Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Rodríguez, Alejandro; Avilés‐Jurado, Francesc Xavier; Schuetz, Philipp; Solé‐Violán, Jordi; Cordero, Lourdes; Restrepo, Marcos I.; Cobo, Pedro; Martins, Javier; Carbayo, Cecilia; Robles-Musso, Emilio; Cárdenas, Antonio; Fierro, J.M. Garrido; Fernández, Dolores Ocaña; Sierra, Rafael J.; Huertos, Ma Jesús; Pérez, Ma Luz Carmona; Laderas, Juan Carlos Pozo; Guerrero, R.; Robles, Juan Carlos; León, Melissa Echevarría; Gómez, Alberto; Màrquez, Enrique; Rodríguez-Carvajal, Manuel; Estella, Ángel; Pomares, José; Ballesteros, José; Romero, O. Moreno; Fernández, Yolanda; Lobato, Francisco Carlos Faria; Prieto, J; Albofedo-Sánchez, José; Martínez, Pilar; Torre, María Victoria de la; Nieto, María; Sola, Estefanía Camara; Castellanos, Miguel Ángel Dı́az; Soler, Guillermo Sevilla; Leyba, C. Ortiz; Garnacho-Montero, José; Hinojosa, R.; Fernández, Esteban; Loza, Ana; León, Cristóbal; López, Samuel González; Arenzana, A.; Ocaña, Dolores; Navarrete, Inés; Beryanaki, Medhi Zaheri; Sánchez, Ignacio; Alé, Manuel Pérez; Brea, Ana Ma Poullet; Casas, Juan Francisco Machado; Arbeloa, C. Serón; Avellanas, M.L.; Lander, Arantxa; Arellano, S. Garrido Ramírez de; Lacueva, M.I. Marquina; Luqué, Pilar; Serrano, Elena Plumed; Lazaro, Juan F Martin; Polo, C. Sánchez; Gutiérrez, Isabel; Bartolomé, Belén Jiménez; Núñez, Carlos López; González, I. Alcantud; Marsilla, José Ignacio Tomás; Andrés, Clara Jaques; Ibañes, Pablo Gtiérrez; Aguilar, Pilar Araujo; Montón, Jose Ma; Regil, Paloma Dorado; Iglesias, Lisardo; González, Carmen Pascual; Fernández, B.; Iglesias, Lorena Martín; Soria, Lucía Viña; Escudero, Raquel; Revuelta, Ma del Rosario Mtnez; Quiroga,; García-Rodríguez, Águeda; Cuadrado, Marta; Mariño, Ana Luz Balán; Socías, Lorenzo; Ibañez, Pedro; Borges-Sa, Marcío; Socías, Antònia; Castillo, Alberto del; Marcos, Ricard; Muñoz, Cristina; Bonell, José M.; Amestarán, Ignacio; López, M. Angeles González; Pàmies, Cecília Vilanova; Goytisolo, José Ma. Bonell; Carbonero, José Antonio Morales; Senoff, Rossana Pérez; Medrano, Marta Generelo López de; Ruiz‐Santana, Sergio; Díaz, Juan José; Ramírez, Catalina Sánchez; Sisón, Montse; Hernández, David; Trujillo, Ana Aragón; Regalado, Luis E.; Fndez, Sonia Rodríguez; Lorente, Leonardo; Rivero, Judith Cabrera; Quintero, María Luisa Mora; Martín, Mar; Martínez, Sergio; Cáceres, Juan J.; Palacio, Manuel Sanchez; Marcos, .; Rodríguez, D. García; Leria, María Ripoll; Suberviola, Borja; Ugarte, Pablo; García-López, Fernando; Iniesta, Rafael Sánchez; Alonso, Ángel; Padilla, Airam; Palacios, Basi Martínez; Grande, M; Rodríguez, Ma. Carmen Martín; Álvarez, Hasania Adbel-Hadi; Checa, A. Ambrós; Albaya, Antonio; Obregón, Alberto Silva; Crespo, Carlos Marian; Estrella, Carlos Armendariz; Puncel, Carmen Benito; Oyargue, Eduardo Quirós; Canabal, Alfonso; Marina, Luis María; Toro, Ismael López de; Simón, Almudena Ortiz; Añón, José María; Messa, J. B. López; Pueyo, Ma Jesús López; Echeverri, Ortíz María del valle Sergio Ossa; Ferreras, Zulema; Herráez, Juan Carlos Ballesteros; Macías, Santiago; Berezo, José