Clinical Utility of Procalcitonin as a Marker of Sepsis: A Potential Predictor of Causative Pathogens

Nakajima, Atsuko; Yazawa, Junko; Sugiki, Daisuke; Mizuguchi, Mari; Sagara, Hironori; Fujisiro, Masahiro; Shibazaki, Mitsuei; Hitani, Akihiko; To, Masako; Haruki, Kosuke

doi:10.2169/internalmedicine.53.1785

Cited by 40 publications

(34 citation statements)

References 20 publications

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“…[1213] PCT levels have been shown to be able to distinguish Gram-negative bacterial (Gram-negative) sepsis from Gram-positive bacterial (Gram-positive) and fungal sepsis. [10141516] Here, we evaluated the diagnostic accuracy of different inflammatory markers to discriminate sepsis caused by different pathogens within a large patient population.…”

Section: Introductionmentioning

confidence: 99%

Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis

Rong

Guo

et al. 2016

J Res Med Sci

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Background:Serum procalcitonin (PCT) levels differ in patients with bacterial or fungal infections and are significantly elevated in patients with Gram-negative bacteremia. We evaluated the diagnostic accuracy of different inflammatory markers to discriminate sepsis caused by different pathogens.Materials and Methods:We included 328 episodes of bacteremia from 292 patients with sepsis and 31 patients with suspected sepsis in this study. Medical records of patients who had bacteremia caused by Gram-negative bacteria (Gram-negative), Gram-positive bacteria (Gram-positive) or fungi were reviewed, and information about PCT and other inflammatory markers was recorded. The diagnostic performance of inflammatory markers was calculated via receiver operating characteristic (ROC) curves.Results:Serum PCT levels in Gram-negative, Gram-positive, and fungal sepsis were 7.47 (interquartile range [IQR]: 1.09–41.26) ng/mL, 0.48 (IQR: 0.15–2.16) ng/mL, and 0.60 (IQR: 0.14–2.06) ng/mL, respectively (P < 0.001). ROC analysis revealed an optimal cut-off value of 2.44 ng/mL for PCT in discriminating Gram-negative sepsis from Gram-positive sepsis, which yielded a sensitivity of 68.4% and a specificity of 77.1%. An optimal cut-off value of 3.11 ng/mL for PCT in discriminating Gram-negative sepsis from fungal sepsis, led to a sensitivity of 63.9% and specificity of 93.3%. Neither PCT nor other inflammatory markers could be used to distinguish between Gram-positive and fungal sepsis.Conclusion:Serum PCT levels were significantly higher in patients with Gram-negative sepsis than in those with Gram-positive or fungal sepsis. PCT is a potential sensitive biomarker for distinguishing Gram-negative sepsis from Gram-positive and fungal sepsis.

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Section: Introductionmentioning

confidence: 99%

Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis

Rong

Guo

et al. 2016

J Res Med Sci

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“…In addition, although we found a positive correlation between CRP and PCT levels, the fact that both parameters did not differ between the sepses caused by gram+ and gram-bacteria also supports our conclusion. Nakajima et al (27) demonstrated in their study that PCT levels were higher in sepsis patients with gramfactor than the group with gram+ factor. However, because they stated as a limitation of their work that they made this comparison with only 7 gram+ and 6 gram-cases, their results must be interpreted with caution.…”

Section: Discussionmentioning

confidence: 92%

Roles of C-Reactive Protein and Procalcitonin in Empirical Treatment Approach to the Bacterial Sepsis Agent

