Procalcitonin: Usefulness in Acute Care Surgery and Trauma

Parli, Sara E.; Trivedi, Grishma; Woodworth, Alison; Chang, Pei Ching

doi:10.1089/sur.2017.307

Cited by 38 publications

(26 citation statements)

References 41 publications

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“…Firstly, PCT a surrogate marker of sepsis; in this line, the combination of the two biomarkers may help in risk prediction and stratification for AKI and sepsis and may highlight [TIMP-2] × [IGFBP7] to be not only an AKI biomarker, but also a marker of sepsis. Previous trials studied PCT as a marker of sepsis after surgery and trauma, however evidence is lacking [29,30]. A second hypothesis may be the association between inflammation and subsequent AKI development.…”

Section: Discussionmentioning

confidence: 99%

Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Godi

Rosa

Martino

et al. 2020

Ann. Intensive Care

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Background: Biomarkers can play a critical role by facilitating diagnosis and stratification of disease, as well as assessment or prediction of disease severity. Urinary tissue inhibitor of metalloproteinase-2 and insulin-like growth factor binding protein 7 product ([TIMP-2] × [IGFBP7]) predict the development and progression of AKI and recently procalcitonin (PCT), a widely used biomarker for sepsis diagnosis and management, has been associated with AKI occurrence in ICU patients. To assess combinations of [TIMP-2] × [IGFBP7] and PCT results for prediction and risk stratification of short-term outcomes in septic and non-septic patients, a retrospective cohort analysis of critically ill patients was performed in a multidisciplinary ICU. ROC curve analysis was used in order to evaluate predictive performance of combined results of [TIMP-2] × [IGFBP7] and PCT at the time of admission for AKI development. To verify the utility of adding [TIMP-2] × [IGFBP7] and PCT results for risk assessment, we evaluated the predictive value of having a singlemarker positivity compared to a double-marker positivity using the widely used cutoff of 0.3 (ng/mL) 2 /1000 for [TIMP-2] × [IGFBP7] and 0.5 μg/L for PCT. Risk assessment for AKI occurrence within 48 h, acute kidney disease (AKD) and mortality at 7 days was performed by logistic/Cox regression analysis. Results: 433 patients were analysed, of whom 168 had AKI within 48 h (93 septic and 65 non-septic patients). Combination of [TIMP-2] × [IGFBP7] and PCT showed a good predictive ability for AKI occurrence (AUC 0.81, 95% CI 0.77-0.86, p < 0.001, Sens 78%, Spec 73%). Combinations of biomarkers increased the odd ratios (OR) considerably. A single-marker positivity showed a fourfold risk increase, while the double-marker positivity a 26-fold risk increase for AKI occurrence. Moreover, the double-marker positivity showed an elevated risk for AKD at 7 days in non-septic patients (OR 15.9, 95% CI 3,21-73,57, p < 0.001) and for mortality within 7 days in septic patients (HR 4.1, 95% CI 1.4-11.8, p = 0.001). Conclusions: Although combining the results of [TIMP-2] × [IGFBP7] and PCT may be a useful tool to identify and stratify ICU patients at high risk for septic AKI and short-term adverse outcomes, data should be confirmed in a large prospective study.

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Section: Discussionmentioning

confidence: 99%

Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Godi

Rosa

Martino

et al. 2020

Ann. Intensive Care

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“…Compared to PCT, the acute phase protein CRP is often supposed to be of lower specificity, as also conditions as surgery, cancer or severe trauma can increase its plasma levels. However, this kinetic also holds true for PCT (Parli et al, 2018). This unravels a statistical misconception and dilemma: the essential indices of a diagnostic test, above all sensitivity and specificity, are a result of a dichotomous grouping of patients according to an arbitrary threshold.…”

Section: Introductionmentioning

confidence: 93%

Host-Derived Delta-Like Canonical Notch Ligand 1 as a Novel Diagnostic Biomarker for Bacterial Sepsis—Results From a Combinational Secondary Analysis

Hildebrand

Decker

Koch

et al. 2019

Front. Cell. Infect. Microbiol.