Ángel; Varela, Jesús Blanco; Schweizer, Pablo Blanco; Salamanca, A González; Lomas, Luis Tamayo; Anzález, Andaluz Ojeda; Avila, Ramón Cicuéndez; Javier, Pérez G. Francisco; Terrero, Antonio Álvarez; Ezpeleta, Fabiola Tena; Sala, Christian; López, Oliverio; Paez, Zulema; García, Alvaro D.; Ule, Demetrio Carriedo; Crespo, Miriam Riesco; Rebolledo, Jesús Pino; Andrés, Nicolás Hidalgo; Zirena, Ana Carolina Caballero; García, Belén Román; Ortiz, María del Valle; Echeverri, Sergio Ossa; Catalán, Rosa Ma; Ferrer, Miquel; Torres, Antoni; Cillóniz, Catia; Ansorregui, Sandra Barbadillo; Cabré, Lluís; Baeza, Ignacio; Rovira, Assumpta; Álvarez-Lerma, Francisco; Vázquez, Antònia; Nolla, J.; Fernández, Francisco Pedro García; Cervelló, Joaquim Ramón; Iglesia, Raquel; Máñez, Rafael; Ballús, J.; Granada, Rosa Ma; Vallès, Jordi; Dı́az, Emili; Ortíz, Marta; Guía, C.; Martín‐Loeches, Ignacio; Páez, Joaquim; Almirall, Jordi; Balanzó, Xavier; Güell, Estel; Yébenes, Juan Carlos; Rello, Jordi; Arnau, Elena; Pérez, Marcos; Laborda, César; Souto, Jesica; Lagunes, Leonel; Catalán, Iñaki; Sirvent, Josep Ma; Arbina, Nerea López de; Serra, Anna Baró; Sánchez, Adriana; Cuenca, Silvia; Badía, Mariona; Baseda-Garrido, Begonia; Valverdú-Vidal, Montserrat; Barcenilla, Fernando Barroso; Palomar, Mercedes; Nuvials, Xavier; Benedicto, Pedro Garrido; Campo, Ferran Roche; Esteban, Mercedes; Luna, J M Rodríguez; Eixarch, Gaspar Masdeu; Diago, Angels Pascual; Nava, Juan Ma; Molina, F.J. González de; Trenado, Josep; Ferrer, Ricard; Josic, Zoran; Ramón, Montserrat Casanovas; Gurri, Francisco; Rodríguez, Paula Campreciós; Rodríguez, Alejandro; Claverías, Laura; Trefler, Sandra; Bodí, M.; Magret, Mónica; Ferri, Cristina; Díaz, Rosa; Mesalles, Eduard; Arméstar, Fernándo; Mendoza, Diego de; Fernández, Carmen Lomas; Berrade, José Julián; Saris, Alfonso Bonet; Pechkova, Marina; Jiménez, Cristina Mora; Gil, Santiago; José, Juliá-Narváez; Marcos, Manuel Robles; Mallqui, Vanessa Farje; Triviño, M; García, Pablo; Fernández-Zapata, Alberto; Recio, Teresa; Arrascaeta, Abilio; García-Ramos, Ma José; Gallego, Elena; Rodrigo, Esther Saiz; Bueno, F. Romero; Díaz, Mercedes; Pérez, Noemí Gil; Hormigo, David López; Delgado, J.; Frutos, Pérez; Pinna, Martina; Cordero, Ma Lourdes; Pastor, José Manuel; Álvarez–Rocha, Luis; Barros, Alexandra Ceniceros; Pedreira, Alejandra Virgós; Vila, Dolores; González, Carmen Fernández; Merayo, Eleuterio; López-Ciudad, Victor Jose; Cañones, Juan Cortes; Vilaboy, Eva; Chao, José Villar; López, Francisco Savira Cid; Vidal, Pablo; Veloso, Marcos A. Pérez; Saborido, Eva Maria; Pardavila, Enrique Alemparte; Montes, Ana Ortega; González, Raul José; Freita, Santiago; Alemparte, Enrique; Ortega, Á Castellanos; López, Ana Marı́a; Canabal, Julio; Ferres, Enrique; Pérez, Javier Blanco; Piquer, M. Ortiz; Ramos, Santiago Freitas; Cendón, Lucas Lage; Casal, Vanesa Gómez; Adrio, Sabela Vara; Fernández, Eva Menor; Prado, Susana González; Franco, Antonio Varela; Monzón, José Luis; Goñi, Félix M.; Sáez, F. del Nogal; Navalpotro, M. Blasco; Abad, Ricardo Díaz; Lasierra, José