Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

Tsangaris, Iraklis; Plachouras, Diamantis; Kavatha, Dimitra; Gourgoulis, G.-M.; Tsantes, Argirios Ε.; Kopterides, Petros; Tsaknis, Georgios; Dimopoulou, Ioanna; Orfanos, Stylianos E.; Giamarellos‐Bourboulis, Evangelos J.; Giamarellou, Helen; Armaganidis, Apostolos

doi:10.1186/1471-2334-9-213

Cited by 55 publications

(61 citation statements)

References 30 publications

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“…They concluded that PCT values on the day of fever onset must be compared with values from the previous day to diagnose infection. Furthermore, in the case of a 'normal' clearance and the absence of re-induction, PCT values on the third day after the fever onset returning to the normal range were associated with better survival [48]. These are in accord with a recent pilot study by Öveges et al [49].…”

Section: Kinetics Over Absolute Valuessupporting

confidence: 80%

“…Tsangaris et al studied patients who were in the ICU for more than 10 days, who were free of infection and Non-responder, fulmin ant sepsis, potenƟally too late for adjuvant therapy at presentaƟon Second ary respond er, in creasing PCT kin eƟcs despite of broad spectrum ATB, potenƟal use of adjuvant th erapy Primary respond er, decreasing kin eƟcs by broad spectrum ATB, too ea rly or no benefit from an adju vant therapy who presented with a new onset of fever [48]. PCT showed a minimum 2-fold increase in patients with proven infection from the day before to the day of fever onset.…”

Section: Kinetics Over Absolute Valuesmentioning

confidence: 99%

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Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Becze¹,

Molnár

Fazakas

2015

International Journal of Antimicrobial Agents

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a b s t r a c tAfter decades of extensive experimental and clinical research, septic shock and the related multiple organ dysfunction still remain the leading cause of mortality in intensive care units (ICUs) worldwide. Defining sepsis is a difficult task, but what is even more challenging is differentiating infection-induced from non-infection-induced systemic inflammatory response-related multiple organ dysfunction. As conventional signs of infection are often unreliable in intensive care, biomarkers are used, of which one of the most frequently investigated is procalcitonin. Early stabilisation of vital functions via adequate supportive therapy and antibiotic treatment has resulted in substantial improvements in outcome over the last decades. However, there are certain patients who may need extra help, hence modulation of the immune system and the host's response may also be an important therapeutic approach in these situations. Polyclonal intravenous immunoglobulins have been used in critical care for decades. A relatively new potential approach could be attenuation of the overwhelming cytokine storm by specific cytokine adsorbents. Both interventions have been applied in daily practice on a large scale, with firm pathophysiological rationale but weak evidence supported by clinical trials. The purpose of this review is to give an overview on the pathophysiology of sepsis as well as the role and interpretation of biomarkers and their potential use in assisting adjunctive therapies in sepsis in the future.

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Section: Kinetics Over Absolute Valuessupporting

confidence: 80%

Section: Kinetics Over Absolute Valuesmentioning

confidence: 99%

Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Becze¹,

Molnár

Fazakas

2015

International Journal of Antimicrobial Agents

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“…However, recent meta-analyses have suggested that PCT alone may be insufficient to accurately differentiate bacterial from nonbacterial sepsis or other causes of SIRS (22)(23)(24). Similarly, previous studies assessing the use of PCT alone or in comparison to other biomarkers for the diagnosis of sepsis have had variable performance characteristics (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), likely due to differences in patient populations, the type of assay performed, the timing of sample testing, the selection of cutoff values, and the selection of the gold standard for determining sepsis.…”

mentioning

confidence: 99%

“…Several studies have evaluated the diagnostic utility of various biomarkers, including ferritin, haptoglobin, interleukin 6, C-reactive protein (CRP), and procalcitonin (PCT), for suspected sepsis in the ICU patient population (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). PCT has been the most-well-studied biomarker and has demonstrated the most promising results to date in the diagnosis of bacterial infection in a number of settings (16)(17)(18)(19)(20)(21).…”

mentioning

confidence: 99%

Use of a Combination Biomarker Algorithm To Identify Medical Intensive Care Unit Patients with Suspected Sepsis at Very Low Likelihood of Bacterial Infection

