis of a previous prospective study. A total of 80 patients had at least two available consecutive PCT determinations, while 63 had also vitamin D. Delta-PCT was defined as a reduction of PCT &gt; 50% after 48 h, &gt;75% after 72 h, and &gt;85% after 96 h. Mortality rate at 28- and 90-days were considered as main outcome. Results: Mortality rate was 18.7% at 28-days and 30.0% at 90-days. Baseline PCT levels did not differ between survived and deceased patients (28-days: p = 0.525; 90-days: p = 0.088). A significantly higher proportion of survived patients showed Delta-PCT (28-days: p = 0.002; 90-days: p &lt; 0.001). Delta-PCT was associated with a lower 28-days (p = 0.007; OR = 0.12, 95%CI 0.02\u20130.46) and 90-days mortality (p = 0.001; OR = 0.17, 95%CI 0.06\u20130.48). A significantly higher proportion of deceased patients showed severe vitamin D deficiency (28-days: p = 0.047; 90-days: p = 0.049). Severe vitamin D deficiency was associated with a higher 28-days (p = 0.058; OR = 3.95, 95%CI 1.04\u201319.43) and 90-days mortality (p = 0.054; OR = 2.94, 95%CI 1.00\u20139.23). Conclusions: Delta-PCT and vitamin D represent two useful tests for predicting prognosis of septic patients admitted to Internal Medicine wards.<\/jats:p>","DOI":"10.3390\/medicina57040331","type":"journal-article","created":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T07:23:17Z","timestamp":1617261797000},"page":"331","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Delta-Procalcitonin and Vitamin D Can Predict Mortality of Internal Medicine Patients with Microbiological Identified Sepsis"],"prefix":"10.3390","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7335-6137","authenticated-orcid":false,"given":"Alberto","family":"Tosoni","sequence":"first","affiliation":[{"name":"CEMAD Digestive Disease Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Cossari","sequence":"additional","affiliation":[{"name":"Department of Economics, Statistics and Finance \u201cGiovanni Anania\u201d, University of Calabria, 87036 Rende, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7546-8041","authenticated-orcid":false,"given":"Mattia","family":"Paratore","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Disease Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4833-0941","authenticated-orcid":false,"given":"Michele","family":"Impagnatiello","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Disease Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanna","family":"Passaro","sequence":"additional","affiliation":[{"name":"Department of Geriatrics, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Vallone","sequence":"additional","affiliation":[{"name":"Department of Emergency and Critical Care, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi D\u2019Aragona, 84125 Salerno, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Zaccone","sequence":"additional","affiliation":[{"name":"Department of Internal and Subintensive Medicine, Azienda Ospedaliero-Universitaria \u201cOspedali Riuniti\u201d, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Gasbarrini","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Disease Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Addolorato","sequence":"additional","affiliation":[{"name":"CEMAD Digestive Disease Center, Fondazione Policlinico Universitario \u201cA. Gemelli\u201d IRCCS, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"De Cosmo","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3932-3803","authenticated-orcid":false,"given":"Antonio","family":"Mirijello","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Internal Medicine Sepsis Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1056\/NEJMp1707170","article-title":"Recognizing Sepsis as a Global Health Priority-A WHO Resolution","volume":"377","author":"Reinhart","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, Regional, and National Sepsis Incidence and Mortality, 1990\u20132017: Analysis for the Global Burden of Disease Study","volume":"395","author":"Rudd","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1080\/07853890.2017.1332776","article-title":"Sepsis in Internal Medicine Wards: Current Knowledge, Uncertainties and New Approaches for Management Optimization","volume":"49","author":"Zaccone","year":"2017","journal-title":"Ann. Med."},{"key":"ref_4","first-page":"4033","article-title":"MEDS Score and Vitamin D Status Are Independent Predictors of Mortality in a Cohort of Internal Medicine Patients with Microbiological Identified Sepsis","volume":"23","author":"Mirijello","year":"2019","journal-title":"Eur. Rev Med Pharmacol. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e22","DOI":"10.1016\/j.ejim.2019.07.008","article-title":"Predictors of Mortality of Bloodstream Infections among Internal Medicine Patients: Mind the Complexity of the Septic Population!","volume":"68","author":"Tosoni","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/0140-6736(93)90277-N","article-title":"High Serum Procalcitonin Concentrations in Patients with Sepsis and Infection","volume":"341","author":"Assicot","year":"1993","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1223","DOI":"10.1515\/cclm-2018-0259","article-title":"Procalcitonin-Guided Antibiotic Therapy: An Expert Consensus","volume":"56","author":"Bartoletti","year":"2018","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Yunus, I., Fasih, A., and Wang, Y. (2018). The Use of Procalcitonin in the Determination of Severity of Sepsis, Patient Outcomes and Infection Characteristics. