Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit

Müller, Beat; Becker, Kenneth L.; Schächinger, Hartmut; Rickenbacher, Peter; Huber, Peter; Zimmerli, Werner; Ritz, R

doi:10.1097/00003246-200004000-00011

Cited by 561 publications

(388 citation statements)

References 41 publications

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“…Circulating levels of procalcitonin (7,27,29) and C-reactive protein (CRP) (11,30,38) have been shown to be useful indicators of sepsis in intensive care unit (ICU) patients. In addition, changes in the individual levels of the host immune system mediators interleukin-1␤ (IL-1␤) (3), IL-6 (13), , , tumor necrosis factor alpha (TNF-␣) (14), FasL (16), and monocyte chemoattractant protein 1 (MCP-1) (6) in the blood of ICU patients have been highlighted as indicative of sepsis.…”

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confidence: 99%

Presymptomatic Prediction of Sepsis in Intensive Care Unit Patients

Lukaszewski

Yates

Jackson

et al. 2008

Clin Vaccine Immunol

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Postoperative or posttraumatic sepsis remains one of the leading causes of morbidity and mortality in hospital populations, especially in populations in intensive care units (ICUs). Central to the successful control of sepsis-associated infections is the ability to rapidly diagnose and treat disease. The ability to identify sepsis patients before they show any symptoms would have major benefits for the health care of ICU patients. For this study, 92 ICU patients who had undergone procedures that increased the risk of developing sepsis were recruited upon admission. Blood samples were taken daily until either a clinical diagnosis of sepsis was made or until the patient was discharged from the ICU. In addition to standard clinical and laboratory parameter testing, the levels of expression of interleukin-1␤ (IL-1␤), IL-6, IL-8, and IL-10, tumor necrosis factor-␣, FasL, and CCL2 mRNA were also measured by real-time reverse transcriptase PCR. The results of the analysis of the data using a nonlinear technique (neural network analysis) demonstrated discernible differences prior to the onset of overt sepsis. Neural networks using cytokine and chemokine data were able to correctly predict patient outcomes in an average of 83.09% of patient cases between 4 and 1 days before clinical diagnosis with high sensitivity and selectivity (91.43% and 80.20%, respectively). The neural network also had a predictive accuracy of 94.55% when data from 22 healthy volunteers was analyzed in conjunction with the ICU patient data. Our observations from this pilot study indicate that it may be possible to predict the onset of sepsis in a mixed patient population by using a panel of just seven biomarkers.

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mentioning

confidence: 99%

Presymptomatic Prediction of Sepsis in Intensive Care Unit Patients

Lukaszewski

Yates

Jackson

et al. 2008

Clin Vaccine Immunol

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“…Previously, PCT was reported to be a better discriminator than CRP in characterizing the degree of inflammation related to infection [17], especially infection complicated by sepsis or organ failure [18]. With this background, PCT has been proposed as a better prognostic marker than CRP [19,20]. Intestinal surgery and major operations often increase PCT [21].…”

Section: Discussionmentioning

confidence: 99%

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

Zou

Cai

et al. 2012

Indian J Surg

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Serum procalcitonin (PCT) levels may have predictive value in the prognosis of postoperative sepsis in elderly patients who have undergone colorectal surgery for colorectal cancer in intensive care units (ICUs). A prospective study involving 90 critically ill patients who underwent colorectal surgery for colorectal cancer in ICUs was performed. Twenty-eight patients were diagnosed with sepsis, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria, and these patients were included in the sepsis group. Sixtytwo patients, who were without evidence of sepsis, were enrolled in the control group. We measured the serum PCT concentrations preoperatively (immediately before induction of anesthesia), upon arrival in the ICU (ICU day 0), on the morning of the first postoperative day (postoperative day 1), and on the morning of the third postoperative day (postoperative day 3). The C-reactive protein (CRP) index, acute physiology and chronic health evaluation II (APACHE II) score, mechanical duration of ventilation, mortality rate, incidence of multiple organ failure, and usage of continuous renal replacement therapy were evaluated. The area under the curve for the receiver operating characteristic curve (AUC-ROCC) was measured to explore the association between the serum PCT and the prognosis. In the sepsis group, 12/28 patients died (mortality rate 43 %). In the control group, 6/ 62 patients died (mortality rate 9.7 %). On the first postoperative day, the serum PCT level was dramatically higher in the sepsis group than in the control group (2.71±1.13 vs. 1.37± 0.57, P≤0.05). The PCT level on the first postoperative day was distinctly higher than that measured upon arrival in the ICU (2.71±1.13 vs. 1.31±0.58, P≤0.05). In the two groups, the CRP concentrations were both markedly higher on the first postoperative day than upon arrival in the ICU (138.89±45.12 vs. 70.43±23.54 in the sepsis group, and 133.13±44.91 vs. 69.65±24.98 in the control group, P≤0.05). Linear regression analysis was performed. The results suggest that the PCT and APACHE-II scores were not significantly associated. On the first and third postoperative days, the PCT levels were associated with increased odds of sepsis (AUC-ROCC, 95 % confidence interval 0.817-0.973, P 00.000, and 0.755-0.944, P00.000, respectively). The outcomes of patients in the sepsis group were worse than those in the control group. PCT levels appear to be early markers of postoperative sepsis in elderly patients undergoing colorectal surgery for colorectal cancer during the ICU course. These findings could allow for early identification of postoperative septic complications and be used for prognostic evaluation of these patients.

