Serum Inflammatory Markers in the Elderly: Are They Useful in Differentiating Sepsis from SIRS?

  • Mahshid Talebi-Taher Mail Department of Geriatric Medicine, Antimicrobial-Resistant Research Center, Iran University of Medical Sciences, Tehran, Iran. .
  • Shahin Babazadeh Department of Internal Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
  • Mitra Barati Department of Pediatrics, Pediatric Infectious Diseases Research Center, AND Iran University of Medical Sciences, Tehran, Iran.
  • Maryam Latifnia Department of Internal Medicine, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Sepsis, C-reactive protein, ESR, PCT, IL-6


Differentiating sepsis from other noninfectious causes of systemic inflammation is often difficult in the elderly. The aim of this study was to evaluate the ability of C-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), procalcitonin (PCT), and Interleukin-6 (IL-6) to identify elderly patients with sepsis. In this single center prospective observational study, we included all consecutive elderly patients admitted with suspected sepsis and systemic inflammatory response syndrome (SIRS) in an emergency department. Blood samples for measuring CRP, PCT, IL-6, ESR and white blood cells (WBC) count were taken at first day of admission. Sensitivity, specificity, positive and negative predictive values were calculated for each inflammatory markers being studied. A total of 150 elderly patients aged 65 and older, 50 with sepsis and 50 with SIRS, and fifty individuals in a normal health status were included. CRP exhibited the greatest sensitivity (98%) and negative predictive value (98.6%) and performed best in differentiating patients with sepsis from those with SIRS. In a receiver operating characteristic curve analysis, IL-6 performed best in distinguishing between SIRS and the control group (AUC 0.75, 95% CI). On the other hand, both CRP and ESR appeared to be a more accurate diagnostic parameter for differentiating sepsis from SIRS among elderly patients.


Bossink AW, Groeneveld AB, Thijs LG. Prediction of microbial infection and mortality in medical patients with fever: plasma procalcitonin, neutrophilic elastase-alpha1- antitrypsin, and lactoferrin compared with clinical variables. Clin Infect Dis 1999;29(2):398-407.

Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341(8844):515-8.

Christ-Crain M, Muller B. Procalcitonin in bacterial infections--hype, hope, more or less? Swiss Med Wkly 2005;135(31-32):451-60.

Giamarellos-Bourboulis EJ, Giannopoulou P, Grecka P, et al. Should procalcitonin be introduced in the diagnostic criteria for the systemic inflammatory response syndrome and sepsis? J Crit Care 2004;19(3):152-7.

Harbarth S, Holeckova K, Froidevaux C, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164(3):396-402.

Lai CC, Chen SY, Wang CY, et al. Diagnostic value of procalcitonin for bacterial infection in elderly patients in the emergency department. J Am Geriatr Soc 2010;58(3):518-22.

Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003;29(4):530-8.

Dwolatzky T, Olshtain-Pops K, Yinnon AM, et al. Procalcitonin in the elderly: normal plasma concentrations and response to bacterial infections. Eur J Clin Microbiol Infect Dis 2005;24(11):763-5.

Dinant GJ, Knottnerus JA, Van Wersch JW. Discriminating ability of the erythrocyte sedimentation rate: a prospective study in general practice. Br J Gen Pract 1991;41(350):365-70.

Reinhart WH. Erythrocyte sedimentation rate--more than an old fashion? Ther Umsch 2006;63(1):108-12.

Ugarte H, Silva E, Mercan D, et al. Procalcitonin used as amarker of infection in the intensive care unit. Crit Care Med 1999;27(3):498-504.

Cicarelli DD, Vieira JE, Bensenor FE. Comparison of Creactive protein and serum amyloid a protein in septic shock patients. Mediators Inflamm 2008;2008:631414.

Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterialinfection: a systematic review and meta-analysis. Clin Infect Dis 2004;39(2):206-17.

Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med 1999;340(6):448-54.

Keshet R, Boursi B, Maoz R, et al. Diagnostic and prognostic significance of serum C-reactive protein levels in patients admitted to the department of medicine. Am J Med Sci 2009;337(4):248-55.

Sierra R, Rello J, Bailen MA, et al. C-reactive protein used as an early indicator of infection in patients with systemic inflammatory response syndrome. Intensive Care Med 2004;30(11):2038-45.

Wener MH, Daum PR, McQuillan GM. The influence of age, sex, and race on the upper reference limit of serum Creactive protein concentration. J Rheumatol 2000;27(10):2351-9.

Cheval C, Timsit JF, Garrouste-Orgeas M, et al. Procalcitonin (PCT) is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients. Intensive Care Med 2000;26(Suppl 2):S153-8.

Muller B, Becker KL, Schachinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28(4):977-83.

Selberg O, Hecker H, Martin M, et al. Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6. Crit Care Med 2000;28(8):2793-8.

Arkader R, Troster EJ, Lopes MR, et al. Procalcitonin doesdiscriminate between sepsis and systemic inflammatory response syndrome. Arch Dis Child 2006;91(2):117-20.

Meynaar IA, Droog W, Batstra M, et al. In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between Sepsis and SIRS than CRP, Il-6, or LBP. Crit Care Res Pract 2011;2011(1):594645.

Chan YL, Tseng CP, Tsay PK, et al. Procalcitonin as a marker of bacterial infection in the emergency department: an observational study. Crit Care 2004;8(1):R12-20.

Gaini S, Koldkjaer OG, Pedersen C, et al. Procalcitonin, lipopolysaccharide-binding protein, interleukin-6 and Creactive protein in community-acquired infections and sepsis: a prospective study. Crit Care 2006;10(2):R53.

25. Stucker F, Herrmann F, Graf JD, et al. Procalcitonin and infection in elderly patients. J Am Geriatr Soc 2005;53(8):1392-5.

Balc IC, Sungurtekin H, Gurses E, et al. Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 2003;7(1):85-90.

Aikawa N, Fujishima S, Endo S, et al. Multicenter prospective study of procalcitonin as an indicator of sepsis. J Infect Chemother 2005;11(3):152-9.

Sudhir U, Venkatachalaiah RK, Kumar TA, et al. Significance of serum procalcitonin in sepsis. Indian J Crit Care Med 2011;15(1):1-5.

Uusitalo-Seppala R, Koskinen P, Leino A, et al. Early detection of severe sepsis in the emergency room: diagnostic value of plasma C-reactive protein, procalcitonin, and interleukin-6. Scand J Infect Dis 2011;43(11-12):883-90.

Caterino JM, Scheatzle MD, Forbes ML, et al. Bacteremic elder emergency department patients: procalcitonin and white count. Acad Emerg Med 2004;11(4):393-6.

How to Cite
Talebi-Taher M, Babazadeh S, Barati M, Latifnia M. Serum Inflammatory Markers in the Elderly: Are They Useful in Differentiating Sepsis from SIRS?. Acta Med Iran. 52(6):438-442.