Luis Flordelís; García-Torrejón, Ma Carmen; Pérez–Calvo, César; López, Diego Pérez; Sánchez‐Alonso, Santiago; Velayos, Carlos; Río, Francisco del; González, Miguel Ángel; Nieto, M.; Cesteros, Carmen Sánchez; Martín, M.C.; Molina, José Ma; Montejo, Juan Carlos; Catalán, M.; Albert, Patricia; Pablo, Ana de; Guerrero, José Eugenio; Zurita, M.E. Miquel; Peyrat, Jaime Benitez; Cámara, Miriam Díaz; Cerdá, Enrique; Álvarez, Manuel; Pey, Carlos; Riestra, Eva Manteiga; Martinez-Fidalgo, Concepción; Rodríguez, Montse; Palencia, Eduardo; Caballero, R. García; Vaquero, Concepción; Mariscal, Francisco; García, Sandra; Cepeda, Rico; Carrasco, Nieves; Prieto, Isidro; Lietor, Aurora; Ramos, Rafael De la Garza; Casas, Rosario Cuadra; Cuesta, Cruz Soriano; Alonso, Susana Sánchez; Galván, Beatríz; Figueira, Juan Carlos; Soriano, M. Cruz; Martín, Bélen Civantos; Caballero, A Robles; Galdos, Pedro; Moreno, Bárbara Balandín; Carmona, Sara Alcántara; Cabo, Fernández del; Hermosa, Cecilia; Gordo, Federico; Algora, A.; Paredes, Amparo; Carmona, T. Grau; Cambroner, J.A.; Ramos, Esther López; Zárate, Yaiza Ortiz de; Gómez-Rosado, Sonia; Lodo, Margarita Mas; Garrobo, N. Franco; Hernández, Silvia Álvarez; Honrubia, Teresa; López, Luis Miguel Prado; Esteban, Andrés; Lorente, José A.; Nín, Nicolás; Sotomayor, Carlos Jaramillo; Arnaiz, Luis; Silvero, Esperanza Molero; Reguera, Eduardo Morales Fdez. de la; Monje, Rosa Ma de la Casa; Serrano, Fátima Martín; Martínez, Ma Victoria Trasmonte; Delgado, Miriam; Martínez, Sofía; Abad, F. Felices; Navalon, Isabel Cremades; Velis, Martín Vigil; Martínez, M.P. Geijo; Baño, Domingo Martínez; Andreu, E; Butí, Sergio Manuel; Rueda, Bernardo Gil; García, Francisco César Becerra; Fernández, Noemí; Para, Luis Herrera; Freire, Alejandro Ortín; Ruiz, M.; Romero, C.; Maraví-Poma, Enrique; Urra, I. Jiménez; Redin, L. Macaya; Tellería, Ana Lucía; Insansti, Josu; Garcia, Noelia Artesero; Macaya, Laura; Palanco, Joaquín Lobo; González, N.; Marco, Pilar; Vidaur, Loreto; Salas, E.; Udabe, Ruth Salaberría; Santamaría, Beatriz; Rodríguez, Tomás Gómez; Vergara, Juan Carlos; Amiano, José Ramón Iruretagoyena; Santos, Iratí Garrido; Manzano, Alberto Blázquez; Arenal, Carlos Castillo; Olaechea, Pedro; Hernández, Higinio Martín; López, Alejandro; Miguel, F. Fonseca San; Blanquer, José; Carbonell, Nieves; Franco, José; Valero, Roberto Reig; Belenger, A.; Altaba, Susana; Álvarez-Sánchez, B.; Robles, José Canovas; Francisco, Jaime Sánchez; Sánchez, Mar Ruiz; Picos, Santiago Alberto; Llanes, Abilio Arrascaeta; Gutiérrez, Eugenio Herrero; Zapata, Alberto Fernández; Sánchez-Miralles, Ángel; Pascual, José L.; Bonastre, Juan; Palamo, M.; Cebrián, Javier; Cuñat, José; Sahuquillo, Mónica Gordón; Romero, Belén; Pallé, S. Borrás; Belmar, Javier de León; Zaragoza, Rafael; Tormo, C.; Chinesta, Susana Sancho; Paricio, Virgilio; Marqués, A. Fe; Sanchez-Morcillo, Silvia; Tormo, S.; Latour, Jos M.; García, Marta; Palomo, Manuel Monescillo; Royo, Francisco Tarín; Hinojosa, Pedro Manzano; Pino, Ma Salomé Sánchez; Ribes, Concha Maragues; Luis, Rubén González; Ribas, Antoli