Vurgun¹,

Evliyaoğlu²,

Arabacı³

et al. 2017

Istanbul Med J

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Although the incidence of blood circulation infections such as bacteremia and sepsis can be reduced with appropriate antibiotic treatment when detected at an early stage (1), such infections are one of the most important causes of morbidity and mortality in hospitalized patients (2, 3). Rapid diagnosis of bloodstream infections is often difficult because traditional blood culture procedures are slow and time consuming, and the isolation of the pathogen through the antibiogram takes at least 48 hours after blood culture (4). Alternative laboratory tests such as erythrocyte sedimentation rate, serum C-reactive protein (CRP) levels, white blood cell count or percentage of neutrophils, and polymerase chain reaction (PCR) are used to detect bacteremia but are slow and tedious and lack sensitivity and specificity (1). Therefore, it is difficult to distinguish bloodstream infections from other diseases with these tests (5, 6). In fact, except for PCR, none of the other tests can on their own confirm the diagnosis of bacteremia (7,8).Interleukins, proatrial natriuretic peptide, copeptin, interferon-ɤ, resistin, and procalcitonin (PCT) have been investigated as potential sepsis biomarkers (7-14), and the most studied among these are PCT levels. Most of these studies have shown that serum PCT levels are low in healthy individuals and elevated in patients with bloodstream infection (11,(13)(14)(15). Other investigators have found inconsistent and variable findings when they conducted examinations by comparing the diagnostic and prognostic values of PCT levels with alternative parameters in the case of bacteremia (16,17). Therefore, there is a need for more studies in order for PCT to become a diagnostic or predictive parameter that is routinely recommended.Early identification and recognition of the first minor symptoms of infection at the onset of bloodstream infections can help determine whether patients are infected by gram-positive (gram+) or gram-negative (gram-) pathogens (4). Because serum PCT levels are influenced by lipopolysaccharides and sepsis-related cytokines (18,19), it is expected that serum PCT levels of blood infections caused by gram-pathogens will be higher than blood infections caused by gram+ pathogens.The aim of our study was to determine, in the differential diagnosis, if the predictive value of serum CRP and PCT levels of culture-positive sepsis patients could effectively separate gram+ from gram-bacterial infections at an earlier time point than the standard blood culture results. This would allow us to determine whether or not the correct treatment could be started by facilitat- Roles of C-Reactive Protein and Procalcitonin in Empirical Treatment Approach to the Bacterial Sepsis AgentObjective: The primary aim of our study was to investigate the usefulness of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in the differential diagnosis of causative gram-positive (Gram+) or gram-negative (Gram-) bacteria in patients with sepsis to facilitate decisions concerning the initial choice of...

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“…PCT appears to have higher specificity and sensitivity for predicting bacterial infection than other markers [4,5]. Serum PCT levels differ in patients and are significantly elevated with GN bacteremia [6,7]. CRP, a kind of acute phase reactive protein synthesized by the liver, can regulate inflammatory reaction and defense mechanisms against infectious diseases [8].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin, c-reactive protein, leukocyte, mean platelet volume levels in bloodstream infections

İrvem¹

2018

Ann Clin Anal Med

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Aim: Levels of Serum Procalcitonin (PCT), C-Reactive Protein (CRP), Leukocyte (WBC) and Mean Platelet Volume (MPV) were evaluated in sepsis patients. We evaluated the diagnostic accuracy of different inflammatory markers to discriminate sepsis caused by different pathogens. Material and Method: In this study we included 126 episodes of bacteremia from 126 patients with sepsis. Medical records of patients who had bacteremia caused by Gram-negative bacteria (GN), Gram-positive bacteria (GP) or yeast were reviewed, and information about PCT and other inflammatory markers was recorded. Mann-Whitney U test and Spearman's correlation analysis were used for statistical analysis. Results: 60.4% of the cases (n=76) were GN, 31.7% (n=40) were GP and 7.9% (n=10) were yeast. There was a statistically significant difference between PCT, CRP, and MPV levels according to the microorganism (p=0.001, p<0.01). There was no statistically significant difference between WBC measurements according to the microorganism (p>0.05). Discussion: According to the microorganism, gram positivity cutoff points were determined for PCT as (≤12.17), CRP as (≤9.70) and MPV as (≤9.32). In bilateral comparisons, there was a significant increase in GN and yeast sepsis, while a significantly low level was found in GP sepsis. There was no significant difference between GN and yeast. When the measurements of PCT according to bacterial species are examined, the highest measurement was 44.6 ng/ml with Escherichia coli bacteria, followed by Candida bacteria with 12.6 ng/ml.

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Clinical Utility of Procalcitonin as a Marker of Sepsis: A Potential Predictor of Causative Pathogens

Cited by 40 publications

References 20 publications

Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis

Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis

Roles of C-Reactive Protein and Procalcitonin in Empirical Treatment Approach to the Bacterial Sepsis Agent

Procalcitonin, c-reactive protein, leukocyte, mean platelet volume levels in bloodstream infections

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