Role of Procalcitonin in Predicting Mortality and Organ Dysfunction at Intensive Care Admission

Suranadi, I Wayan; Sinardja, Cynthia Dewi; Suryadi, Iwan Antara

doi:10.2147/ijgm.s362558

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…One study excluded patients under mechanical ventilation, [ 55 ] and two excluded patients using vasopressors [ 32 , 55 ]. Only three studies reported the use of empirical antibiotics, being in both cases used in more than 90% of patients [ 48 , 54 , 65 ].…”

Section: Resultsmentioning

confidence: 99%

Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis

Molano-Franco,

Arevalo-Rodriguez,

Muriel

et al. 2023

Diagn Progn Res

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Background Numerous biomarkers have been proposed for diagnosis, therapeutic, and prognosis in sepsis. Previous evaluations of the value of biomarkers for predicting mortality due to this life-threatening condition fail to address the complexity of this condition and the risk of bias associated with prognostic studies. We evaluate the predictive performance of four of these biomarkers in the prognosis of mortality through a methodologically sound evaluation. Methods We conducted a systematic review a systematic review and meta-analysis to determine, in critically ill adults with sepsis, whether procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6), and presepsin (sCD14) are independent prognostic factors for mortality. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to March 2023. Only Phase-2 confirmatory prognostic factor studies among critically ill septic adults were included. Random effects meta-analyses pooled the prognostic association estimates. Results We included 60 studies (15,681 patients) with 99 biomarker assessments. Quality of the statistical analysis and reporting domains using the QUIPS tool showed high risk of bias in > 60% assessments. The biomarker measurement as a continuous variable in models adjusted by key covariates (age and severity score) for predicting mortality at 28–30 days showed a null or near to null association for basal PCT (pooled OR = 0.99, 95% CI = 0.99–1.003), CRP (OR = 1.01, 95% CI = 0.87 to 1.17), and IL-6 (OR = 1.02, 95% CI = 1.01–1.03) and sCD14 (pooled HR = 1.003, 95% CI = 1.000 to 1.006). Additional meta-analyses accounting for other prognostic covariates had similarly null findings. Conclusion Baseline, isolated measurement of PCT, CRP, IL-6, and sCD14 has not been shown to help predict mortality in critically ill patients with sepsis. The role of these biomarkers should be evaluated in new studies where the patient selection would be standardized and the measurement of biomarker results. Trial registration PROSPERO (CRD42019128790).

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Section: Resultsmentioning

confidence: 99%

Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis

Molano-Franco,

Arevalo-Rodriguez,

Muriel

et al. 2023

Diagn Progn Res

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“…( 34PCT levels correlate with mortality when the value rises above 7 ng/ml . Even though the (35) PCT value could be useful for reducing antibiotic duration in selected cases, PCT as a single test is not reliable for predicting sepsis in ICU patients and should not be used to start antimicrobials.…”

Section: Pct In Sepsismentioning

confidence: 99%

The Role of Biomarkers in Distinguishing Infectious From Non-Infectious Diseases

Melinte,

Radu,

Văcăroiu

et al. 2023

Internal Medicine

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Background. The use of C-reactive protein (CRP) and procalcitonin (PCT) as guiding biomarkers in treating severe infections could improve the use of antibiotics. Biomarker dynamics are more reliable than single values in predicting sepsis when making the diagnosis and evaluating the response to antibiotic therapy. Both CRP and PCT used protocols have to be consistent with the clinical context and patient populations. Objectives: reviewing the use of PCT and CRP in various clinical contexts and the patient population Sources. We analyzed the most recent studies of these biomarkers for antimicrobial stewardship, including meta-analyses and original trials. Content. According to several studies, critically ill patients who get antibiotic treatment under the guidance of CRP and PCT see a decrease in antibiotic exposure and related adverse effects. When patients are hospitalized in intensive care units (ICUs), CRP and PCT can be used to distinguish between viral and non-infectious causes of systemic inflammation. In septic patients, CRP levels are reliable to show a high negative predictive value (NPV), especially on day 1 of ICU admission. Consequently, CRP levels decrease during therapy with appropriate antibiotics in the next 3 days. Implication. In addition to other clinical and laboratory parameters, CRP and PCT provide information about the risk of the bacterial infection worsening or improving under appropriate treatment. These improve antibiotic treatment decisions, allowing individualized treatment regimens with reduced overall antibiotic exposure.

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“…12–14 Other authors have disputed the use of PCT as a diagnostic instrument or to begin the antibiotic therapy, but they support the use of PCT in the decision of stopping the antibiotics, 15 as well as in the prognosis of sepsis. 16–18 …”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14] Other authors have disputed the use of PCT as a diagnostic instrument or to begin the antibiotic therapy, but they support the use of PCT in the decision of stopping the antibiotics, 15 as well as in the prognosis of sepsis. [16][17][18] CRP is an acute-phase protein, synthesized by the liver, following the activation of IL-6 during inflammation, 19 and has also been studied as an inflammatory biomarker in sepsis. A multitude of different opinions exist regarding the use of CRP in sepsis.…”

Section: Introductionmentioning

confidence: 99%

The Contribution of Procalcitonin, C-Reactive Protein and Interleukin-6 in the Diagnosis and Prognosis of Surgical Sepsis: An Observational and Statistical Study

Țocu¹,

Mihailov²,

Socolovschi³

et al. 2023

JMDH

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Background Sepsis affects over 30 million people worldwide each year, causing approximately 6 million deaths. Challenges in clinical diagnosis and the need for an early diagnosis to prevent mortality due to sepsis have led to dependence on inflammatory biomarkers like Procalcitonin (PCT), C-reactive protein (CRP), and Interleukin-6 (IL-6). Objective This study was performed to observe the contribution of inflammatory biomarkers in the diagnosis and prognosis of patients with surgical sepsis. Methods We performed a retrospective observational study in a Clinical Emergency Hospital, which included a number of 125 patients with surgical sepsis admitted between January 2020 and December 2021. The patients were included in the study based on the Sepsis-3 definition. PCT, CRP, IL-6, Sepsis-related Organ Failure Assessment (SOFA) score, Charlson Comorbidity Index (CCI), the time up to surgery, the days of treatment in Intensive Care Unit (ICU) and the total days of hospitalization had been statistically analyzed. Results The mean age of all patients was 65.14 years. The mean value in all patients for PCT was 20.08 ng/mL, for CRP was 175.42 mg/l, and for IL-6 was 799.6 pg/mL. The strongest correlation between biomarkers was between CRP and IL-6 (r = 0.425; p < 0.0001). Of all biomarkers, the CRP correlated the strongest with patient outcomes (r = 0.544; p < 0.0001). The area under curve (AUC) for the mean values of the inflammatory biomarkers was calculated and the best diagnostic performance was for CRP with 0.816 (95% CI: 0.744–0.887). Conclusion CRP and IL-6 were the most efficient in sepsis diagnosis. The association of PCT, CRP and IL-6 has increased the range of certainty in sepsis diagnosis. CRP was the most efficient biomarker in the prognosis of sepsis.

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Role of Procalcitonin in Predicting Mortality and Organ Dysfunction at Intensive Care Admission

Cited by 4 publications

References 13 publications

Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis

Basal procalcitonin, C-reactive protein, interleukin-6, and presepsin for prediction of mortality in critically ill septic patients: a systematic review and meta-analysis

The Role of Biomarkers in Distinguishing Infectious From Non-Infectious Diseases

The Contribution of Procalcitonin, C-Reactive Protein and Interleukin-6 in the Diagnosis and Prognosis of Surgical Sepsis: An Observational and Statistical Study

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