Procalcitonin in the assessment of bacteraemia in emergency department patients: results of a large retrospective study

Kim, So Young; Jeong, Tae Dong; Lee, Woochang; Chun, Sail; Min, Won Ki

doi:10.1177/0004563214568685

Cited by 8 publications

(11 citation statements)

References 19 publications

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“…We found remarkably high AUROCs of CRP level and PCT level compared to previous studies [6, 14, 18, 19, 26]. These studies, however, excluded patients without SIRS or suspected infection, or they compared patients with bacteremia to patients without bacteremia.…”

Section: Discussioncontrasting

confidence: 42%

The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study

et al. 2019

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Background Early diagnosis and treatment has proven to be of utmost importance in the outcome of sepsis patients. We compared the accuracy of the neutrophil-lymphocyte count ratio (NLCR) to conventional inflammatory markers in patients admitted to the Intensive Care Unit (ICU). Methods We performed a retrospective cohort study consisting of 276 ICU patients with sepsis and 388 ICU patients without sepsis. We compared the NLCR as well as C-reactive protein (CRP) level, procalcitonin (PCT) level, white blood cell (WBC) count, neutrophil count and lymphocyte count on ICU admission between sepsis and non-sepsis ICU patients. To evaluate the sensitivity and specificity, we constructed receiver operating characteristics (ROC) curves. Results Significant differences in NLCR values were observed between sepsis and non-sepsis patients (15.3 [10.8–38.2] (median [interquartile range] vs. 9.3 [6.2–14.5]; P<0.001), as well as for CRP level, PCT level and lymphocyte count. The area under the ROC curve (AUROC) of the NLCR was 0.66 (95%CI = 0.62–0.71). AUROC was significantly higher for CRP and PCT level with AUROC’s of 0.89 (95%CI 0.87–0.92) and 0.88 (95%CI 0.86–0.91) respectively. Conclusions The NLCR is less suitable than conventional inflammatory markers CRP and PCT to detect the presence of sepsis in ICU patients. Trial registration ClinicalTrials.gov NCT01274819 .

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Section: Discussioncontrasting

confidence: 42%

The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study

et al. 2019

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“…The impetus for promptly initiating appropriate broad-spectrum antimicrobial therapy must be weighed against the concern for reducing unnecessary antimicrobial therapy and potential harms, such as drug resistance, Clostridium difficile infections, and adverse drug effects (3). The lack of a specific test to assist clinicians in early decision-making regarding initiation and discontinuation of antimicrobial therapy for severe infection and presumed sepsis has led to expanded interest in inflammatory biomarkers, such as procalcitonin (PCT) (4-12).Previous trials evaluating PCT have used value ranges to guide clinical decisions within the construct of initiating and discontinuing antimicrobial therapy using clinical criteria (4,5,(7)(8)(9)(10)(12)(13)(14). By using serial measurements and established cutoff values in intensive care units (ICUs), these studies have shown that PCT values guide antimicrobial therapy (13-18).…”

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confidence: 99%

“…Previous trials evaluating PCT have used value ranges to guide clinical decisions within the construct of initiating and discontinuing antimicrobial therapy using clinical criteria (4,5,(7)(8)(9)(10)(12)(13)(14). By using serial measurements and established cutoff values in intensive care units (ICUs), these studies have shown that PCT values guide antimicrobial therapy (13-18).…”

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Determining the Clinical Utility of an Absolute Procalcitonin Value for Predicting a Positive Culture Result

