Comparison of diagnostic accuracy among procalcitonin, C-reactive protein, and interleukin 6 for blood culture positivity in general ICU patients

Wu, Qin; Yang, Hao; Kang, Yan

doi:10.1186/s13054-018-2269-5

Cited by 11 publications

(6 citation statements)

References 2 publications

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“…The production of PCT, a prohormone of calcitonin, might be increased in response to cytokines involved in TLR4-dominant activation by gram-negative bacteria, whereas CD14 is a broad-spectrum component of innate immunity that can discern various ligands via TLR family activation by both gram-negative and gram-positive bacteria (18,32). Moreover, we demonstrated that the analysis of PCT levels was superior to the analysis of presepsin and CRP levels for predicting blood culture positivity and gram-negative bacteraemia, which is similar to findings reported in previous studies showing that PCT analysis was better than CRP analysis in predicting bacteraemia (10,12). Consistent with the reported AUCs achieved using the levels of PCT for the differentiation of gram-negative bacteraemia from gram-positive bacteraemia, which were between 0.77 and 0.87 (30,31), we confirmed that the combined analysis of PCT and presepsin levels led to markedly higher AUCs than the analysis of PCT levels alone, which indicated that the combined analysis of PCT and presepsin levels obviously enhanced the accuracy of predicting bacteraemia and gram-negative etiology (AUCs, 0.877 and 0.900, respectively).…”

Section: Discussionsupporting

confidence: 89%

“…However, it still usually takes at least 2-3 days to obtain a blood culture result, which may delay the timing of diagnosis and treatment for sepsis. Biomarkers could provide additional information for the prediction of bloodstream infection (9)(10)(11)(12) and prognosis (13,14). Presepsin, a soluble CD14 (sCD14), is emerging as a novel circulating marker of sepsis (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

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Comparison Among Presepsin, Procalcitonin, and C-Reactive Protein in Predicting Blood Culture Positivity and Pathogen in Sepsis Patients

Xiao,

Zhang,

Wang

et al. 2023

Shock

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Background Sepsis is caused by the invasion of the bloodstream by microorganisms from local sites of infection, leading to high mortality. This study aimed to compare the predictive ability of the biomarkers presepsin, procalcitonin (PCT) and C-reactive protein (CRP) for bacteraemia. Methods In this retrospective, multicentre study, a dataset of patients with sepsis who were prospectively enrolled between November 2017 and June 2021 was analysed. The performances of the biomarkers for predicting positive blood cultures and infection with specific pathogens were assessed by the areas under the receiver operating characteristic curves (AUCs). The independent effects of the pathogen and foci of infection on presepsin and PCT levels were assessed by linear logistic regression models. Results A total of 577 patients with 170 (29.5%) positive blood cultures were enrolled. The AUC achieved using PCT levels (0.856) was significantly higher than that achieved using presepsin (0.786, p = 0.0200) and CRP (0.550, p < 0.0001) levels in predicting bacteraemia. The combined analysis of PCT and presepsin levels led to a significantly higher AUC than the analysis of PCT levels alone for predicting blood culture positivity (0.877 vs. 0.856, p = 0.0344) and gram-negative bacteraemia (0.900 vs. 0.875, p = 0.0216). In a linear regression model, the elevated concentrations of presepsin and PCT were both independently related to E. coli, Klebsiella spp., Pseudomonas spp., and Streptococcus spp. infections and Sequential Organ Failure Assessment (SOFA) score. Presepsin levels were also associated with Acinetobacter spp. and abdominal infection, and PCT levels were positively associated with other Enterobacteriaceae and negatively associated with respiratory infection. Combined analysis of presepsin and PCT levels provided a high sensitivity and specificity in identifying Escherichia coli or Klebsiella spp infection. Conclusions Presepsin and PCT were promising markers for predicting bacteraemia and common pathogens at the time of sepsis onset with a synergistic effect.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Comparison Among Presepsin, Procalcitonin, and C-Reactive Protein in Predicting Blood Culture Positivity and Pathogen in Sepsis Patients

