Discordance between initial procalcitonin and Sequential Organ Failure Assessment score predicts in-hospital mortality in culture-positive bacterial sepsis: a retrospective cohort from an Indonesian tertiary hospital

Abstract

Objectives: A single initial procalcitonin (PCT) measurement has inconsistent prognostic value in sepsis. We examined whether a PCT that is low relative to the Sequential Organ Failure Assessment (SOFA) score identifies a distinct high-mortality phenotype in culture-positive bacterial sepsis. Methods: In this retrospective cohort of 441 adults with culture-positive bacterial sepsis at an Indonesian tertiary hospital (January 2023-June 2025), SOFA (≥6) and initial PCT (<2 ng/mL) were cross-classified into four concordance-discordance phenotypes (reference: concordant-low). In-hospital mortality was analyzed by logistic regression adjusted for the Charlson Comorbidity Index, Gram category, and serum creatinine; a continuous discordance index was used as a sensitivity analysis. Results: < 0.001): concordant-low 62.5%, discordant low SOFA/high PCT 49.2%, concordant-high 78.8%, and discordant high SOFA/low PCT 90.4%. The high SOFA/low PCT phenotype was independently associated with mortality (adjusted odds ratio 6.10; 95% confidence interval 1.92-19.36), as was the continuous index (odds ratio 1.74 per SD; 95% confidence interval 1.42-2.14). The effect was additive rather than synergistic. Conclusion: Organ dysfunction disproportionate to the PCT response identifies a very high-mortality phenotype in culture-positive sepsis, independent of comorbidity, Gram category, and renal function, offering an accessible marker for early risk stratification in resource-limited settings.

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