Procalcitonin and procalcitonin kinetics for diagnosis and prognosis of intravascular catheter-related bloodstream infections in selected critically ill patients: a prospective observational study

Abstract

BackgroundProcalcitonin (PCT) has emerged as a valuable marker of sepsis. The potential role of PCT in diagnosis and therapy monitoring of intravascular catheter-related bloodstream infections (CRBSI) in intensive care unit (ICU) is still unclear and was evaluated.MethodsForty-six patients were included in the study, provided they were free of infection upon admission and presented the first episode of suspected CRBSI during their ICU stay. Patients who had developed any other infection were excluded. PCT was measured daily during the ICU hospitalization. Primary endpoint was proven CRBSI. Therapy monitoring as according to infection control was also evaluated.ResultsAmong the 46 patients, 26 were diagnosed with CRBSI. Median PCT on the day of infection suspicion (D0) was 7.70 and 0.10 ng/ml for patients with and without proven CRBSI, respectively (p < 0.001). The area under the curve (AUC) for PCT was 0.990 (95% CI; 0.972 – 1.000), whereas a cut-off value of 0.70 ng/ml provided sensitivity and specificity of 92.3 and 100% respectively. In contrast, the AUC for white blood cells (WBC) was 0.539 (95% CI; 0.369 – 0.709), and for C-reactive protein (CRP), 0.603 (95% CI; 0.438 – 0.768). PCT was the best predictor of proven infection. Moreover, an increase >0.20 ng/ml of PCT between the D0 and any of the 4 preceding days was associated with a positive predictive value exceeding 96%. PCT concentrations from the D2 to D6 after suspected infection tended to decrease in controlled patients, whereas remained stable in non-controlled subjects. A PCT concentration exceeding 1.5 ng/ml during D3 was associated with lack of responsiveness to therapy (p = 0.028).ConclusionsWe suggest that PCT could be a helpful diagnostic and prognostic marker of CRBSI in critically ill patients. Both absolute values and variations should be considered.

Clinical Utility of Procalcitonin as a Marker of Sepsis: A Potential Predictor of Causative Pathogens

“…Furthermore, the ROC analysis showed an AUC for the PCT level of 0.80, suggesting that the PCT test had moderate accuracy (according to the classification of Akobeng (13)) for diagnosing sepsis. This finding is consistent with the observations of previous reports suggesting that the PCT level is superior to the endotoxin, interleukin (IL)-6 and CRP levels as a biomarker for the diagnosis of sepsis (5,8,(14)(15)(16)(17)(18)(19). In addition to the confirmation study, the present study provides novel evidence that: 1) the serum PTC level is a superior marker of sepsis, but not local infections, such as pneumonia, and 2) serum PCT elevation is more closely associated with GNR infection than GPC infection in patients with sepsis.…”

“…Furthermore, in the context of local bacterial or viral infection, the circulating PCT level remains at <1.6 ng/mL (4). Other studies have suggested that measuring the PCT level is useful for making an early diagnosis of sepsis (5), as well as assessing the severity (6) and prognosis (7,8) of septic patients.…”

Changes in Circulating Procalcitonin Versus C-Reactive Protein in Predicting Evolution of Infectious Disease in Febrile, Critically Ill Patients

“…The clinical relevance of changes in the markers is less clear, however. Changes in CRP and PCT over 2–7 days have been described in non-critically ill patient populations [13]–[20], in relatively small studies, about 50 patients or less [4], [9], [13], [15], [16], [19], [21]–[25], in specific conditions [2], [8], [10], [13], [15]–[17], [19], [20], [22], [24], [26]–[29] or in heterogeneous conditions in the ICU [4]–[7], [9], [11], [21], [23], [30]–[32], to judge the course of infection and its sequelae. CRP decreases of more than about 25% per day within the first week of treatment of (bloodstream) infections or sepsis have been suggested to help predict a beneficial response and disease course, while slower decreases or increases have been associated with persistent infection, organ failure or mortality, also in the ICU [7,8,11,17–19,21-,23,26–29,32].…”

Preliminary study on serum paraoxonase-1 status and chemokine (C-C motif) ligand 2 in hospitalized elderly patients with catheter-associated asymptomatic bacteriuria

“…Inappropriate treatment is potentially harmful because of the emergence of resistant pathogens, supra-infections, and unnecessary costs [3]. Unfortunately, diagnosis is often complicated by symptoms such as fever, chills and hypotension, which are non-specific [4]. The Infectious Disease Society of America recommended against routine screening for, and antimicrobial treatment of, asymptomatic bacteriuria in elderly, whether community dwellers or institutionalized.…”