Procalcitonin and interleukin 6 for predicting blood culture positivity in sepsis

Naffaa, Mohammad E.; Makhoul, Badira F.; Tobia, Amjad; Kaplan, Marielle; Aronson, Doron; Azzam, Zaher S.; Saliba, Walid

doi:10.1016/j.ajem.2013.12.058

Cited by 28 publications

(14 citation statements)

References 24 publications

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“…Procalcitonin has been shown to be an independent predictor for 30-day mortality in ADHF [95•]. However, another study did not find this association with allcause mortality [96]. Whether procalcitonin is a strong predictor for outcome in acute heart failure remains uncertain and more studies are needed to answer this question.…”

Section: Procalcitoninmentioning

confidence: 99%

Biomarkers for Risk Prediction in Acute Decompensated Heart Failure

Velde

Meijers

Boer

2014

Curr Heart Fail Rep

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Risk prediction in patients admitted with acute decompensated heart failure (ADHF) remains a challenge. Biomarkers may improve risk prediction, which in turn may help to better inform patients regarding short-term and long-term prognosis, therapy and care. Most data on biomarkers have been derived from patient cohorts with chronic heart failure. In ADHF, currently, risk tools largely rely on common clinical and biochemical parameters. However, ADHF is not a single disease. It presents in various manners and different etiologies may underlie ADHF, which are reflected by different biomarkers. In the last decade, many studies have reported the prognostic value of these biomarkers. These studies have attempted to describe a value for statistical modeling, e.g., reclassification indices, in an effort to report incremental value over a clinical model or the "gold standard". However, the overall incremental predictive value of biomarkers has been modest compared to already existing clinical models. Natriuretic peptides, e.g., (NTpro-)BNP, are the benchmark, but head-to-head comparisons show that there are novel biomarkers with comparable prognostic value. Multimarker strategies may provide superior risk stratification. Future studies should elucidate cost-effectiveness of single or combined biomarker testing. The purpose of this review was to provide an update on current biomarkers and to identify new promising biomarkers than can be used in prognostication of acute heart failure.

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Section: Procalcitoninmentioning

confidence: 99%

Biomarkers for Risk Prediction in Acute Decompensated Heart Failure

Velde

Meijers

Boer

2014

Curr Heart Fail Rep

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“…The subsequent delays in diagnosis and treatment of infection can negatively impact care in the intensive care unit (ICU). Biomarkers, such as procalcitonin (PCT), have been suggested as predictors of blood culture positivity in patients with different diseases [1, 2]. However, the performances of PCT, C-reactive protein (CRP), and interleukin 6 (IL-6) in the prediction of blood culture positivity have never been assessed in a general ICU population.…”

mentioning

confidence: 99%

Comparison of diagnostic accuracy among procalcitonin, C-reactive protein, and interleukin 6 for blood culture positivity in general ICU patients

Yang

Kang

2018

Crit Care

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“…By using serial measurements and established cutoff values in intensive care units (ICUs), these studies have shown that PCT values guide antimicrobial therapy (13)(14)(15)(16)(17)(18). However, no reports have described the utility of using initial PCT levels to guide upstream anti-infective therapy decision-making or the predictive ability of PCT values in the context of objective criteria of infection, such as culture positivity.…”

mentioning

confidence: 99%

Determining the Clinical Utility of an Absolute Procalcitonin Value for Predicting a Positive Culture Result

Caffarini

DeMott

Patel

et al. 2017

Antimicrob Agents Chemother

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Various procalcitonin ranges have been established to guide antimicrobial therapy; however, there are no data that establish whether the initial procalcitonin value can determine the likelihood of a positive culture result. This study aimed to establish if the initial procalcitonin value, on clinical presentation, has a positive predictive value for any positive culture result. This was a retrospective study of 813 medical intensive care unit patients. Data collected included patient demographics, procalcitonin assay results, sources of infection, culture results, and lengths of stay. Patients were excluded if they were immunocompromised. The primary outcome of this study was to determine a procalcitonin value that would predict any positive culture. Secondary outcomes included the sensitivity, specificity, positive predictive value, and negative predictive value for procalcitonin. After exclusions, a total of 519 patient charts were reviewed to determine the impact of the initial procalcitonin value on culture positivity. In our analyses, the receiver operating characteristic values were 0.62 for all cultures, 0.49 for pulmonary infections, 0.43 for urinary tract infections, and 0.78 for bacteremia. A procalcitonin value of 3.61 ng/ml was determined to be the threshold value for a positive blood culture result (prevalence, 4%). For bacteremia, the sensitivity of procalcitonin was 75%, the specificity was 72%, the positive predictive value was 20%, and the negative predictive value was 97%. Procalcitonin was a poor predictor of culture positivity. An initial procalcitonin value of less than 3.61 ng/ml may be useful in predicting whether bacteremia is absent. Procalcitonin should not be used as the only predictor for determining initiation of antibiotic therapy.KEYWORDS biomarkers, diagnostics, procalcitonin, sepsis S epsis is a leading cause of death and disability in the United States (1, 2). Mortality from sepsis increases with each hour that anti-infective therapy is delayed (3). The impetus for promptly initiating appropriate broad-spectrum antimicrobial therapy must be weighed against the concern for reducing unnecessary antimicrobial therapy and potential harms, such as drug resistance, Clostridium difficile infections, and adverse drug effects (3). The lack of a specific test to assist clinicians in early decision-making regarding initiation and discontinuation of antimicrobial therapy for severe infection and presumed sepsis has led to expanded interest in inflammatory biomarkers, such as procalcitonin (PCT) (4-12).Previous trials evaluating PCT have used value ranges to guide clinical decisions within the construct of initiating and discontinuing antimicrobial therapy using clinical criteria (4,5,(7)(8)(9)(10)(12)(13)(14). By using serial measurements and established cutoff values in intensive care units (ICUs), these studies have shown that PCT values guide antimicrobial therapy (13-18). However, no reports have described the utility of using initial PCT levels to guide upstream anti-infective...

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Procalcitonin and interleukin 6 for predicting blood culture positivity in sepsis

Cited by 28 publications

References 24 publications

Biomarkers for Risk Prediction in Acute Decompensated Heart Failure

Biomarkers for Risk Prediction in Acute Decompensated Heart Failure

Comparison of diagnostic accuracy among procalcitonin, C-reactive protein, and interleukin 6 for blood culture positivity in general ICU patients

Determining the Clinical Utility of an Absolute Procalcitonin Value for Predicting a Positive Culture Result

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