Prognostic value of PCT in septic emergency patients

Peschanski, Nicolas; Chenevier‐Gobeaux, Camille; Mzabi, Lynda; Lucas, Rémy; Ouahabi, S.; Aquilina, Vianney; Brunel, Valéry; Lefèvre, Guillaume; Ray, Patrick

doi:10.1186/s13613-016-0146-4

Cited by 14 publications

(23 citation statements)

References 24 publications

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“…In patients with stopping advice, this occurred only in 42.3% (11/26). These results are in line with previous studies which showed that high PCT levels are associated with an unfavourable outcome [ 27 , 28 ]. Furthermore, a not adequately declining PCT is an independent predictor of mortality in septic patients [ 29 , 30 ].…”

Section: Discussionsupporting

confidence: 93%

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Höhn

Balfer

Heising

et al. 2018

Ann. Intensive Care

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BackgroundIn randomised controlled trials, procalcitonin (PCT)-guided antibiotic treatment has been proven to significantly reduce length of antibiotic therapy in intensive care unit (ICU) patients. However, concern was raised on low protocol adherence and high rates of overruling, and thus the value of PCT-guided treatment in real clinical life outside study conditions remains unclear. In this study, adherence to a PCT protocol to guide antibiotic treatment in patients with severe sepsis and septic shock was analysed.MethodsFrom 2012 to 2014, surgical ICU patients with severe sepsis or septic shock were retrospectively screened for PCT measurement series appropriate to make treatment decisions on antibiotic therapy. We compared (1) patients with appropriate PCT measurement series to patients without appropriate series; (2) patients who reached the antibiotic stopping advice threshold (PCT < 0.5 ng/mL and/or decrease to 10% of peak level) to patients who did not reach a stopping advice threshold; and (3) patients who were treated adherently to the PCT protocol to non-adherently treated patients. The groups were compared in terms of antibiotic treatment duration, PCT kinetics, and other clinical outcomes.ResultsOf 81 patients with severe sepsis or septic shock, 14 were excluded due to treatment restriction or short course in the ICU. The final analysis was performed on 67 patients. Forty-two patients (62.7%) had appropriate PCT measurement series. In patients with appropriate PCT series, median initial PCT (p = 0.001) and peak PCT levels (p < 0.001) were significantly higher compared to those with non-appropriate series. In 26 patients with appropriate series, PCT levels reached an antibiotic stopping advice. In 8 of 26 patients with stopping advice, antibiotics were discontinued adherently to the PCT protocol (30.8%). Patients with adherently discontinued antibiotics had a shorter antibiotic treatment (7d [IQR 6–9] vs. 12d [IQR 9–16]; p = 0.002). No differences were seen in terms of other clinical outcomes.ConclusionIn patients with severe sepsis and septic shock, procalcitonin testing was irregular and adherence to a local PCT protocol was low in real clinical life. However, adherently treated patients had a shorter duration of antibiotic treatment without negative clinical outcomes. Procalcitonin peak values and kinetics had a clear impact on the regularity of PCT testing.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0415-5) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 93%

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Höhn

Balfer

Heising

et al. 2018

Ann. Intensive Care

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“…Peschanski et al . found that PCT levels at admission were moderately accurate in identifying the outcome in septic patients, with 51% sensitivity and an AUC of 0.6737. Additionally, a recent meta-analysis showed that the commonly used cut-off for PCT of 0.5 ng/mL only had a sensitivity of 44% to identify patients with pneumonia who have a high risk of death38.…”

Section: Discussionmentioning

confidence: 99%

Serum soluble urokinase-type plasminogen activator receptor as a biological marker of bacterial infection in adults: a systematic review and meta-analysis

