Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock

Clec’h, Christophe; Fosse, Jean-Philippe; Karoubi, Philippe; Vincent, François; Chouahi, Imad; Hamza, Lilia; Cupa, M; Cohen, Yves

doi:10.1097/01.ccm.0000195012.54682.f3

Cited by 123 publications

(88 citation statements)

References 20 publications

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“…PCT levels were found to be several times higher in surgical compared with medical patients with the same gravity of septic shock [37]. This indicates that the degree of the inflammatory response is different depending on aetiology [38][39][40][41].…”

Section: Sepsis Is Different In Surgical and Medical Patientsmentioning

confidence: 86%

“…In contrast, in medical patients it is primarily the activation of PAMPs, resulting in a less extensive inflammatory response, hence lower PCT levels. For example, in a study by Clec'h et al, the median (interquartile range) PCT values in systemic inflammatory response syndrome in medical versus surgical patients were 0.3 (0.1-1.0) ng/mL vs. 5.7 (2.7-8.3) ng/mL, and in septic shock were 8.4 (3.6-76.0) ng/mL vs. 34.0 (7.1-76.0) ng/mL, respectively [37].…”

Section: Sepsis Is Different In Surgical and Medical Patientsmentioning

confidence: 99%

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Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Becze¹,

Molnár

Fazakas

2015

International Journal of Antimicrobial Agents

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a b s t r a c tAfter decades of extensive experimental and clinical research, septic shock and the related multiple organ dysfunction still remain the leading cause of mortality in intensive care units (ICUs) worldwide. Defining sepsis is a difficult task, but what is even more challenging is differentiating infection-induced from non-infection-induced systemic inflammatory response-related multiple organ dysfunction. As conventional signs of infection are often unreliable in intensive care, biomarkers are used, of which one of the most frequently investigated is procalcitonin. Early stabilisation of vital functions via adequate supportive therapy and antibiotic treatment has resulted in substantial improvements in outcome over the last decades. However, there are certain patients who may need extra help, hence modulation of the immune system and the host's response may also be an important therapeutic approach in these situations. Polyclonal intravenous immunoglobulins have been used in critical care for decades. A relatively new potential approach could be attenuation of the overwhelming cytokine storm by specific cytokine adsorbents. Both interventions have been applied in daily practice on a large scale, with firm pathophysiological rationale but weak evidence supported by clinical trials. The purpose of this review is to give an overview on the pathophysiology of sepsis as well as the role and interpretation of biomarkers and their potential use in assisting adjunctive therapies in sepsis in the future.

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Section: Sepsis Is Different In Surgical and Medical Patientsmentioning

confidence: 86%

Section: Sepsis Is Different In Surgical and Medical Patientsmentioning

confidence: 99%

Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Becze¹,

Molnár

Fazakas

2015

International Journal of Antimicrobial Agents

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“…PCT thresholds to differentiate bacterial infection from inflammation are commonly higher in perioperative medicine than in medical patients (15). A frequently accepted PCT threshold of 0.5 ng/mL or a drop from the peak of at least 80% failed to predict, in a single centre observational study, treatment response in a subpopulation of septic shock patients admitted for an intraabdominal infection.…”

Section: Should We Use Biomarkers To Stop Antibiotic Therapy In Critimentioning

confidence: 98%

Duration of antibiotic therapy in the intensive care unit

Zilahi¹,

McMahon²,

Póvoa³

et al. 2016

J. Thorac. Dis.

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There are certain well defined clinical situations where prolonged therapy is beneficial, but prolonged duration of antibiotic therapy is associated with increased resistance, medicalising effects, high costs and adverse drug reactions. The best way to decrease antibiotic duration is both to stop antibiotics when not needed (sterile invasive cultures with clinical improvement), not to start antibiotics when not indicated (treating colonization) and keep the antibiotic course as short as possible. The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown, however, there is a growing evidence that reduction in the length of antibiotic courses to 7-8 days can minimize the consequences of antibiotic overuse in critical care, including antibiotic resistance, adverse effects, collateral damage and costs. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) do have a valuable role in helping guideantibiotic duration but should be interpreted cautiously in the context of the clinical situation. On the other hand, microbiological criteria alone are not reliable and should not be used to justify a prolonged antibiotic course, as clinical cure does not equate to microbiological eradication. We do not recommend a 'one size fits all' approach and in some clinical situations, including infection with non-fermenting Gram-negative bacilli (NF-GNB) clinical evaluation is needed but shortening the antibiotic course is an effective and safe way to decrease inappropriate antibiotic exposure.

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“…Sin embargo, no hay suficiente evidencia que establezca que la procalcitonina predice la sobrevida en población infantil (14)(15)(16)(17)(18)(19)(20)(21)(22)(23) . Este estudio pretende determinar si existe relación entre valores de procalcitonina y la muerte en niños con sepsis que ingresan a la unidad de cuidado intensivo pediátrico (UCIP).…”

Section: Introductionunclassified

Análisis de la asociación entre procalcitonina y mortalidad por sepsis en menores de 18 años en una unidad de cuidados intensivos, Pasto- Colombia 2012 - 2014

2017

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Introducción: La procalcitonina aumenta tempranamente en pacientes con sepsis, sin embargo, es necesario profundizar la relación entre sus niveles y el compromiso multiorgánico, así como sus desenlaces como la muerte. Objetivo: Determinar si existe asociación entre los valores de procalcitonina y la muerte en niños con sepsis que ingresan a cuidado intensivo pediátrico (UCIP). Materiales y métodos: Estudio de corte transversal de pacientes menores de 18 años con sepsis que ingresaron a la UCIP del Hospital Infantil Los Ángeles, Pasto - Colombia, durante 2012 y 2014. Se analizó la relación entre el riesgo de muerte y los niveles de procalcitonina controlando por covariables clínicas y demográficas. Resultados: Se analizaron datos de 325 pacientes con sepsis, la enfermedad mostró una prevalencia de 27,3%, de los cuales fallecieron el 23,7% (77). La edad mediana fue 22 meses, rango intercuartil- RI (6 - 84). La mediana de procalcitonina fue de 10 ng/mL, RI (2,95 - 38). Niños con valores >10ng/mL tienen un incremento del riesgo de muerte de 2 a 6 veces más comparados con aquellos que presentaron valores inferiores. Conclusión: La procalcitonina puede ser utilizada como indicador y predictor del riesgo de muerte en menores de 18 años con sepsis.

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Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock

Abstract: The diagnostic cutoff value of procalcitonin was higher in surgical than in medical patients. Early procalcitonin was of prognostic interest in medical patients.

Cited by 123 publications

References 20 publications

Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Duration of antibiotic therapy in the intensive care unit

Análisis de la asociación entre procalcitonina y mortalidad por sepsis en menores de 18 años en una unidad de cuidados intensivos, Pasto- Colombia 2012 - 2014

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