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0206527"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jiph.2019.06.003","article-title":"Role of Procalcitonin in Predicting Etiology in Bacteremic Patients: Report from a Large Single-Center Experience","volume":"13","author":"Bassetti","year":"2020","journal-title":"J. Infect. Public Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1186\/s13054-019-2481-y","article-title":"Procalcitonin Levels in Candidemia versus Bacteremia: A Systematic Review","volume":"23","author":"Cortegiani","year":"2019","journal-title":"Crit. Care"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"54","DOI":"10.23736\/S0031-0808.19.03809-6","article-title":"The Use of Procalcitonin for the Management of Sepsis in Internal Medicine Wards: Current Evidence","volume":"62","author":"Tosoni","year":"2020","journal-title":"Panminerva Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/ncpendmet0716","article-title":"Unexpected Actions of Vitamin D: New Perspectives on the Regulation of Innate and Adaptive Immunity","volume":"4","author":"Adams","year":"2008","journal-title":"Nat. Clin. Pract. Endocrinol. Metab."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"301","DOI":"10.3109\/07853890.2016.1162910","article-title":"Vitamin D Deficiency in the Critically Ill","volume":"48","author":"Koekkoek","year":"2016","journal-title":"Ann. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1928","DOI":"10.1097\/CCM.0000000000001148","article-title":"Effect of Cholecalciferol Supplementation on Vitamin D Status and Cathelicidin Levels in Sepsis: A Randomized, Placebo-Controlled Trial","volume":"43","author":"Quraishi","year":"2015","journal-title":"Crit. Care Med."},{"key":"ref_15","first-page":"456.e7\u2013456.e13","article-title":"Clinical and Microbiological Outcome in Septic Patients with Extremely Low 25-Hydroxyvitamin D Levels at Initiation of Critical Care","volume":"22","author":"Vallecoccia","year":"2016","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"67","DOI":"10.3109\/07853890.2015.1134807","article-title":"Vitamin D Deficiency at Admission Is Not Associated with 90-Day Mortality in Patients with Severe Sepsis or Septic Shock: Observational FINNAKI Cohort Study","volume":"48","author":"Mutt","year":"2016","journal-title":"Ann. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1097\/01.CCM.0000050454.01978.3B","article-title":"2001 SCCM\/ESICM\/ACCP\/ATS\/SIS International Sepsis Definitions Conference","volume":"31","author":"Levy","year":"2003","journal-title":"Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1001\/jama.2016.0288","article-title":"Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Seymour","year":"2016","journal-title":"JAMA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1911","DOI":"10.1210\/jc.2011-0385","article-title":"Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline","volume":"96","author":"Holick","year":"2011","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1520","DOI":"10.1001\/jama.2014.13204","article-title":"Effect of High-Dose Vitamin D3 on Hospital Length of Stay in Critically Ill Patients with Vitamin D Deficiency: The VITdAL-ICU Randomized Clinical Trial","volume":"312","author":"Amrein","year":"2014","journal-title":"JAMA"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"415","DOI":"10.2147\/IJGM.S147561","article-title":"Prevalence and Association of Vitamin D Deficiency and Mortality in Patients with Severe Sepsis","volume":"10","author":"Trongtrakul","year":"2017","journal-title":"Int. J. Gen. Med."},{"key":"ref_22","unstructured":"(2021, February 02). The R Project for Statistical Computing. Available online: https:\/\/www.r-project.org\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ejim.2019.05.003","article-title":"Predictors of Mortality of Bloodstream Infections among Internal Medicine Patients in a Swiss Hospital: Role of Quick Sequential Organ Failure Assessment","volume":"65","author":"Psychogiou","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"706","DOI":"10.14740\/jocmr2251w","article-title":"Procalcitonin Kinetics in the First 72 Hours Predicts 30-Day Mortality in Severely Ill Septic Patients Admitted to an Intermediate Care Unit","volume":"7","author":"Pieralli","year":"2015","journal-title":"J. Clin. Med. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1308","DOI":"10.1515\/cclm-2018-1181","article-title":"Procalcitonin (PCT)-Guided Antibiotic Stewardship: An International Experts Consensus on Optimized Clinical Use","volume":"57","author":"Schuetz","year":"2019","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1038\/s41598-018-19976-w","article-title":"Early Immune Anergy towards Recall Antigens and Mitogens in Patients at Onset of Septic Shock","volume":"8","author":"Feuerecker","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"331.e1\u2013331.e7","DOI":"10.1016\/j.jcrc.2010.07.012","article-title":"Early Changes of Procalcitonin May Advise about Prognosis and Appropriateness of Antimicrobial Therapy in Sepsis","volume":"26","author":"Georgopoulou","year":"2011","journal-title":"J. Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/S1473-3099(17)30592-3","article-title":"Effect of Procalcitonin-Guided Antibiotic Treatment on Mortality in Acute Respiratory Infections: A Patient Level Meta-Analysis","volume":"18","author":"Schuetz","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Li, Y., and Ding, S. (2020). Serum 25-Hydroxyvitamin D and the risk of mortality in adult patients with Sepsis: A meta-analysis. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-4879-1"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1038\/nrendo.2010.226","article-title":"Antibacterial Effects of Vitamin D","volume":"7","author":"Hewison","year":"2011","journal-title":"Nat. Rev. Endocrinol."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/331\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T13:25:43Z","timestamp":1760361943000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/57\/4\/331"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,1]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["medicina57040331"],"URL":"https:\/\/doi.org\/10.3390\/medicina57040331","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,1]]}}}