Diagnostic value of procalcitonin and C reactive protein for infection and sepsis in elderly patients

Abstract

IntroductionBiomarkers are useful for diagnosing infection and sepsis in adults, but data are limited in elderly patients. Furthermore, clinical symptoms of infection in elderly patients are usually atypical or unclear. We aimed to assess the usefulness of PCT, CRP, and WBC in distinguishing elderly patients infected with sepsis from infected without sepsis and those with no infection.We also aimed to find a cut-off value for diagnosing sepsis and infection without sepsis in elderly critically ill patients. MethodsIn this single-center and prospective observational study, patients older than 65 years were enrolled. Serum levels of PCT, CRP, and WBC were measured within 24 hours. Patients were allocated into sepsis(S), infected without sepsis (IWS), and no-infection (NI) groups. Data were analyzed with Mann-Whitney's U test and Kruskal-Wallis test. The Receiver Operating Characteristic (ROC) curves were used to assess the accuracies of the biomarkers in diagnosing IWS and S. ResultsWe analyzed 188 patients with a mean age of 77,05 ±7.4 in the study; 95 (50.5%) of them were women. 64 (34%) of whom were classified as IWS, 29 (15%) as S, and 95 (50.5%) as NI group.There were significant differences in the PCT, CRP levels between the IWS and NI, S and NI (p<0. 001, p<0.001, p< 0.001, p<0.01, respectively). The PCT levels were significantly different when the NI group was compared to IWS (p<0.001) and S (p<0.001) groups. The CRP levels were also different when the NI group was compared to both IWS (p<0.001) and S (p<0.001). PCT was significantly higher in S compared to IWS (p<0.001), while CRP and WBC were not (p< 0.80, p<0.07, respectively). The value of PCT for discrimination of patients with IWS was highest with an AUC of 0.886, followed by CRP (AUC = 0.787; p<0.001), and WBC (AUC = 0.695; p<0.001).PCT also yielded the highest value for discrimination of patients with S with an AUC of 0.994, followed by CRP (AUC = 0.795:p<0.001) and WBC (AUC=0.768,p<0.01).The PCT cut-off values were 0.485μ/L and 1.245 μg / L for the discrimination of patients with IWS and S, respectively. The cut-off values of CRP level were 59.45 mg / L and 57.50 mg/L for infected without sepsis and sepsis, respectively. ConclusionsPCT was found to be a more valuable marker than CRP and WBC for the discrimination of elderly patients with infected without sepsis and sepsis.

A new indicator: The diagnostic value of CD8+T/B lymphocyte ratio in sepsis progression

“… 42 In our study, the differences of these three items between the sepsis group and septic shock group were not statistically significant, which may be related to the nature of these indicators. When the organism is damaged by trauma, infection, and tumor, CRP increases sharply within several hours, so as PCT level 43 and WBC counting, 44 which are endowed with great practical value in the early diagnosis of infection. Their diagnostic value was dramatically reduced once infection progresses, while lymphocyte subpopulation played a unique role in the diagnosis of sepsis progression.…”

IL-6 and IL-10 Are Associated With Gram-Negative and Gram-Positive Bacteria Infection in Lymphoma

“…A similar trend was reflected in the IL-10 level of the G-group. Some studies have shown that PCT can be used as an indicator of infectious diseases, infection severity and disease prognosis (32)(33)(34). However, a single PCT has some limitations, and other indicators often need to be combined in clinical practice (35).…”

Particularities of diagnosis in an elderly patient with neglected peritonitis: a case report

“…20 However, other studies involving elderly patients have reported low accuracy in the diagnosis of sepsis using WBC and even CRP, compared with PCT, which has a much higher accuracy and can differentiate localized infection from sepsis and septic shock. 17,21 Gbinigie et al suggested that many useful diagnostic tests in younger patients do not help diagnose bacterial infections in the elderly. 22 In our patient, the WBC did not lead us to a diagnosis of neglected peritonitis with septic shock.…”

“…In addition to blood culture, which is the gold standard in the diagnosis of sepsis but which requires time to obtain the results, 16 PCT and CRP are useful in the early diagnosis of bacterial infection, peritonitis, sepsis, and septic shock. 8,17 PCT and CRP are among the most frequently measured biomarkers worldwide. 10,11,18,19 Because our patient had a fever, we measured these biomarkers, which revealed very high values, as follows: PCT ¼ >32 mg/L (values >10 mg/L suggest septic shock) and CRP ¼ 1228.5 nmol/L (values >95.2 nmol/L suggest an inflammatory syndrome).…”