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Background: Sepsis is a life-threatening syndrome, resulting from a dysbalanced host response to infection. However, especially the early, pro-inflammatory immune response in sepsis is similar to other inflammatory conditions without infectious cause, e.g., trauma or surgery. This aspect challenges the value of current biomarkers for diagnosis, as these are often broadly induced. We earlier identified Delta-like Protein 1 (DLL1), a canonical Notch ligand, to be released from monocytes upon bacterial stimulation. Considering the importance of monocytes in the pathophysiology of sepsis, we hypothesized that this mechanism might occur also in the clinical setting and DLL1 might serve as a biomarker of life-threatening bacterial infection. Methods: We combined samples from three different studies, including subgroups of patients with sepsis ( n = 80), surgical patients ( n = 50), trauma patients ( n = 36), as well as healthy controls ( n = 50). We assessed plasma concentrations of DLL1 using ELISA. We performed Area-under-receiver-operator-curve (AUROC) analysis to evaluate the diagnostic performance of DLL1 compared to leucocytes, C-reactive protein (CRP), and procalcitonin (PCT). Results: Plasma concentrations of DLL1 were strongly elevated already at sepsis onset and maintained elevated until day 7. In contrast, neither surgical patients nor patients after severe trauma presented with elevated levels, while conventional biomarkers of inflammation (e.g., leucocytes and CRP), responded. AUROC analysis revealed a cut-off of 30 ng/ml associated with the best diagnostic performance, yielding a superior accuracy of 91% for DLL1, compared to 75, 79, and 81% for CRP, leucocytes, and PCT. Conclusion: DLL1 is a novel host-derived biomarker for the diagnosis of sepsis with a better performance compared to established ones, most likely due to its high robustness in non-infectious inflammatory responses. Clinical Trial Registration: POCSEP-Trial DRKS00008090 ; MIRSI DRKS00005463 ; SPRINT DRKS00010991 .

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“…Although a PCT value would be useful to exclude bacterial meningitis in patients with convulsion presentation, elevation of serum PCT has been reported for several conditions other than bacterial infection. These conditions include severe trauma, surgery [ 8 ], burn injury [ 9 ], post cardiopulmonary arrest [ 10 ], severe liver failure [ 3 ], severe pancreatitis [ 11 ], and cardiac shock [ 12 ]. Any one of them can confuse diagnostic decisions based on a PCT value.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of Serum Procalcitonin in Patients with Convulsion in Emergency Department, an Observational Study

et al. 2020

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Procalcitonin (PCT), a widely used biomarker for bacterial infections, is sometimes measured in convulsion patients to distinguish bacterial infections including bacterial meningitis. However, serum PCT elevation is reported in several other conditions. This study assessed the diagnostic value of serum PCT concentrations in convulsion patients. This study examined a convulsion group: patients admitted to our critical care center during April 2018 through September 2019 via the emergency department presenting with convulsions. Randomly sampled patients admitted without convulsions were categorized as a non-convulsion group. Serum PCT analysis was performed with consideration of whether or not the patient had an infection. Diagnostic values of serum PCT for bacterial infection were evaluated for convulsion and non-convulsion patients using the positive likelihood ratio of PCT. This study found 84 patients as eligible for the convulsion group; 1:2 matched 168 control patients were selected as non-convulsion group members. The positive likelihood ratio for bacterial infection was found to be significantly lower in the convulsion group than in the control group (1.94 vs. 2.65) when setting the positive cut-off for PCT as 0.5 ng/mL. Convulsion patients had a higher PCT value. The positive likelihood ratio for patients without bacterial infection was lower.

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Procalcitonin: Usefulness in Acute Care Surgery and Trauma

Abstract: Although trends in PCT concentrations may offer insight, no standard approach can be recommended currently.

Cited by 38 publications

References 41 publications

Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Urinary [TIMP-2] × [IGFBP7] and serum procalcitonin to predict and assess the risk for short-term outcomes in septic and non-septic critically ill patients

Host-Derived Delta-Like Canonical Notch Ligand 1 as a Novel Diagnostic Biomarker for Bacterial Sepsis—Results From a Combinational Secondary Analysis

Diagnostic Value of Serum Procalcitonin in Patients with Convulsion in Emergency Department, an Observational Study

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