High Serum Procalcitonin Levels Do Not Predict Bacteremia in Adult Patients with Acute Fever

Debard, Anne-Lise; Vautrin, Cyrille; Pariset, C.; Bienvenu, Jacques; Monneret, Guillaume

doi:10.1086/368095

Cited by 11 publications

(8 citation statements)

References 6 publications

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“…Some reports have questioned the role of PCT, CRP and some cytokines for the diagnosis and the prognosis of critically ill patients [14,15]. A more recent article [23] showed a moderate diagnostic performance of PCT, with mean values of 71% (95% CI 67 to 76%) for both sensitivity and specificity, and AUROCC of 0.78 (95% CI 0.73 to 0.83).…”

Section: Discussionmentioning

confidence: 99%

“…PCT and CRP have already been identified as useful markers of systemic inflammation due to infective (mainly bacterial) agents [8-15]. An effective immune response against bacterial infections requires the development of a T helper (Th)1 response that is associated with the release of IFN-γ [16].…”

Section: Introductionmentioning

confidence: 99%

“…All the above discussed mediators of sepsis pathophysiology might be exploited to gain useful data on the prognosis and early diagnosis of systemic inflammatory response syndrome (SIRS) patients. However, other reports [8,14,15] have questioned the role of PCT, CRP and some cytokines in the clinical management of critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

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Impact of interleukin-10, soluble CD25 and interferon-γ on the prognosis and early diagnosis of bacteremic systemic inflammatory response syndrome: a prospective observational study

et al. 2013

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IntroductionThe pathophysiology of sepsis consists of two phases. A first phase characterized by a substantial increase of pro-inflammatory mediators including cytokines and systemic inflammatory markers, and a second phase (immunoparalysis, immunodysregulation) associated with the rise of anti-inflammatory mediators. In this study we prospectively analyzed 52 consecutive patients with diagnosis of systemic inflammatory response syndrome (SIRS) at hospital admission to evaluate prognostic and early diagnostic performance of interleukin-10 (IL-10), soluble CD25 (sCD25) and interferon-γ (IFN-γ) and to confirm the prognostic accuracy of the sequential organ failure assessment (SOFA) score.MethodsPatients were divided in two groups (group 1, n = 28 patients with bacteremic SIRS and group 2, n = 24 patients with non-bacteremic SIRS) and then stratified into survivors (n = 39) and nonsurvivors (n = 13). Serum markers were evaluated on the day of hospital admission (D-1) and on the 7th day of hospital stay (D-7). Concentration of sCD25 was evaluated by a sandwich ELISA kit. Levels of IL-10 and IFN-γ were quantified by a cytokine biochip array by the evidence investigator analyzer. Differences between groups were established by the Mann-Whitney test. Accuracy, sensitivity and specificity of diagnostic markers were evaluated by the receiver-operating characteristic curve analysis. Multivariate analysis was carried out to evaluate whether studied biomarkers are independent predictors of poor outcome in prognosis, and of bacteremic SIRS in diagnosis.ResultsIL-10, sCD25 and SOFA scores of survivors and nonsurvivors were significantly different both at D-1 (P = 0.0014; P = 0.014 and P = 0.0311 respectively) and at D-7 (P = 0.0002, P = 0.014 and P = 0.0012 respectively). Between the above groups IFN-γ level was significantly different only at D-7 (P = 0.0013). Moreover IL-10 and sCD25 were significantly higher in bacteremic versus non-bacteremic SIRS patients at D-1 and at D-7 (P < 0.05). IFN-γ values showed a significant decrease (P < 0.05) in patients of group 1 only at D-7. The diagnostic accuracy of IL-10 and sCD25 was confirmed by the analysis of the AUROCC at D-1 and D-7 respectively. Multivariate analysis revealed that sCD25 and IL-10 are independent predictors of a poor outcome for our patients during the first day of hospital admission.ConclusionsIL-10 and sCD25 gave a significant contribution to prognostic evaluation and early diagnosis of bacteremic SIRS. SOFA score appeared to be a reliable prognostic tool in this subset of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of interleukin-10, soluble CD25 and interferon-γ on the prognosis and early diagnosis of bacteremic systemic inflammatory response syndrome: a prospective observational study

et al. 2013

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“…It has recently been suggested that procalcitonin be used in the emergency department to indicate the need for antibiotics 28 and that an emergency department procalcitonin of < 0.4 ng/mL be used to withhold antibiotics 29 . Subsequent letters to the editor have questioned these assertions 30–34 . We believe that many of the concerns related to the diagnostic role of procalcitonin have been addressed in our study.…”

