Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Leroux, Pierre; Ruffi, Sébastien De; Ramont, Laurent; Gornet, Marion; Orsini, Guillaume Giordano; Losset, Xavier; Kanagaratnam, Lukshe; Gennai, Stéphane

doi:10.1155/2021/2344212

Cited by 5 publications

(8 citation statements)

References 30 publications

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“…Nueve se desarrollaron en España [ 37 , 39 , 40 , 43 , 44 , 46 , 48 , 49 , 53 ], siete en otros países europeos [ 36 , 41 , 45 , 50 , 51 , 52 , 54 ] y tres en Asia [ 38 , 42 , 47 ]. En total se han incluido 18.120 pacientes con 2.877 bacteriemias verdaderas (15,88 %).…”

Section: Resultsunclassified

“…En la tabla 2 se muestra la evaluación de la calidad de los estudios de cohortes incluidos y de sus riesgos de sesgos según la escala NOS [ 34 ]: 9 de ellos fueron calificados de calidad alta (bajo riesgo de sesgos) [ 26 , 36 , 37 , 39 , 40 , 41 , 43 , 49 , 50 ], 9 moderada [ 38 , 42 , 44 , 45 , 46 , 47 , 48 , 52 , 53 ] y 1 baja (alto riesgo de sesgos) [ 51 ]. Para los estudios incluidos y agrupados de la revisión sistemática [ 24 ] se asumió el análisis publicado en la misma que utilizó para la evaluación de la calidad la herramienta Quality Assessment of Diagnostic Accuracy Studies (QUADAS) [ 71 ], cuyas puntuaciones oscilan entre 0 y 14, para evaluar la calidad metodológica de los estudios incluidos.…”

Section: Resultsunclassified

“…Se identificaron 1.372 artículos en las bases de datos seleccionadas. Finalmente, 20 fueron los artículos que se incluyeron en esta revisión sistemática: 19 estudios de cohortes [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] y una revisión sistemática [24].…”

Section: Métodosunclassified

“…Las poblaciones fueron heterogéneas ya que presentaron un porcentaje de bacteriemia verdadera desde el 8% [24] hasta el 31% [48], trece fueron prospectivos frente a siete retrospectivos, todos los pacientes eran adultos con una edad media desde 44 (DE 21) años [44] hasta mediana de 79 años [48] y la proporción de hombres varió desde el 37% [38] hasta el 67% [44]. En la mayoría de los estudios (12) la extracción de HC se produjo en pacientes con fiebre o sospecha de infección bacteriana con o sin sepsis [24,26,37,41,42,45,[47][48][49][50][51][52] , dos en diagnosticados de neumonía adquirida en la comunidad [39,40], dos en pacientes con infección del tracto urinario [36,43], dos en enfermos con neutropenia febril [38,46], uno en pacientes con sospecha de meningitis [44] y uno en pacientes con enfermedad hematológica y fiebre [53]. Todos los estudios incluyeron criterios o definiciones para considerar los HC contaminados, considerándose estos como HC negativos.…”

Section: Métodosunclassified

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Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Julián-Jiménez,