doi:10.1016/j.jinf.2015.11.007

Cited by 111 publications

(73 citation statements)

References 31 publications

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“…Guervilly et al reported that PCT values were significantly higher in patients with bacterial co‐infections. In addition, PCT has been suggested to exclude bacterial co‐infections in patients with H1N1 infection and to reliably and accurately reduce inappropriate antibiotic exposure . Our results showed that serum PCT levels were significantly higher in patients with bacterial co‐infection compared with those infected with H1N1 alone, confirming that PCT is associated with bacterial co‐infection.…”

Section: Discussionsupporting

confidence: 66%

“…Plasma PCT concentrations are low in healthy individuals and increase during bacterial, parasitic, or fungal infections, whereas they remain at normal levels during viral infections or non‐infectious inflammatory reactions . Studies attempting to assess PCT levels in patients with H1N1 infection have found that PCT helped to distinguish bacterial co‐infections from H1N1 infections alone . Nevertheless, to the best of our knowledge, previous studies published to date have focused on adults and patients with severe disease but have included few pediatric patients with H1N1 infections.…”

Section: Introductionmentioning

confidence: 99%

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Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

et al. 2018

Influenza Resp Viruses

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Objective This study evaluated the diagnostic value of measuring the levels of procalcitonin (PCT) and C‐reactive protein (CRP) to differentiate children co‐infected with H1N1 influenza and bacteria from children infected with H1N1 influenza alone. Methods Consecutive patients (children aged < 5 years) with laboratory‐confirmed H1N1 influenza who were hospitalized or received outpatient care from a tertiary‐care hospital in Canton, China, between January 1, 2012, and September 1, 2017, were included in the present study. Laboratory results, including serum PCT and CRP levels, white blood cell (WBC) counts, and bacterial cultures, were analyzed. The predictive value of the combination of biomarkers versus any of the biomarkers alone for diagnosing bacterial co‐infections was evaluated using logistic regression analyses. Results Significantly higher PCT (1.46 vs 0.21 ng/mL, P < 0.001) and CRP (19.20 vs 5.10 mg/dL, P < 0.001) levels were detected in the bacterial co‐infection group than in the H1N1 infection‐alone group. Using PCT or CRP levels alone, the areas under the curves (AUCs) for predicting bacterial co‐infections were 0.801 (95% CI, 0.772‐0.855) and 0.762 (95% CI, 0.722‐0.803), respectively. Using a combination of PCT and CRP, the logistic regression‐based model, Logit( P ) = −1.912 + 0.546 PCT + 0.087 CRP, showed significantly greater accuracy (AUC: 0.893, 95% CI: 0.842‐0.934) than did the other three biomarkers. Conclusions The combination of PCT and CRP levels could provide a useful method of distinguishing bacterial co‐infections from an H1N1 influenza infection alone in children during the early disease phase. After further validation, the flexible model derived here could assist clinicians in decision‐making processes.

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Section: Discussionsupporting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

et al. 2018

Influenza Resp Viruses

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“…However, recently this was disputed when a study of 972 patients with H1N1 found that a cut off PCT of <0.29 ng/mL in a population with a 20% prevalence of community acquired respiratory coinfection has a high negative predictive value of 92%. PCT, therefor, appears to be effective at excluding co-infection in this group of patients (47). That said, it is important to interpret biomarker results cautiously and to correlate the results with clinical findings.…”

Section: Signalling or Functioning Are Biomarkers Good Surrogates Fomentioning

confidence: 92%

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

Morley¹,

Torres²,

Cillóniz³

et al. 2017

Ann. Transl. Med.