Caffarini

DeMott

Patel

et al. 2017

Antimicrob Agents Chemother

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Various procalcitonin ranges have been established to guide antimicrobial therapy; however, there are no data that establish whether the initial procalcitonin value can determine the likelihood of a positive culture result. This study aimed to establish if the initial procalcitonin value, on clinical presentation, has a positive predictive value for any positive culture result. This was a retrospective study of 813 medical intensive care unit patients. Data collected included patient demographics, procalcitonin assay results, sources of infection, culture results, and lengths of stay. Patients were excluded if they were immunocompromised. The primary outcome of this study was to determine a procalcitonin value that would predict any positive culture. Secondary outcomes included the sensitivity, specificity, positive predictive value, and negative predictive value for procalcitonin. After exclusions, a total of 519 patient charts were reviewed to determine the impact of the initial procalcitonin value on culture positivity. In our analyses, the receiver operating characteristic values were 0.62 for all cultures, 0.49 for pulmonary infections, 0.43 for urinary tract infections, and 0.78 for bacteremia. A procalcitonin value of 3.61 ng/ml was determined to be the threshold value for a positive blood culture result (prevalence, 4%). For bacteremia, the sensitivity of procalcitonin was 75%, the specificity was 72%, the positive predictive value was 20%, and the negative predictive value was 97%. Procalcitonin was a poor predictor of culture positivity. An initial procalcitonin value of less than 3.61 ng/ml may be useful in predicting whether bacteremia is absent. Procalcitonin should not be used as the only predictor for determining initiation of antibiotic therapy.KEYWORDS biomarkers, diagnostics, procalcitonin, sepsis S epsis is a leading cause of death and disability in the United States (1, 2). Mortality from sepsis increases with each hour that anti-infective therapy is delayed (3). The impetus for promptly initiating appropriate broad-spectrum antimicrobial therapy must be weighed against the concern for reducing unnecessary antimicrobial therapy and potential harms, such as drug resistance, Clostridium difficile infections, and adverse drug effects (3). The lack of a specific test to assist clinicians in early decision-making regarding initiation and discontinuation of antimicrobial therapy for severe infection and presumed sepsis has led to expanded interest in inflammatory biomarkers, such as procalcitonin (PCT) (4-12).Previous trials evaluating PCT have used value ranges to guide clinical decisions within the construct of initiating and discontinuing antimicrobial therapy using clinical criteria (4,5,(7)(8)(9)(10)(12)(13)(14). By using serial measurements and established cutoff values in intensive care units (ICUs), these studies have shown that PCT values guide antimicrobial therapy (13-18). However, no reports have described the utility of using initial PCT levels to guide upstream anti-infective...

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“…[2] Bacterial infections that reach blood are called bacterteremia. [3] Cases of bacteremia can be established through culture testing and drug sensitivity which is the gold standard examination. [4] Bacteremia can cause death with a mortality of 30% where high mortality is associated with the establishment of inaccurate and late diagnoses.…”

Section: Introductionmentioning

confidence: 99%

Neutrophil Lymphocytes Ratio as a Predictor of Bacteremia In Children

Lubis

Pasaribu

et al. 2020

Global Journal for Research Analysis

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Bacterial infections are an important problem in the world. Early and accurate diagnosis to detect infection is very important in order to reduce mortality. Many bacterial infections that cause leukocytes are circulating and are characterized by increased neutrophils and decreased lymphocytes, this is caused by the inammatory process. The neutrophil lymphocyte ratio (NLR) is one of the infection markers currently being investigated because it is easy to do, simple with relatively low cost so that it can be used in daily practice. Research with a cross-sectional retrospective design on children performed blood culture at H. Adam Malik Hospital in 2017. Sampling was done in total population and a sample of 506 children who met the inclusion and exclusion criteria was obtained. Data analysis used the chai squared test (p <0.05). This study looked at the 5 most bacteria, namely Klebsiella pneumonia, Acinetobacter baumanii, Staphylococcus aureus, Escherichia coli, Staphylococcus haemolyticus. The neutrophil lymphocyte ratio is better for determining bacteremia with sensitivity of 80.5%, specicity of 26.9%, positive predictive value of 33% and negative predictive value of 74% and cut off 1.3 but cannot be used as a guide because the relationship between blood culture and NLR is not signicant with (p=0.1) and (OR=1.4)

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Procalcitonin in the assessment of bacteraemia in emergency department patients: results of a large retrospective study

Abstract: When procalcitonin is used as a serum marker for ruling out bacteraemia, a cut-off of 0.1 ng/mL may be used. Procalcitonin improves the diagnostic accuracy of existing markers of bacteraemia.

Cited by 8 publications

References 19 publications

The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study

The value of the neutrophil-lymphocyte count ratio in the diagnosis of sepsis in patients admitted to the Intensive Care Unit: A retrospective cohort study

Determining the Clinical Utility of an Absolute Procalcitonin Value for Predicting a Positive Culture Result

Neutrophil Lymphocytes Ratio as a Predictor of Bacteremia In Children

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