Eduardo García,

Merinos-Sánchez

et al. 2023

Rev Esp Quimioter

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Introduction. Obtaining blood cultures (HC) is performed in 15% of the patients treated with suspicion of infection in the Hospital Emergency Services (ED) with a variable diagnostic yield (2-20%). The 30-day mortality of patients with bacteremia is two or three times higher than the rest with the same process. Procalcitonin (PCT) is a biomarker that has been used as a tool to help predict bacteremia in HEDs. The main objective of this systematic review is to investigate the diagnostic accuracy of PCT in predicting true bacteraemia in adult patients treated with clinical suspicion of infection in the ED, as well as to identify a specific PCT value as the most relevant from the clinical decision diagnostic point of view that can be recommended for decision making Method. A systematic review was performed following the PRISMA guidelines in the PubMed, Web of Science, EMBASE, Lilacs, Cochrane, Epistemonikos, Tripdatabase and ClinicalTrials.gov databases from January 2010 to May 31, 2023 without language restrictions and using a combination of MESH terms: “Bacteremia/ Bacteraemia/ Blood Stream Infection”, “Procalcitonin”, “Emergencies/ Emergency/ Emergency Department” and “Adults”. Observational cohort studies and partially an systematic review were included. No meta-analysis techniques were performed, but the results were compared narratively. Results. A total of 1,372 articles were identified, of which 20 that met the inclusion criteria were finally analyzed. The included studies represent a total of 18,120 processed HC with 2,877 bacteraemias (15.88%). Ten studies were rated as high, 9 moderate and 1 low quality. The AUC-COR of all the studies ranges from 0.68 (95% CI: 0.59-0.77) to 0.98 (95% CI: 0.97-0.99). The PCT value >0.5 ng/ml is the most widely used and proposed in up to ten of the works included in this systematic review, whose estimated mean yield is an AUC-COR of 0.833. If only the results of the 6 high-quality studies using a cut-off point (PC) >0.5 ng/mL PCT are taken into account, the estimated mean AUC-COR result is 0.89 with Se of 77.6% and It is 78%. Conclusions. PCT has a considerable diagnostic accuracy of bacteraemia in patients treated in EDs for different infectious processes. The CP>0.5 ng/ml has been positioned as the most suitable for predicting the existence of bacteraemia and can be used to reasonably rule it out.

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Section: Resultsunclassified

Section: Métodosunclassified

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Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Julián-Jiménez,

Eduardo García,

Merinos-Sánchez

et al. 2023

Rev Esp Quimioter

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“…A similar trend was reflected in the IL-10 level of the G-group. Some studies have shown that PCT can be used as an indicator of infectious diseases, infection severity and disease prognosis (32)(33)(34). However, a single PCT has some limitations, and other indicators often need to be combined in clinical practice (35).…”

Section: Discussionmentioning

confidence: 99%

IL-6 and IL-10 Are Associated With Gram-Negative and Gram-Positive Bacteria Infection in Lymphoma

Zhu

Li²,

Zheng³

et al. 2022

Front. Immunol.

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To investigate the Th1/Th2 cytokine profile in patients with lymphoma during the myelosuppression stage of infection. 52 patients with gram-negative bacterial infection (G- group), 49 patients with gram-positive bacterial infection (G+ group), 51 uninfected patients with lymphoma (uninfected group) and 20 healthy controls (healthy group) were enrolled in this study. We evaluated the quantification of Th1/Th2 cytokines with flow cytometry bead assay (CBA) in the sera to explore a rapid diagnostic method to determine the type of infection and anti-infective effect. The levels of procalcitonin (PCT) were also detected simultaneously. The four groups did not differ with regard to IL-2 and IL-4 (P>0.05). The IFN-γ and TNF-α levels of patients with lymphoma were higher than those of healthy controls (P<0.05). There was significantly upregulated IL-6 and IL-10 expression in the G- group (P<0.001). A similar trend was reflected in the IL-6 of the G+ group, which was significantly increased (P<0.001). However, no significant upregulation was observed for IL-10 in the G+ group. According to the different degrees of increased IL-6 and IL-10 levels, We proposed to use the G- Bacterial Infection Cytokine Profile (G- BICP) and the G+ Bacterial Infection Cytokine Profile (G+ BICP) for the first time to differentiate between Gram-negative and Gram-positive (G-/G+) bacterial infection in adults with lymphoma in the myelosuppression stage after chemotherapy. The IL-6, IL-10 and PCT in the G- group and the IL-6, PCT in the G+ group were significantly decreased at day 4 and day 8 compared with those at day 1. IL-6 and IL-10 are closely associated with the severity and treatment efficacy in adults with lymphomas who develop infections after chemotherapy and can help distinguish between G- and G+ bacterial infections at an early stage.

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Dynamics of Serum Procalcitonin Can Predict Outcome in Patients of Infected Pancreatic Necrosis: A Prospective Analysis

et al. 2022

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Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department

Cited by 5 publications

References 30 publications

Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

Diagnostic accuracy of procalcitonin for bacteremia in the emergency department: a systematic review

IL-6 and IL-10 Are Associated With Gram-Negative and Gram-Positive Bacteria Infection in Lymphoma

Dynamics of Serum Procalcitonin Can Predict Outcome in Patients of Infected Pancreatic Necrosis: A Prospective Analysis

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