Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis

Abstract

BackgroundEarly recognition is a key factor to achieve improved outcomes for septic patients. Combinations of biomarkers, as opposed to single ones, may improve timely diagnosis and survival. We investigated the performance characteristics of sepsis biomarkers, alone and in combination, for diagnosis of verified bacterial sepsis using Sepsis-2 and Sepsis-3 criteria, respectively.MethodsProcalcitonin (PCT), neutrophil-lymphocyte count ratio (NLCR), C-reactive protein (CRP), and lactate were determined in a total of 1,572 episodes of adult patients admitted to the emergency department on suspicion of sepsis. All sampling were performed prior to antibiotic administration. Discriminant analysis was used to construct two composite biomarkers consisting of linear combinations of the investigated biomarkers, one including three selected biomarkers (i.e., NLCR, CRP, and lactate), and another including all four (i.e., PCT, NLCR, CRP, and lactate). The diagnostic performances of the composite biomarkers as well as the individual biomarkers were compared using the area under the receiver operating characteristic curve (AUC).ResultsFor diagnosis of bacterial sepsis based on Sepsis-3 criteria, the AUC for PCT (0.68; 95% CI 0.65–0.71) was comparable to the AUCs for the both composite biomarkers. Using the Sepsis-2 criteria for bacterial sepsis diagnosis, the AUC for the NLCR (0.68; 95% CI 0.65–0.71) but not for the other single biomarkers, was equal to the AUCs for the both composite biomarkers. For diagnosis of severe bacterial sepsis or septic shock based on the Sepsis-2 criteria, the AUCs for both composite biomarkers were significantly greater than those of the single biomarkers (0.85; 95% CI 0.82–0.88 for the composite three-biomarker, and 0.86; 95% CI 0.83–0.89 for the composite four-biomarker).ConclusionsCombinations of biomarkers can improve the diagnosis of verified bacterial sepsis in the most critically ill patients, but in less severe septic conditions either the NLCR or PCT alone exhibit equivalent performance.

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

“…Preoperative PCT levels are related to the presence or absence of an ongoing sepsis process and possible ongoing antimicrobial therapy, which naturally influence baseline values [67]. To the best of our knowledge, the present study is the first study to specifically address PCT kinetics after surgical procedures in burn patients and demonstrate that this biomarker maintains its performance in this particular set of patients, even in the presence of preoperative sepsis.…”

Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case‐control study

“…Procalcitonin is a 116‐amino acid peptide with an approximate molecular weight of 14.5 kDa, and PCT is a useful predictive marker of the inflammatory process with rapidly increased serum levels in inflammation or sepsis . The elevated serum PCT level we observed in CKD patients can be attributed to the following reasons.…”

Removal of Procalcitonin and Selected Cytokines during Continuous Veno-Venous Hemodialysis Using High Cutoff Hemofilters in Patients with Sepsis and Acute Kidney Injury

“…After 24 h of treatment, the concentration of the same cytokines in the dialysis fluid was assessed. The method of cytokine concentration assessment was described before [3]. The detection limit of concentrations of individual cytokines was as follows: total TNF-α (monomer – 17 kDa; trimer – 51 kDa) 0–8.5 pg/mL; IL-1β (17.5 kDa) 0–0.63 pg/mL; IL-6 (21 kDa) 0–10.5 pg/mL; IL-12 (75 kDa) 0–2.5 pg/mL; IL-17 (20 kDa) 0–1.2 pg/mL.…”

“…Continuous renal replacement therapy is a potential method of extracorporeal removal of inflammatory mediators in septic patients. Procalcitonin (PCT) levels have been shown to be closely correlated with the course and the outcome of patients with several bacterial infections and sepsis [2, 3]. In the available literature, studies on the influence of continuous veno-venous hemodialysis with high cutoff hemofilters (HCO-CVVHD) on concentrations of PCT, serum ­C-reactive protein (CRP), hypoxia-inducible factor 1-alpha (HIF1-α) and cytokines in the blood serum are few and concern individual cases or small numbers of patients.…”