Predictive value of the kinetics of procalcitonin and C-reactive protein for early clinical stability in patients with bloodstream infections due to Gram-negative bacteria

Gutiérrez‐Gutiérrez, Belén; Morales, Isabel; Pérez-Galera, Salvador; Fernández‐Riejos, Patricia; Retamar, Pilar; Cueto, Marina de; Pascual, Álvaro

doi:10.1016/j.diagmicrobio.2018.07.019

Cited by 15 publications

(10 citation statements)

References 37 publications

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“…Ryuzo and colleagues discovered a similar result, where CRP and interleukin-6 were higher in gramnegative bacteremia than in gram-positive bacteremia in intensive care unit patients [1]. Another study also showed CRP and procalcitonin as effective predictors of bloodstream GNB infection [20]. Although laboratory data may act as potential indicators of GNB infection, it still requires time to obtain the result, and this may jeopardize the early treatment strategy.…”

Section: Discussionmentioning

confidence: 91%

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Hsu

Chen

et al. 2021

BMC Infect Dis

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Background Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis (a potentially fatal condition caused by the body’s response to an infection), may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on bacterial culture, which is time consuming. Therefore, an economic and effective GNB (defined as a positive blood, sputum, or urine culture) infection detection tool in the emergency department (ED) is warranted. Methods We conducted a retrospective cohort study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) bacterial culture from blood, sputum, or urine ordered and obtained in the ED. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via univariate logistic regression and receiver operating characteristic (ROC) curve analysis. Results A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The odds ratios of patients with body temperature ≥ 38.5 °C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, in predicting GNB infection were found to be 2.3, 1.4, 1.9, and 1.6, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively. Conclusion The four physiological parameters were rapid and reliable independent predictors for detection of GNB infection.

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Section: Discussionmentioning

confidence: 91%

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Hsu

Chen

et al. 2021

BMC Infect Dis

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“…Ryuzo and colleagues discovered a similar result, where CRP and interleukin-6 were higher in gramnegative bacteremia than in gram-positive bacteremia in intensive care unit patients [1]. Another study also showed CRP and procalcitonin as effective predictors of bloodstream GNB infection [22]. Although laboratory data may act as potential indicators of GNB infection, it still requires time to obtain the result, and this may jeopardize the early treatment strategy.…”

Section: Discussionmentioning

confidence: 91%

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Hsu

Chen

et al. 2020

Preprint

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Background Early detection and treatment of Gram-negative bacteria (GNB), major causative pathogens of sepsis, may benefit a patient’s outcome, since the mortality rate increases by 5–10% for each hour of delayed therapy. Unfortunately, GNB diagnosis is based on blood culture, which is time consuming. Therefore, an economic and effective GNB infection detection tool in the emergency department (ED) is warranted. Methods We conducted a retrospective case control-study in the ED of a university-affiliated medical center between January 01, 2014 and December 31, 2017. The inclusion criteria were as follows: (1) age ≥ 18; (2) clinical suspicion of bacterial infection; (3) positive bacterial culture of blood or sputum or urine. Descriptive statistics was performed on patient demographic characteristics, vital signs, laboratory data, infection sites, cultured microorganisms, and clinical outcomes. The accuracy of vital signs to predict GNB infection was identified via logistic regression and receiver operating characteristic (ROC) analysis. Results A total of 797 patients were included in this study; the mean age was 71.8 years and 51.3% were male. The results revealed that patients with body temperature ≥ 38.5°C, heart rate ≥ 110 beats per minute, respiratory rate ≥ 20 breaths per minute, and Glasgow coma scale (GCS) < 14, had a 2.3-, 1.4-, 1.9-, and 1.6-fold greater risk of GNB infection, respectively. The area under the curve values for ROC analysis of these measures were 0.70, 0.68, 0.69, and 0.67, respectively. Conclusion The four physiological parameters were rapid and reliable independent predictors for early detection of GNB infection.

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“…Thus, the decision of a more incisive diagnostic workup and therapy may be due to the CRP non-decrease, while waiting for blood cultures results. 32 In addition, a meta-analysis and systematic review concluded that the weighted mean difference of CRP levels beyond 48 hours was significantly higher in non-survivors when compared to survivors, which suggests that CRP level after 48 hours may be a good outcome predictor in critically ill patients. 33 Our sample with a median SAPS II of 39 predicts an intra-hospital mortality rate of 43.8%.…”

Section: Fast Responsementioning

confidence: 99%

Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

et al. 2019

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Introduction: The ideal biomarker to assess response and prognostic assessment in the infected critically ill patient is still not available. The aims of our study were to analyze the association between early C-reactive protein kinetics and duration and appropriateness of antibiotic therapy and its usefulness in predicting mortality in infected critically ill patients. Material and Methods:We have carried out an observational retrospective study in a cohort of 60 patients with community-acquired pneumonia, aspiration pneumonia and bacteremia at an intensive care unit. We have collected C-reactive protein consecutive serum levels for eight days as well as duration and appropriateness of initial antibiotic therapy. C-reactive protein kinetic groups were defined based on the levels at days 0, 4 and 7. With a follow-up of one year, we have evaluated mortality at different time-points. Results:We have obtained three different C-reactive protein kinetic groups from the sample: fast response, delayed but fast response and delayed and slow response. We did not find statistically significant associations between C-reactive protein kinetics and early (intensive care unit, hospital and 28-days) or late (six months and one year) mortality and antibiotic therapy duration (p > 0.05). Although there were no statistically significant differences between the appropriateness of antibiotic therapy and the defined groups (p = 0.265), no patient with inappropriate antibiotic therapy presented a fast response pattern.Discussion: Several studies suggest the importance of this protein in infection. Conclusion: Early C-reactive protein kinetics is not associated with response and prognostic assessment in infected critically ill patients. Nevertheless, a fast response pattern tends to exclude initial inappropriate antibiotic therapy. RESUMOIntrodução: O biomarcador ideal capaz de avaliar a resposta e prognóstico no doente crítico infetado ainda não está disponível. Os objetivos do nosso estudo foram avaliar a relação da cinética precoce da proteína C-reativa com a duração e apropriação da terapêutica antibiótica e a sua utilidade na predição de mortalidade. Material e Métodos:Realizámos um estudo retrospetivo observacional numa coorte de 60 doentes com pneumonia adquirida na comunidade, pneumonia de aspiração e bacteremia numa unidade de cuidados intensivos. Colhemos níveis séricos de proteína C-reativa durante oito dias e a duração e apropriação da terapêutica antibiótica inicial. Definimos grupos de cinética de proteína C-reativa com base nos níveis dos dias 0, 4 e 7. Durante um ano de seguimento, analisámos a mortalidade em diferentes momentos.Resultados: Da amostra obtivemos três grupos de cinética de proteína C-reativa: resposta rápida, resposta atrasada mas rápida e resposta atrasada e lenta. Não observamos associação estatisticamente significativa entre a cinética da proteína C-reativa com a mortalidade precoce (unidade de cuidados intensivos, hospital e aos 28 dias) ou tardia (seis meses e um ano) e duração da terapêutica antibió...

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Predictive value of the kinetics of procalcitonin and C-reactive protein for early clinical stability in patients with bloodstream infections due to Gram-negative bacteria

Cited by 15 publications

References 37 publications

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Clinical physiological parameters for the prediction of gram-negative bacterial infection in the emergency department

Usefulness of Early C-Reactive Protein Kinetics in Response and Prognostic Assessment in Infected Critically Ill Patients: An Observational Retrospective Study

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