Does serum procalcitonin aid in the diagnosis of bloodstream infection regardless of whether patients exhibit the systemic inflammatory response syndrome?

Arora, R; Campbell, James P.; Simon, György; Sahni, Nishant

doi:10.1007/s15010-016-0965-0

Cited by 15 publications

(11 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on the results in objective 1, it was demonstrated that the PCT values had a higher predictive usefulness than the lactic acid. These results correlated with a study published in the Journal of Infections, in which the ROC curves used for detection of bacterial systemic infection showed that detection was significantly higher using PCT (mean 0.683; 95% CI, 0.65-0.71) than that using lactic acid (mean 0.615; 95% CI, 0.58 -0.64) (10). From the laboratory's perspective, the suggested cutoff for lactic acid at 18.02 mg/dL (2.0 mmol/L) does not seem appropriate for when a patient first presents in the ED.…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

Oro

Gauthreaux

Lamoureux

et al. 2019

The Journal of Applied Laboratory Medicine

View full text Add to dashboard Cite

Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

show abstract

Section: Discussionsupporting

confidence: 89%

“…This is especially important because limitations have been observed when using the SIRS criteria to diagnose sepsis. A study revealed that 1 out of 8 patients who were coded as having severe sepsis and septic shock did not meet the SIRS criteria at initial admission to the hospital (10).…”

Section: Discussionmentioning

confidence: 99%

The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

Oro

Gauthreaux

Lamoureux

et al. 2019

The Journal of Applied Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…Biomarkers and their kinetics may aid the clinical examination in the differentiation of infectious from non-infectious inflammatory responses [5, 6]. Numerous sepsis biomarkers are described in the literature [7], and procalcitonin (PCT) is one of the most studied biomarkers.…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

et al. 2018

View full text Add to dashboard Cite

BackgroundEarly sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses.MethodsThis study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis.ResultsPCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate.ConclusionsPCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0585-6) contains supplementary material, which is available to authorized users.

show abstract

“…It was found that when the body is stimulated by an inflammatory response, especially bacterial infection, different cells in multiple organs secrete procalcitonin ( Linscheid et al, 2003 ; Nishikura, 1999 ). Many studies have shown that procalcitonin has an excellent predictive ability for sepsis ( Arora et al, 2017 ; Kibe, Adams & Barlow, 2011 ; Nishikawa et al, 2017 ). Additionally, another study showed that there is a risk of bacteremia in patients with acute fever when the procalcitonin level is greater than 0.5 ng/ml ( Kim et al, 2011 ).…”

Section: Introductionmentioning

confidence: 99%

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

Lin

Chen

et al. 2017

PeerJ

View full text Add to dashboard Cite

BackgroundFew studies compared the diagnostic value of procalcitonin with a combination of other tests including lactate and high-sensitivity C-reactive protein in the prediction of pathogenic bacteremia in emergency department adult patients.MethodsWe performed a retrospective study assessing the differences in performances of procalcitonin at a cutoff of 0.5 ng/mL, lactate at a cutoff of 19.8 mg/dL, high-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL and their combinations for predicting bacteremia in emergency department adult patients. Sensitivity, specificity, overall accuracy, positive-test and negative-test likelihood, and diagnostic odds ratio with 95% confidence interval for each test combination were calculated for comparison. The receiver operating characteristic curve for every single test were compared using DeLong’s method. We also performed a sensitivity analysis in two expanded patient cohorts to assess the discriminative ability of procalcitonin or test combination.ResultsA total of 886 patients formed the initial patient cohort. The area under the receiver operating characteristic curve for discriminating positive blood culture was: procalcitonin = 0.72 (95% CI [0.69–0.75]) with a derived optimal cutoff at 3.9 ng/mL; lactate 0.69 (0.66–0.72) with an optimal cutoff at 17.9 mg/dL; high-sensitivity C-reactive protein 0.56 (0.53–0.59) with an optimal cutoff of 13 mg/dL; with pairwise comparisons showing statistically significant better performance of either procalcitonin or lactate outperforming high-sensitivity C-reactive protein. To predict positive blood cultures, the diagnostic odds ratio for procalcitonin was 3.64 (95% CI [2.46–5.51]), lactate 2.93 (2.09–4.14), and high-sensitivity C-reactive protein 0.91 (0.55–1.55; P = 0.79). About combined tests, the diagnostic odds ratio for procalcitonin and lactate increases were 3.98 (95% CI [2.81–5.63]) for positive blood culture prediction. Elevated procalcitonin level rendered a six-fold increased risk of positive gram-negative bacteremia with a diagnostic odds ratio of 6.44 (95% CI [3.65–12.15]), which showed no further improvement in any test combinations. In the sensitivity analysis, as a single test to predict unspecified, gram-negative and gram-positive bacteremia, procalcitonin performed even better in an expanded cohort of 2,234 adult patients in terms of the diagnostic odds ratio.DiscussionsFor adult emergency patients, procalcitonin has an acceptable discriminative ability for bacterial blood culture and a better discriminative ability for gram-negative bacteremia when compared with lactate and high-sensitivity C-reactive protein. High-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL performed poorly for the prediction of positive bacterial culture.

show abstract

Does serum procalcitonin aid in the diagnosis of bloodstream infection regardless of whether patients exhibit the systemic inflammatory response syndrome?

Cited by 15 publications

References 27 publications

The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

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

Contact Info

Product

Resources

About