Han

Nachamkin

Coffin

et al. 2015

Antimicrob Agents Chemother

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“…Most of these studies have shown that serum PCT levels are low in healthy individuals and elevated in patients with bloodstream infection (11,(13)(14)(15). Other investigators have found inconsistent and variable findings when they conducted examinations by comparing the diagnostic and prognostic values of PCT levels with alternative parameters in the case of bacteremia (16,17).…”

mentioning

confidence: 99%

Roles of C-Reactive Protein and Procalcitonin in Empirical Treatment Approach to the Bacterial Sepsis Agent

Vurgun¹,

Evliyaoğlu²,

Arabacı³

et al. 2017

Istanbul Med J

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Although the incidence of blood circulation infections such as bacteremia and sepsis can be reduced with appropriate antibiotic treatment when detected at an early stage (1), such infections are one of the most important causes of morbidity and mortality in hospitalized patients (2, 3). Rapid diagnosis of bloodstream infections is often difficult because traditional blood culture procedures are slow and time consuming, and the isolation of the pathogen through the antibiogram takes at least 48 hours after blood culture (4). Alternative laboratory tests such as erythrocyte sedimentation rate, serum C-reactive protein (CRP) levels, white blood cell count or percentage of neutrophils, and polymerase chain reaction (PCR) are used to detect bacteremia but are slow and tedious and lack sensitivity and specificity (1). Therefore, it is difficult to distinguish bloodstream infections from other diseases with these tests (5, 6). In fact, except for PCR, none of the other tests can on their own confirm the diagnosis of bacteremia (7,8).Interleukins, proatrial natriuretic peptide, copeptin, interferon-ɤ, resistin, and procalcitonin (PCT) have been investigated as potential sepsis biomarkers (7-14), and the most studied among these are PCT levels. Most of these studies have shown that serum PCT levels are low in healthy individuals and elevated in patients with bloodstream infection (11,(13)(14)(15). Other investigators have found inconsistent and variable findings when they conducted examinations by comparing the diagnostic and prognostic values of PCT levels with alternative parameters in the case of bacteremia (16,17). Therefore, there is a need for more studies in order for PCT to become a diagnostic or predictive parameter that is routinely recommended.Early identification and recognition of the first minor symptoms of infection at the onset of bloodstream infections can help determine whether patients are infected by gram-positive (gram+) or gram-negative (gram-) pathogens (4). Because serum PCT levels are influenced by lipopolysaccharides and sepsis-related cytokines (18,19), it is expected that serum PCT levels of blood infections caused by gram-pathogens will be higher than blood infections caused by gram+ pathogens.The aim of our study was to determine, in the differential diagnosis, if the predictive value of serum CRP and PCT levels of culture-positive sepsis patients could effectively separate gram+ from gram-bacterial infections at an earlier time point than the standard blood culture results. This would allow us to determine whether or not the correct treatment could be started by facilitat- Roles of C-Reactive Protein and Procalcitonin in Empirical Treatment Approach to the Bacterial Sepsis AgentObjective: The primary aim of our study was to investigate the usefulness of serum C-reactive protein (CRP) and procalcitonin (PCT) levels in the differential diagnosis of causative gram-positive (Gram+) or gram-negative (Gram-) bacteria in patients with sepsis to facilitate decisions concerning the initial choice of...

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Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

Abstract: Background: Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.

Cited by 55 publications

References 30 publications

Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Can procalcitonin levels indicate the need for adjunctive therapies in sepsis?

Use of a Combination Biomarker Algorithm To Identify Medical Intensive Care Unit Patients with Suspected Sepsis at Very Low Likelihood of Bacterial Infection

Roles of C-Reactive Protein and Procalcitonin in Empirical Treatment Approach to the Bacterial Sepsis Agent

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