Sepsis biomarkers in neutropaenic systemic inflammatory response syndrome patients on standard care wards

Ratzinger, Franz; Haslacher, Helmuth; Perkmann, Thomas; Schmetterer, Klaus G.; Poeppl, Wolfgang; Mitteregger, Dieter; Dorffner, Georg; Burgmann, Heinz

doi:10.1111/eci.12476

Cited by 16 publications

(15 citation statements)

References 40 publications

(63 reference statements)

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“…Between July 2011 and September 2012, patients with clinically suspected sepsis were evaluated on 14 medical and 13 surgical standard care wards of Vienna General Hospital (latitude 48°N), Austria. As described elsewhere52535455, patients for whom the treating physician had requested a blood culture analysis were screened for fulfilment of two or more SIRS criteria, as defined by the ACCP/SCCM conference56. Iatrogenic neutropenia related to chemotherapy was not recognized as a valid SIRS criterion.…”

Section: Methodsmentioning

confidence: 99%

25(OH)D and 1,25(OH)D vitamin D fails to predict sepsis and mortality in a prospective cohort study

Ratzinger

Haslacher

Stadlberger

et al. 2017

Sci Rep

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The clinical role of vitamin D in sepsis and mortality prediction is controversially discussed. Therefore, we conducted a prospective cohort study on standard care wards, including 461 patients with suspected sepsis fulfilling two or more SIRS criteria. On the first and third day after onset of SIRS symptoms levels of 25(OH)D, 1,25(OH)D and sepsis biomarkers were analysed for their predictive capacity for identifying infection, bacteraemia and an elevated mortality risk. Additionally, several SNPs associated with vitamin D metabolism were evaluated. Bacteraemic patients (28.5%) presented with significantly lower 1,25(OH)D levels than SIRS patients without bacteraemia on the first and third day, while 25(OH)D did not show a predictive capacity. No significant differences of either 1,25(OH)D or 25(OH)D levels were found between SIRS patients with and without infections or between survivors and non-survivors. Sepsis biomarkers, including procalcitonin and CRP, showed a significantly higher discriminatory capacity for these classification tasks. The vitamin D metabolism-related SNPs analysed did not indicate any association with our outcome measures. In conclusion, 1,25(OH)D but not 25(OH)D showed a minor discriminatory value for the prediction of bacteraemia that was inferior to CRP and PCT but both failed to predict sepsis and mortality in a prospective cohort of SIRS patients.

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Section: Methodsmentioning

confidence: 99%

25(OH)D and 1,25(OH)D vitamin D fails to predict sepsis and mortality in a prospective cohort study

Ratzinger

Haslacher

Stadlberger

et al. 2017

Sci Rep

Self Cite

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show abstract

“…122 However, in neutropenic patients with sepsis, neither PCT nor CRP differed significantly between patients with and without an infection, thus they seem to offer little help in early differentiation between bacterial infection and inflammation in this population. 123 …”

Section: Diagnosismentioning

confidence: 99%

Bloodstream infections in neutropenic cancer patients: A practical update

2016

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Bloodstream infections (BSI) are among the most frequent complications in neutropenic cancer patients and, if caused by Gram-negative rods, are associated with high mortality. Thus, fever during neutropenia warrants prompt empirical antibiotic therapy which should be active against the most frequent Gram-negatives. In the last decade, there has been a worldwide increase in multidrug resistant (MDR) strains. In these cases, the traditional choices such as oral therapy, ceftazidime, cefepime, piperacillin-tazobactam, or even carbapenems, might be ineffective. Therefore novel deescalation approach has been proposed for patients who are at high risk for infections due to MDR bacteria. It consists of starting antibiotics which cover the most probable resistant strain but it is narrowed down after 72 hours if no MDR pathogen is isolated. With increasing bacterial resistance, the benefit of fluoroquinolone prophylaxis during prolonged neutropenia remains to be confirmed. Antibiotic stewardship and infection control programs are mandatory in every cancer center.

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“…The role of PCT in detecting sepsis in immunocompromised patients, however, remains controversial as studies have shown conflicting results. [32][33][34][35] On the other hand, PCT has demonstrated an acceptable accuracy for the diagnosis of bacterial infections in septic patients with liver cirrhosis compared to patients with normal liver function. [36] These results contrast with those of Tang et al [37] who described a low diagnostic performance of PCT in differentiating sepsis from non-infectious SIRS in critically ill adults.…”

Section: Pct As a Diagnostic Toolmentioning

confidence: 99%

Procalcitonin: A promising tool or just another overhyped test?

Paudel¹,

Dogra²,

Montgomery-Yates³

et al. 2020

Int. J. Med. Sci.

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Sepsis is the leading cause of death worldwide. Timely administration of antibiotics is recognized as the cornerstone in the management of sepsis. However, inappropriate use of antibiotics may lead to adverse effects and the selection of drug-resistant pathogens. Microbiological cultures remain the gold standard to diagnose infection despite their low sensitivity and the intrinsic delay to obtain the results. Certain biomarkers have the benefit of rapid turnover, potentially providing an advantage in timely diagnosis leading to accurate treatment. Over the last few decades, there is an ongoing quest for the ideal biomarker in sepsis. Procalcitonin (PCT), when used alone or alongside additional clinical information, has shown to be a promising tool to aid in the diagnosis and management of patients with sepsis. In February 2017, the Food and Drug Administration (FDA) approved the use of PCT to guide antibiotic treatment in lower respiratory tract infections and sepsis. Despite a good negative predictive value for bacterial infection, the utility of PCT-guided antibiotic initiation is conflicting at best. On the other hand, the use of PCT-guided antibiotic discontinuation has shown to reduce the duration of antibiotic use, the associated adverse effects, and to decrease the overall mortality. The current review discusses the history and pathophysiology of procalcitonin, synthesizes its utility in the diagnosis and management of sepsis, highlights its limitations and compares it with other biomarkers in sepsis.

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Sepsis biomarkers in neutropaenic systemic inflammatory response syndrome patients on standard care wards

Cited by 16 publications

References 40 publications

25(OH)D and 1,25(OH)D vitamin D fails to predict sepsis and mortality in a prospective cohort study

25(OH)D and 1,25(OH)D vitamin D fails to predict sepsis and mortality in a prospective cohort study

Bloodstream infections in neutropenic cancer patients: A practical update

Procalcitonin: A promising tool or just another overhyped test?

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