Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department

Lin, Chiung Tsung; Lu, Jang Jih; Chen, Yu Ching; Kok, Victor C.; Horng, Jorng-Tzong

doi:10.7717/peerj.4094

Cited by 32 publications

(24 citation statements)

References 37 publications

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“…However, the relative complexity of using different cut-offs depending on Sepsis-3 status (requiring prior calculation of SOFA-score) warrants the use of the same cut-off value (Shapiro≥3 or NLCR> 12) irrespective of sepsis status in an ED setting. CRP and serum lactate was considered not suitable as predictors of BSI due to significantly lower AUC values, consistent with earlier studies [9,11,29], and were therefore not further evaluated. Elevated levels of CRP and lactate are likely too nonspecific indicators of inflammation and hypoxia/critical illness to be useful in the prediction of positive blood culture.…”

Section: Discussionmentioning

confidence: 60%

“…These have been single biomarkers (e.g. C-reactive protein [9], serum procalcitonin [10] and serum lactate [11]) or a combination of clinical parameters and biomarkers [12][13][14]. The Shapiro score [15], originally developed to rule out patients with low risk of positive blood culture, is one of those validated tools [16][17][18] and the differential count ratio of neutrophils and lymphocytes (NLCR), reflecting physiological stress response [19], has in addition recently been shown to predict BSI [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Early prediction of blood stream infection in a prospectively collected cohort

et al. 2021

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Background Blood stream infection (BSI) and sepsis are serious clinical conditions and identification of the disease-causing pathogen is important for patient management. The RISE (Rapid Identification of SEpsis) study was carried out to collect a cohort allowing high-quality studies on different aspects of BSI and sepsis. The aim of this study was to identify patients at high risk for BSI who might benefit most from new, faster, etiological testing using neutrophil to lymphocyte count ratio (NLCR) and Shapiro score. Methods Adult patients (≥ 18 years) presenting at the emergency department (ED) with suspected BSI were prospectively included between 2014 and 2016 at Örebro University Hospital. Besides extra blood sampling, all study patients were treated according to ED routines. Electronic patient charts were retrospectively reviewed. A modified Shapiro score (MSS) and NLCR were extracted and compiled. Continuous score variables were analysed with area under receiver operator characteristics curves (AUC) to evaluate the ability of BSI prediction. Results The final cohort consisted of 484 patients where 84 (17%) had positive blood culture judged clinically significant. At optimal cut-offs, MSS (≥3 points) and NLCR (> 12) showed equal ability to predict BSI in the whole cohort (AUC 0.71/0.74; sensitivity 69%/67%; specificity 64%/68% respectively) and in a subgroup of 155 patients fulfilling Sepsis-3 criteria (AUC 0.71/0.66; sensitivity 81%/65%; specificity 46%/57% respectively). In BSI cases only predicted by NLCR> 12 the abundance of Gram-negative to Gram-positive pathogens (n = 13 to n = 4) differed significantly from those only predicted by MSS ≥3 p (n = 7 to n = 12 respectively) (p < 0.05). Conclusions MSS and NLCR predicted BSI in the RISE cohort with similar cut-offs as shown in previous studies. Combining the MSS and NLCR did not increase the predictive performance. Differences in BSI prediction between MSS and NLCR regarding etiology need further evaluation.

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Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

Early prediction of blood stream infection in a prospectively collected cohort

et al. 2021

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“…Several studies have supported the use of PCT for making a diagnosis of sepsis [11,[19][20][21][22], while others have recommended its use to rule out sepsis. [23] It has a good negative predictive value for bacterial infection [24], especially bacteremia [25][26][27][28][29], although the current evidence does not suggest a suitable threshold to exclude bacteremia. PCT is detectable in the serum within a few hours after its induction, reaches its peak within 24 hours, and if treatment is adequate, the levels start to decline by approximately 50% per day.…”

Section: Pct As a Diagnostic Toolmentioning

confidence: 84%

Procalcitonin: A promising tool or just another overhyped test?

Paudel¹,

Dogra²,

Montgomery-Yates³

et al. 2020

Int. J. Med. Sci.

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Sepsis is the leading cause of death worldwide. Timely administration of antibiotics is recognized as the cornerstone in the management of sepsis. However, inappropriate use of antibiotics may lead to adverse effects and the selection of drug-resistant pathogens. Microbiological cultures remain the gold standard to diagnose infection despite their low sensitivity and the intrinsic delay to obtain the results. Certain biomarkers have the benefit of rapid turnover, potentially providing an advantage in timely diagnosis leading to accurate treatment. Over the last few decades, there is an ongoing quest for the ideal biomarker in sepsis. Procalcitonin (PCT), when used alone or alongside additional clinical information, has shown to be a promising tool to aid in the diagnosis and management of patients with sepsis. In February 2017, the Food and Drug Administration (FDA) approved the use of PCT to guide antibiotic treatment in lower respiratory tract infections and sepsis. Despite a good negative predictive value for bacterial infection, the utility of PCT-guided antibiotic initiation is conflicting at best. On the other hand, the use of PCT-guided antibiotic discontinuation has shown to reduce the duration of antibiotic use, the associated adverse effects, and to decrease the overall mortality. The current review discusses the history and pathophysiology of procalcitonin, synthesizes its utility in the diagnosis and management of sepsis, highlights its limitations and compares it with other biomarkers in sepsis.

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“…al. (12) a cutoff value of 3.39 ng/ml for PCT showed a sensitivity of 80%, a specificity of 71%, a positive predictive value of 35%, a negative predictive value of 91% and an area under the curve of 0.73 for gramnegative bacterial infection.…”

Section: Risk Factorsmentioning

confidence: 94%

Correlation of Serum Procalcitonin, Lactate Levels With Microbial Pattern in Patients With Sepsis

Kumar¹,

Ananthakumar²,

Devi³

et al. 2020

ATMPH

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Sepsis is defined as life -threatening organ dysfunction due to dysregulated host response to infection. To ensure a better outcome early identification of sepsis and a goal directed therapy is must .The objective of the study is to identify the correlation between levels of Serum Procalcitonin and Blood lactate with culture positive sepsis. This is a Retrospective and Prospective study that included 78patients admitted in Chettinad Hospital And Research Institute withSepsis . Procalcitonin with a cut off value of 2.4 ng/ml shows a significant correlation with culture positive bacterial infection, AUROC (0.759, p value of 0.002) sensitivity, specificity of 69.8%, 73.3% respectively. Blood samples were drawn at time of admission before initiation of treatment and were processed within 30 minutes of collection using an autoanalyser. Serum Procalcitonin, Lactate was done to all subjects included in the study. Analysis of Serum Procalcitonin was done using immunochromatographic test. The findings suggested that higher procalciton in levels are found to be significantly correlated with bacterial infection, especially Gram negative bacterial infection, when compared with Lactate. Procalcitonin levels can be used as predictor of bacterial infection; especially Gram negative bacterial infection even before obtaining culture results, so early effective empirical antibiotics can be started.

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Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department

Cited by 32 publications

References 37 publications

Early prediction of blood stream infection in a prospectively collected cohort

Early prediction of blood stream infection in a prospectively collected cohort

Procalcitonin: A promising tool or just another overhyped test?

Correlation of Serum Procalcitonin, Lactate Levels With Microbial Pattern in Patients With Sepsis

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