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Community acquired pneumonia (CAP) is the leading infectious cause of mortality worldwide with approximately 10% of patients hospitalized requiring intensive care unit (ICU) admission. The ability to predict clinical stability (CS) and treatment failure (TF) enables the clinician to alter antibiotics appropriately, facilitate a timely ICU admission, or arrange a suitable discharge. The detection of CS and TF can be difficult and changes in clinical signs may be subtle or delayed. Thus clinical scores and biomarkers are routinely used to identify severity and monitor clinical progression. The evidence, however, is vast and the definitive role of these systems is at times difficult to elucidate. The aim of this review is to analyse the current literature and to provide a rational and clinically focused view of the predictive utility of various systems used to identify CS and TF in CAP.

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“…These technologies are still promising but not fully validated yet. Another promising area of research is the right use of biomarkers [6] in either decision-based algorithms like CHAID (Chi-squared Automatic Interaction Detection) [7] or biomarker combinations to increase diagnostic accuracy [8].An important "My paper 10 years later" described the trends in infective endocarditis in the ICU [9]. The authors pointed to sustained high mortality rates in patients with infective endocarditis, rates that may exceed 60 % mortality in ICU.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Focus on infection and sepsis in intensive care patients

Martín‐Loeches

Perner

2016

Intensive Care Med

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Over the last year, several papers have shed light on the management of severe infections and sepsis in intensive care units (ICU). With this overview, we will highlight the important new findings with a focus on infectious disease and sepsis in critically ill patients.The concept of healthcare-associated pneumonia (HCAP) tried to highlight the increasing prevalence of multidrug-resistant pathogens [1]. The majority of the studies have been conducted outside Europe. Vallés et al. conducted a prospective, multicentre study in Spain [2] in which the etiology of community-acquired pneumonia (CAP) and HCAP was comparable, as S. pneumoniae was the most frequently found pathogen. Therefore, based on this European study, empirical antibiotic therapy recommended for CAP would be appropriate for 90 % of patients with HCAP, at least in that population, and clearly differs from experiences in countries with higher rates of resistant pathogens.One important element over the last year in infectious diseases in critically ill patients has been the development of both less invasive and more sensitive diagnostic techniques in pneumonia [3]. A "What's new in intensive care" paper highlighted the innovative technologies that could result in a more timely recognition of respiratory infections [4] in critically ill patients through the detection of bacterial colonization (colorimetric endotracheal tubes) and the interaction between bacterial growth and host response (exhaled breath analysis) [5]. These technologies are still promising but not fully validated yet. Another promising area of research is the right use of biomarkers [6] in either decision-based algorithms like CHAID (Chi-squared Automatic Interaction Detection) [7] or biomarker combinations to increase diagnostic accuracy [8].An important "My paper 10 years later" described the trends in infective endocarditis in the ICU [9]. The authors pointed to sustained high mortality rates in patients with infective endocarditis, rates that may exceed 60 % mortality in ICU. They suggested a standardized approach to bacteriological testing including broad-range polymerase chain reaction (PCR) because of the high rates of culture-negative bacteraemia. SeptiFast is the first real-time PCR-based system and, to date, the most intensively investigated in clinical cohort studies. To this end, two papers have provided evidence regarding the new rapid diagnostic tests in bacteraemia. Warhurst et al.[10] conducted a phase III prospective multicentre diagnostic accuracy study of SeptiFast against microbiological culture in critical care settings. SeptiFast had a significantly greater specificity (0.86) than sensitivity (0.50) for bacteraemia. The most interesting finding was that despite the potential benefit of such a technique, there was a low prevalence of blood cultureproven pathogens (9.2 %), acknowledging the potential limitations of this technology in diagnosing bloodstream infection when compared with bloodstream infection at the species/genus level. An updated systematic review and ...

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Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Abstract: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.

Cited by 111 publications

References 31 publications

Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

Combination of procalcitonin and C‐reactive protein levels in the early diagnosis of bacterial co‐infections in children with H1N1 influenza

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

Focus on infection and sepsis in intensive care patients

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