Han

Zhao

et al. 2016

Sci Rep

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The serum concentration of soluble urokinase-type plasminogen activator receptor (suPAR) reflects immune activation. We performed a meta-analysis to evaluate the usefulness of suPAR for the diagnosis and prognosis of bacterial infections. PubMed, Embase and Cochrane Library databases were searched for studies reporting the detection of suPAR in adult patients with bacterial infections. Seventeen studies were selected from 671 studies. The pooled sensitivity and specificity of suPAR for diagnosing infection were 0.73 and 0.79, respectively, and the area under the summary receiver operating characteristic curve (AUC) was 0.82. Subgroup analyses revealed suPAR showed similar AUC values for diagnosing sepsis and bacteremia, but the AUC for differentiating sepsis from systemic inflammatory response syndrome (SIRS) was only 0.68. Elevated suPAR levels were significantly associated with a high risk of death, with a pooled risk ratio of 3.37 (95% confidence interval, 2.60–4.38). The pooled sensitivity and specificity for predicting mortality were 0.70 and 0.72, respectivfely, with an AUC of 0.77. Serum suPAR could be a biomarker for the diagnosis and prognosis of bacterial infection, but it is relatively ineffective for differentiating sepsis from SIRS. Further investigation is required to evaluate whether using of suPAR in combination with other biomarkers can improve diagnostic efficacy.

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“…The studies included in this review were published from 2009 to 2019, with most of the studies being published after 2014 (90%). The following 10 studies were included in the review: Nargis et al [14], Mustafić et al [15], Cui et al [16], Lipińska-Gediga et al [17], Shokouhi et al [18], Ryoo et al [19], Peschanski et al [20], Demirdal et al [21], Tsangaris et al [22], and Yu et al [23]. Among the 10 studies, six were conducted in Asia [16,18,20,21,23] and four were conducted in Europe [15,17,20,22].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

The Advancement in Detecting Sepsis and Its Outcome: Usefulness of Procalcitonin in Diagnosing Sepsis and Predicting Fatal Outcomes in Patients Admitted to Intensive Care Unit

Malik¹,

Nair²,

Illango³

et al. 2021

Cureus

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Sepsis still remains a big challenge in patients admitted to intensive care units (ICUs) despite stellar advances made in the field of medicine. We can achieve better clinical outcomes in patients by diagnosing sepsis earlier. Procalcitonin (PCT), an inflammatory biomarker, has shown promising results in this regard. Therefore, this systematic review was done to assess the use of PCT in diagnosing and predicting severe outcomes in patients admitted to ICU and to assess if introducing PCT as a routine biochemical tool in hospitals would be helpful to achieve better clinical course in ICU patients.To identify relevant articles, we searched PubMed, Google Scholar, and references of included articles. Eligible studies were identified by two investigators independently and data were extracted. Original articles that evaluated the diagnostic and prognostic value of serum PCT levels in predicting sepsis, the severity of sepsis, and mortality among adult patients admitted to ICU were included in this study. A total of 2,063 citations were identified by the search, among which 10 studies (five prospective cohort, three retrospective cohort, one cross-sectional, and one case-control study) met the inclusion criteria. Most studies showed moderate-to-low risk of bias which was evaluated using the Quality in Prognosis Studies tool. All studies showed a positive correlation between initial PCT levels and detecting mortality resulting from sepsis, six studies found PCT helpful in detecting sepsis, and four studies evaluated the role of PCT in detecting severity in patients with sepsis. One study found area under the curve of serum PCT level for predicting 28day mortality to be 0.82 (95% confidence interval [CI]: 0.70-0.94; p < 0.001) in adults and 0.83 (95% CI: 0.73-0.92; p < 0.001) in the elderly having an optimal cut-off level of serum PCT of 0.2 ng/mL in both the adult and elderly groups, with a sensitivity of 81 and 75% and specificity of 81.7 and 80.4%, respectively.PCT has shown promising results in detecting sepsis and its clinical course. For early diagnosis and management of sepsis, severe sepsis, and mortality in patients admitted to the ICU for a more favorable clinical outcome, PCT can be used.

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Prognostic value of PCT in septic emergency patients

Cited by 14 publications

References 24 publications

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Adherence to a procalcitonin-guided antibiotic treatment protocol in patients with severe sepsis and septic shock

Serum soluble urokinase-type plasminogen activator receptor as a biological marker of bacterial infection in adults: a systematic review and meta-analysis

The Advancement in Detecting Sepsis and Its Outcome: Usefulness of Procalcitonin in Diagnosing Sepsis and Predicting Fatal Outcomes in Patients Admitted to Intensive Care Unit

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