Procalcitonin kinetics within the first days of sepsis: relationship with the appropriateness of antibiotic therapy and the outcome

Charles, Pierre‐Emmanuel; Tinel, Claire; Barbar, Saber Davide; Aho, Serge; Prin, Sébastien; Doise, Jean Marc; Olsson, Nils‐Olivier; Blettery, B; Quenot, Jean‐Pierre

doi:10.1186/cc7751

Cited by 131 publications

(122 citation statements)

References 33 publications

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“…Decreased procalcitonin (PCT) levels have been reported to be linked to a lower risk of mortality,75, 76, 77 and active research efforts have focused on instances where the decision to discontinue antimicrobial therapy regimens is made based on a protocol using PCT values to determine whether the period of antimicrobial drug use can be shortened without negatively influencing turning points in a patient's course. We referred to 9 RCT reports during our meta‐analysis on this topic 78, 79, 80, 81, 82, 83, 84, 85, 86.…”

Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Introductionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…In the present study, the median PCT values in patients with sepsis and trauma were similar to those found by Castelli et al (13) and Billeter et al (3) , respectively. Although the initial values of PCT in patients with sepsis are usually higher in more severe patients, the correlation with mortality is not as clear (5,14) . However, specifically in patients with pneumonia, apparently its efficiency as a marker of adverse outcome is greater (4,16) .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, in sepsis patients, particularly bacterial, initial PCT values proved to be far higher. The mean values ranged from 4.3 (nonsevere sepsis) to 21.3 ng/mL (septic shock) (5,14,15) . In the present study, the median PCT values in patients with sepsis and trauma were similar to those found by Castelli et al (13) and Billeter et al (3) , respectively.…”

Section: Discussionmentioning

confidence: 99%

“…The recent pandemic by influenza A (H1N1) virus (2) has reinforced the importance of biomarkers that might assist the clinician in diagnosis and management of patients with severe community-acquired pneumonia and acute respiratory failure. Procalcitonin (PCT) has been studied and has shown itself to be useful in the differential diagnosis (3) , prognosis (4) , and antimicrobial management (5) of both community and hospitalacquired infections, proving to be an exclusion marker of viral infections exclusion, particularly in patients with severe community-acquired infections (6,7) .…”

Section: Introductionmentioning

confidence: 99%

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Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Duarte

Bredt

et al. 2011

Einstein (São Paulo)

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Objective: To verify serum procalcitonin levels of patients with acute respiratory failure secondary to influenza A (H1N1) upon their admission to the Intensive Care Unit and to compare these results to values found in patients with sepsis and trauma admitted to the same unit. Methods: Analysis of records of patients infected with influenza A (H1N1) and respiratory failure admitted to the General Intensive Care Unit during in a period of 60 days. The values of serum procalcitonin and clinical and laboratory data were compared to those of all patients admitted with sepsis or trauma in the previous year. Results: Among patients with influenza A (H1N1) (n = 16), the median serum procalcitonin level upon admission was 0.11 ng/mL, lower than in the sepsis group (p < 0.001) and slightly lower than in trauma patients. Although the mean values were low, serum procalcitonin was a strong predictor of hospital mortality in patients with influenza A (H1N1). Conclusion: Patients with influenza A (H1N1) with severe acute respiratory failure presented with low serum procalcitonin values upon admission, although their serum levels are predictors of hospital mortality. The kinetics study of this biomarker may be a useful tool in the management of this group of patients.

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“…Im Gegensatz dazu war eine Antibiose, die nicht gegen den urs ä chlichen Erreger gerichtet war, mit einem weiteren Anstieg der PCT-Konzentration verbunden. Ein ausbleibender PCT-Abfall unter empirischer Antibiotikatherapie k ö nnte also Hinweise auf ein Therapieversagen liefern und eine eventuell erforderliche Therapieumstellung anzeigen [117] .…”

Section: Therapiesteuerungunclassified

Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen?/Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

Boenisch

Fae

Drexel

et al. 2013

Laboratoriumsmedizin

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Zusammenfassung :In der Diagnostik von Infektionen und inflammatorischen Prozessen ist das C-reaktive Protein (CRP) einer der meistverwendeten Parameter, unter anderem aufgrund der geringen Kosten und der schnellen Verf ü gbarkeit. Im Zuge der letzten Jahre gewannen jedoch andere Entz ü ndungsparameter, wie zum Beispiel das Interleukin 6 (IL-6) oder Procalcitonin (PCT), zunehmend an Bedeutung. Obwohl diese Parameter im klinischen Alltag noch nicht ü berall etabliert sind, besitzen sie doch wesentliche Vorteile in der Diagnostik und im Verlaufsmonitoring von entz ü ndlichen Erkrankungen. Beispielsweise ist die Erkennung entz ü ndlicher Komplikationen auf Intensivstationen durch erh ö hte IL-6 Spiegel 24 bis 48 Stunden vor einer Erh ö hung des CRP m ö glich. Die deutliche Ü berlegenheit von PCT gegen ü ber CRP in der Diagnostik von bakteriellen Infektionen und Sepsis begr ü ndet sich in der h ö heren Spezifit ä t des PCT f ü r bakterielle Infektionen. Der PCT-Verlauf erm ö glicht daher eine bessere Beurteilung des Therapieerfolges und Krankheitsverlaufs des Patienten und liefert Hinweise auf eine gegebenenfalls erforderliche Therapieumstellung. Daraus ergibt sich die Frage, ob die Messung des CRPSpiegels durch IL-6 und/oder PCT ersetzt werden kann. In dieser Ü bersichtsarbeit wird die derzeitige Bedeutung von CRP im Verh ä ltnis zu den neueren Entz ü ndungsparametern in der Diagnostik von bakteriellen Infektionen, im therapeutischen Monitoring und in seiner Aussagekraft bez ü glich der Prognose des Patienten auf Intensivstationen dargestellt.Schl ü sselw ö rter: C-reaktive Protein (CRP); Entz ü ndungsmarker; Infektion; Intensivstation; Interleukin 6 (IL-6); Procalcitonin (PCT); Sepsis.Abstract : C-reactive protein (CRP) currently constitutes one of the most widely used parameters for the diagnosis of infections and inflammatory processes, due to simple methods and low costs. However, in recent years, other parameters, such as interleukin 6 (IL-6) and procalcitonin (PCT), have gained in importance. Although these parameters are presently not established everywhere in clinical routine, they provide significant advantages in the diagnosis and monitoring of inflammatory diseases. For instance, in intensive care, the increase in IL-6 levels may indicate inflammatory complications 24 to 48 h prior to the increase in circulating CRP levels. In contrast to CRP, PCT shows a higher specificity for bacterial infections, which facilitates the diagnosis of bacterial infections and sepsis. Therefore, PCT values provide a better evaluation of prognosis and therapeutic success and of a necessary change in therapy. These points raise the question whether CRP levels should at least in part be replaced by PCT and/or IL-6. Thus, this review seeks to examine the value of CRP in relation to PCT and IL-6 in the diagnosis of bacterial infections, in therapeutic monitoring, and regarding prognosis in critical care patients.

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Procalcitonin kinetics within the first days of sepsis: relationship with the appropriateness of antibiotic therapy and the outcome

Cited by 131 publications

References 33 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Procalcitonin in patients with influenza A (H1N1) infection and acute respiratory failure

Spielen CRP-Spiegel neben IL-6 und PCT noch eine Rolle für Patienten auf Intensivstationen?/Are circulating levels of CRP compared to IL-6 and PCT still relevant in intensive care unit patients?

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