Section: Discussionmentioning

confidence: 82%

The potential role of procalcitonin in the emergency department management of febrile young adults during a sustained meningococcal epidemic

2004

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The finding of a procalcitonin level > or = 0.5 ng/mL in young adults with undifferentiated fever indicates an increased chance that the presenting illness may be meningococcal disease. In New Zealand's continuing meningococcal epidemic empirical antibiotics should be strongly considered in those with elevated procalcitonin levels in the hope of reducing meningococcal disease deaths due to delays in antibiotic administration.

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“…However, this review included studies across a wide range of age group, clinical setting and spectrum diseases: 46% were paediatric patients and 57% did not have SIRS. Additionally, in some clinical situations of infectious origin commonly found in ICU, PCT can be normal or even undetectable early course of infections [24], localised infections [25], or subacute endocarditis [19,26,27]. …”

Section: Discussionmentioning

confidence: 99%

A composite score combining procalcitonin, C-reactive protein and temperature has a high positive predictive value for the diagnosis of intensive care-acquired infections

et al. 2013

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BackgroundNosocomial infection diagnosis in the intensive care unit (ICU) remains a challenge. We compared routine measurements of procalcitonin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and temperature in the detection of ICU-acquired infections.MethodProspective observational cohort study in a University hospital Medicosurgical ICU. All patients admitted to the ICU ≥ 5 days (n = 141) were included into two groups, either infected (documented infection, n = 25) or non-infected (discharged from the ICU without diagnosis of infection, n = 88).ResultsPCT, CRP, WBC and temperature progression from day −4 (D-4) to day 0 (D0) (day of infection diagnosis or ICU discharge) was analysed. Differences (Δ) were calculated as D0 levels minus the lowest preceding value. D0 PCT and CRP were significantly increased in infected compared to non-infected patients (median, 1st and 3rd quartiles): 3.6 ng/mL (0.92-25) for PCT, 173 mg/L (126–188) for CRP versus 0.02 ng/mL (0.1-0.9) and 57 mg/mL (31–105) respectively (p < 0.0001). In multivariate analysis, D0 temperature > 38.6°C, PCT > 1.86 ng/mL, and CRP > 88 mg/L, performed well (AUCs of 0.88, 0.84, and 0.88 respectively). The sensitivity/specificity profiles of each marker (76%/94% for temperature, 68%/91% for PCT, and 92%/70% for CRP) led to a composite score (0.068 × D0 PCT + 0.005 × D0 CRP + 0.7 × temperature) more highly specific than each component (AUC of 0.90 and sensitivity/specificity of 80%/97%).ConclusionCombining CRP, PCT and temperature is an approach which may increase of nosocomial infection detection in the ICU.

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High Serum Procalcitonin Levels Do Not Predict Bacteremia in Adult Patients with Acute Fever

Cited by 11 publications

References 6 publications

Impact of interleukin-10, soluble CD25 and interferon-γ on the prognosis and early diagnosis of bacteremic systemic inflammatory response syndrome: a prospective observational study

Impact of interleukin-10, soluble CD25 and interferon-γ on the prognosis and early diagnosis of bacteremic systemic inflammatory response syndrome: a prospective observational study

The potential role of procalcitonin in the emergency department management of febrile young adults during a sustained meningococcal epidemic

A composite score combining procalcitonin, C-reactive protein and temperature has a high positive predictive value for the diagnosis of intensive care-acquired infections

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