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“…W ä hrend beim Gesunden nur geringe Konzentrationen von PCT messbar sind [75] , k ö nnen im Fall einer schweren Infektion oder einer Sepsis bis auf das mehrfach Tausendfache erh ö hte Spiegel nachgewiesen werden [8,9] . PCT-Konzentrationen steigen ca.…”

Section: Diagnostische Bedeutung Von Pctunclassified

“…sowohl mit dem Schweregrad der Erkrankung als auch mit der nachfolgenden Mortalit ä t korrelieren [8,9,25,26] . In einer Studie an 472 kritisch kranken Intensivpatienten konnten Jensen et al [51] zeigen, dass hohe PCT-Werte und ein PCT-Anstieg von einem Tag fr ü he Indikatoren f ü r Mortalit ä t innerhalb 90 Tage nach Aufnahme auf der Intensivstation waren.…”

Section: Therapiesteuerungunclassified

“…W ä hrend Calcitonin in den C-Zellen der Schilddr ü se synthetisiert wird, induziert eine mikrobielle Infektion die Synthese und Freisetzung von PCT durch parenchymale Zellen, wie zum Beispiel Lunge, Leber, Niere, Muskel und Fettgewebe [6,7] . Die H ö he des Anstiegs korreliert dabei mit dem Schweregrad der Erkrankung und der Prognose [8,9] . Experimentelle Untersuchungen konnten zeigen, dass die Synthese von PCT sowohl durch bakterielle Toxine als auch durch Entz ü ndungsmediatoren wie IL-6 induziert wird [10 -12] .…”

Section: Introductionunclassified

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Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen?/Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

Boenisch

Fae

Drexel

et al. 2013

Laboratoriumsmedizin

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Zusammenfassung :In der Diagnostik von Infektionen und inflammatorischen Prozessen ist das C-reaktive Protein (CRP) einer der meistverwendeten Parameter, unter anderem aufgrund der geringen Kosten und der schnellen Verf ü gbarkeit. Im Zuge der letzten Jahre gewannen jedoch andere Entz ü ndungsparameter, wie zum Beispiel das Interleukin 6 (IL-6) oder Procalcitonin (PCT), zunehmend an Bedeutung. Obwohl diese Parameter im klinischen Alltag noch nicht ü berall etabliert sind, besitzen sie doch wesentliche Vorteile in der Diagnostik und im Verlaufsmonitoring von entz ü ndlichen Erkrankungen. Beispielsweise ist die Erkennung entz ü ndlicher Komplikationen auf Intensivstationen durch erh ö hte IL-6 Spiegel 24 bis 48 Stunden vor einer Erh ö hung des CRP m ö glich. Die deutliche Ü berlegenheit von PCT gegen ü ber CRP in der Diagnostik von bakteriellen Infektionen und Sepsis begr ü ndet sich in der h ö heren Spezifit ä t des PCT f ü r bakterielle Infektionen. Der PCT-Verlauf erm ö glicht daher eine bessere Beurteilung des Therapieerfolges und Krankheitsverlaufs des Patienten und liefert Hinweise auf eine gegebenenfalls erforderliche Therapieumstellung. Daraus ergibt sich die Frage, ob die Messung des CRPSpiegels durch IL-6 und/oder PCT ersetzt werden kann. In dieser Ü bersichtsarbeit wird die derzeitige Bedeutung von CRP im Verh ä ltnis zu den neueren Entz ü ndungsparametern in der Diagnostik von bakteriellen Infektionen, im therapeutischen Monitoring und in seiner Aussagekraft bez ü glich der Prognose des Patienten auf Intensivstationen dargestellt.Schl ü sselw ö rter: C-reaktive Protein (CRP); Entz ü ndungsmarker; Infektion; Intensivstation; Interleukin 6 (IL-6); Procalcitonin (PCT); Sepsis.Abstract : C-reactive protein (CRP) currently constitutes one of the most widely used parameters for the diagnosis of infections and inflammatory processes, due to simple methods and low costs. However, in recent years, other parameters, such as interleukin 6 (IL-6) and procalcitonin (PCT), have gained in importance. Although these parameters are presently not established everywhere in clinical routine, they provide significant advantages in the diagnosis and monitoring of inflammatory diseases. For instance, in intensive care, the increase in IL-6 levels may indicate inflammatory complications 24 to 48 h prior to the increase in circulating CRP levels. In contrast to CRP, PCT shows a higher specificity for bacterial infections, which facilitates the diagnosis of bacterial infections and sepsis. Therefore, PCT values provide a better evaluation of prognosis and therapeutic success and of a necessary change in therapy. These points raise the question whether CRP levels should at least in part be replaced by PCT and/or IL-6. Thus, this review seeks to examine the value of CRP in relation to PCT and IL-6 in the diagnosis of bacterial infections, in therapeutic monitoring, and regarding prognosis in critical care patients.

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Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit

Abstract: In a medical ICU, serum calcitonin precursor concentrations are more sensitive and are specific markers of sepsis as compared with serum C-reactive protein, interleukin-6, and lactate levels.

Cited by 561 publications

References 41 publications

Presymptomatic Prediction of Sepsis in Intensive Care Unit Patients

Presymptomatic Prediction of Sepsis in Intensive Care Unit Patients

Value of Serum Procalcitonin in Evaluating the Prognosis of Sepsis in Elderly Patients with Colorectal Cancer Undergoing Emergency Colorectal Surgery

Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen?/Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

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