Utilidad de la procalcitonina y proteína C reactiva para predecir bacteriemia en las infecciones del tracto urinario en el servicio de urgencias

Julián-Jiménez, Agustín; Gutiérrez-Martín, P.; Lizcano-Lizcano, A.; López-Guerrero, M.; Barroso-Manso, Á.; Heredero-Gálvez, Eva

doi:10.1016/j.acuro.2015.03.003

Cited by 23 publications

(25 citation statements)

References 26 publications

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“…Several new publications have focused on the utility of PCT in urinary tract infection (UTI) with or without sepsis [44–46]. A threshold of 1.16 ng/ml was proposed by Julian-Jemenez et al [44] as having the largest area under the receiver operating characteristic curve at 0.993 and therefore the most relevant in guiding medical decision-making [44].…”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

240

181

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Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

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Section: Introductionmentioning

confidence: 99%

“…A threshold of 1.16 ng/ml was proposed by Julian-Jemenez et al [44] as having the largest area under the receiver operating characteristic curve at 0.993 and therefore the most relevant in guiding medical decision-making [44]. The utility of PCT in this setting was also investigated in a Swiss RCT [47].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

240

181

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“…Clinically, the combination of the C-reactive protein level and white blood cell count is commonly used as a basis for determining infection ( Julian-Jimenez et al, 2015 ; Leli et al, 2014 ; Liu et al, 2017 ; Ljungstrom et al, 2017 ), although there is a lack of solid evidence. C-reactive protein is a marker of acute inflammation and is associated with non-specific inflammatory responses by the human body to infection or trauma.…”

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

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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.

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“…En nuestra experiencia durante años, tras el análisis del rendimiento de los hemocultivos indicados en nuestro SU y la búsqueda de herramientas objetivas que nos puedan ayudar a mejorar la sospecha de bacteriemia 8,9 , hemos incluido además de las variables indicadas por Cuervo et al 1 , otros datos analíticos (como el lactato y la procalcitonina) y la situación clínica del paciente con sospecha de bacteriemia (de acuerdo con los criterios clásicos de sepsis, sepsis grave y shock séptico), ya que la posibilidad de bacteriemia aumenta según lo hace la gravedad clínica 4 . De forma que, inicialmente para las neumonías y las infecciones del tracto urinario (también en nuestro entorno las dos causas más frecuentes de bacteriemia y sepsis grave) 8,9 , y posteriormente para todos los pacientes con infección, hemos adaptado a nuestro SU las recomendaciones publicadas en la revista de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) 6 (Tabla 1).…”

Section: Importancia De La Predicción De Bacteriemia En Los Serviciosunclassified

“…De forma que, inicialmente para las neumonías y las infecciones del tracto urinario (también en nuestro entorno las dos causas más frecuentes de bacteriemia y sepsis grave) 8,9 , y posteriormente para todos los pacientes con infección, hemos adaptado a nuestro SU las recomendaciones publicadas en la revista de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC) 6 (Tabla 1). Por otro lado, en numerosos SU ya se ha implantado el "código sepsis (CS)" (iniciativa española a la que se han sumado múltiples Sociedades Científicas Internacionales, entre ellas la Sociedades Chilenas de Medicina Intensiva y la de Medicina de Urgencias y, esperamos que también pronto, la Sociedad Chilena de Infectología).…”

Section: Importancia De La Predicción De Bacteriemia En Los Serviciosunclassified

Importancia de la predicción de bacteriemia en los servicios de urgencias

Julián-Jiménez

2016

Rev. chil. infectol.

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Utilidad de la procalcitonina y proteína C reactiva para predecir bacteriemia en las infecciones del tracto urinario en el servicio de urgencias

Cited by 23 publications

References 26 publications

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

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

Importancia de la predicción de bacteriemia en los servicios de urgencias

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