Xiao,

Zhang,

Wang

et al. 2023

Shock

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“…Previous studies have shown that the commonly used inflammatory markers such as PCT and CRP alone are not accurate enough in identifying BSI [16][17][18]. PCT generally showed higher predictive value for BSI than CRP, but its AUC varied (0.70-0.85) when used in different wards and populations [19][20][21]. In our FUO cohort, PCT level > 0.3 ng/mL within 24 h after admission alone provided only a moderate AUC (0.73, 95% CI 0.66-0.80) in identifying BSI, with high specificity to discriminate…”

Section: Discussionmentioning

confidence: 99%

Development of a risk prediction model for bloodstream infection in patients with fever of unknown origin

Shi

et al. 2022

J Transl Med

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Background Bloodstream infection (BSI) is a significant cause of mortality among patients with fever of unknown origin (FUO). Inappropriate empiric antimicrobial therapy increases difficulty in BSI diagnosis and treatment. Knowing the risk of BSI at early stage may help improve clinical outcomes and reduce antibiotic overuse. Methods We constructed a multivariate prediction model based on clinical features and serum inflammatory markers using a cohort of FUO patients over a 5-year period by Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression. Results Among 712 FUO patients, BSI was confirmed in 55 patients. Five independent predictors available within 24 h after admission for BSI were identified: presence of diabetes mellitus, chills, C-reactive protein level of 50–100 mg/L, procalcitonin > 0.3 ng/mL, neutrophil percentage > 75%. A predictive score incorporating these 5 variables has adequate concordance with an area under the curve of 0.85. The model showed low positive predictive value (22.6%), but excellent negative predictive value (97.4%) for predicting the risk of BSI. The risk of BSI reduced to 2.0% in FUO patients if score < 1.5. Conclusions A simple tool based on 5 variables is useful for timely ruling out the individuals at low risk of BSI in FUO population.

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“…Therefore, biomarkers may play a vital role in the timely diagnosis and management of sepsis. C-reactive protein (CRP) and procalcitonin (PCT) are widely used biomarkers, but their diagnostic accuracy has been challenged ( Wu et al., 2017 ; Wu et al., 2018 ; Yeh et al., 2019 ). It is reported that surgery and trauma can interfere with the results even in patients without infection ( Parli et al., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Calprotectin as a diagnostic marker for sepsis: A meta-analysis

Gao

Jia

Han

et al. 2022

Front. Cell. Infect. Microbiol.

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IntroductionSepsis is a life-threatening condition, and biomarkers are needed to diagnose sepsis fast and accurately. We aimed to perform this meta-analysis to investigate the diagnostic value of calprotectin on sepsis in critically ill patients.MethodsThe investigators searched MEDLINE, Embase, Web of Science and Cochrane Library. Studies were included if they assessed the diagnostic accuracy of serum calprotectin for sepsis in intensive care unit (ICU). We estimated its diagnostic value and explored the source of heterogeneity. The bivariate model and the hierarchical summary receiver operating characteristic (HSROC) curve were used in the meta-analysis.ResultsSix records assessing 821 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), and diagnostic odds ratio (DOR) were separately as 0.77, 0.85, 5.20, 0.27, respectively. The Fagan's nomogram showed post‐test probabilities of 91% and 35% for positive and negative outcomes, respectively. Subgroup analysis indicated that sepsis definition could be a possible source of heterogeneity, but there’s no sufficient data to investigate sepsis-3 definition. Sensitivity analysis suggested that two studies could affect the stability of pooled results.ConclusionOn the basis of our meta-analysis, calprotectin is a helpful marker for early diagnosis of sepsis on ICU admission.

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Comparison of diagnostic accuracy among procalcitonin, C-reactive protein, and interleukin 6 for blood culture positivity in general ICU patients

Cited by 11 publications

References 2 publications

Comparison Among Presepsin, Procalcitonin, and C-Reactive Protein in Predicting Blood Culture Positivity and Pathogen in Sepsis Patients

Comparison Among Presepsin, Procalcitonin, and C-Reactive Protein in Predicting Blood Culture Positivity and Pathogen in Sepsis Patients

Development of a risk prediction model for bloodstream infection in patients with fever of unknown origin

Calprotectin as a diagnostic marker for sepsis: A meta-analysis

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