Evaluation of Serum Procalcitonin in Patients with Systemic Inflammatory Response Syndrome with and without Infection
-
Zahra Ahmadinejad
,
Banafshe Dadsetan
,
Mohammad Jalili
,
Abdolreza Soudbakhsh
,
Mehrnaz Rasolinejad
Abstract
Procalcitonin (PCT) is a precursor peptide for the hormone calcitonin and is frequently increased in overt sepsis. The aim of this study was to test diagnostic accuracy of procalcitonin among patients with positive systemic inflammatory response syndrome (SIRS) in identifying sepsis. In this cross sectional study, from 563 patients with positive SIRS admitted through the emergency department of a university hospital, we included 120 patients. Procalcitonin was measured semi-quantitatively. Two groups of patients (with and without infection) were defined based on clinical, laboratory and bacteriologic findings throughout the admission course; the serum PCT levels were compared between the two groups. Seventy two (60%) patients were male and 48 (40%) were female, and the mean age was 49.1 ± 20.2years. Final diagnosis was infection in 71 patients (59.2%) and 49 (40.8%) had non-infectious SIRS. When considering PCT > 0.5 μg/L as the cut-off point, PCT had a sensitivity of 88.7%, a specificity of 77.6%, a positive predictive value of 85.1% and a negative predictive value of 82.6%. Serum level of procalcitoninin infectious group was significantly higher than in non-infectious group (P < 0.0001). PCT level was a predictor of mortality in patients with infectious SIRS. (P = 0.01) In summary, PCT is a useful marker for differentiating sepsis from other cause of SIRS. With change in the cut-off value of PCT in any situation its application can be maximized. Procalcitonin can also be a good marker for predicting outcome in patients with infection.
Alberti C, Brun-Buisson C, Goodman SV, Guidici D, Granton J, Moreno R, et al; European Sepsis Group. Influence of systemic inflammatory response syndrome and sepsis on outcome of critically ill infected patients. Am J Respir Crit Care Med 2003;168(1):77-84.
Ueda S, Nishio K, Minamino N, Kubo A, Akai Y, Kangawa K, et al. Increased plasma levels of adrenomedullin in patients with systemic inflammatory response syndrome. Am J Respir Crit Care Med 1999;160(1):132-6.
Kofoed K, Andersen O, Kronborg G, Tvede M, Petersen J, Eugen-Olsen J, et al. Use of plasma C-reactive protein, procalcitonin,neutrophils, macrophage migration inhibitory factor, soluble urokinase-type plasminogen activator receptor, and soluble triggering receptor expressed on myeloid cells-1 in combination to diagnose infections: a prospective study. Crit Care 2007;11(2):R38.
Christ-Crain M, Müller B. Procalcitonin in bacterial infections: hype, hope, more or less? Swiss Med Wkly2005;135(31-32):451-60.
Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B. Serum procalcitonin measurement as diagnosticand prognostic marker in febrile adult patients presenting to the emergency department. Crit Care 2007;11(3):R60.
Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al; Geneva Sepsis Network. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am JRespir Crit Care Med 2001;164(3):396-402.
Becker KL, Nylén ES, White JC, Müller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89(4):1512-25.
Whang KT, Steinwald PM, White JC, Nylen ES, Snider RH,Simon GL, et al. Serum calcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab1998;83(9):3296-301.
Preas HL 2nd, Nylen ES, Snider RH, Becker KL, White JC, Agosti JM, et al. Effects of anti-inflammatory agents on serum levels of calcitonin precursors during human experimentalendotoxemia. J Infect Dis 2001;184(3):373-6.
Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007;7:10.
Sponholz C, Sakr Y, Reinhart K, Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Crit Care 2006;10(5):R145.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al, Early Goal-Directed Therapy Collaborative Group. Early goal-directed therapy in the treatment ofsevere sepsis and septic shock. N Engl J Med 2001;345(19):1368-77.
Müller B, Christ-Crain M, Schuetz P. Meta-analysis of procalcitonin for sepsis detection. Lancet Infect Dis 2007;7(8):498-9.
Schuetz P, Christ-Crain M, Wolbers M, Schild U, Thomann R, Falconnier C, et al; ProHOSP study group. Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial. BMC Health Serv Res 2007;7:102.
Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Müller C, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin- guidance with standard therapy. Chest 2007;131(1):9-19.
Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitoninguided treatment on antibiotic use and outcome in lowerrespiratory tract infections: cluster-randomised, singleblinded intervention trial. Lancet 2004;363(9409):600-7.
Christ-Crain M, Stolz D, Bingisser R, Müller C, MiedingerD, Huber PR, et al. Procalcitonin guidance of antibiotictherapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174(1):84-93.
López Sastre JB, Pérez Solís D, Roqués Serradilla V,Fernández Colomer B, Coto Cotallo GD, Krauel Vidal X, et al; Grupo de Hospitales Castrillo. Procalcitonin is not sufficiently reliable to be the sole marker of neonatal sepsis of nosocomial origin. BMC Pediatr 2006;6:16.
Prat C, Domínguez J, Rodrigo C, Giménez M, Azuara M, Blanco S, et al. Use of quantitative and semiquantitative procalcitonin measurements to identify children with sepsisand meningitis. Eur J Clin Microbiol Infect Dis 2004;23(2):136-8.
Chirouze C, Schuhmacher H, Rabaud C, Gil H, Khayat N, Estavoyer JM, et al. Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever. Clin Infect Dis 2002;35(2):156-61.
Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis2007;7(3):210-7.
Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA. Procalcitonin test in the diagnosis of bacteremia: a metaanalysis. Ann Emerg Med 2007;50(1):34-41.
van Rossum AM, Wulkan RW, Oudesluys-Murphy AM.Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis 2004;4(10):620-30.
Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics 2003;112(5):1054-60.
Fernández Lopez A, Luaces Cubells C, García García JJ, Fernández Pou J; Spanish Society of Pediatric Emergencies. Procalcitonin in pediatric emergency departments for the early diagnosis of invasive bacterial infections in febrile infants: results of a multicenter study and utility of a rapid qualitative test for this marker. Pediatr Infect Dis J 2003;22(10):895-903.
| Files | ||
| Issue | Vol 47, No 5 (2009) | |
| Section | Original Article(s) | |
| Keywords | ||
| Systemic inflammatory response syndrome sepsis procalcitonin emergency department | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
