Sepsis Biomarkers. Value and Limitations

Vincent, Jean‐Louis; Teixeira, Larissa Silva

doi:10.1164/rccm.201410-1895ed

Cited by 29 publications

(23 citation statements)

References 13 publications

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“…PCT levels are highly correlated with bloodstream infections [12], and a recent meta-analysis demonstrated that elevated PCT levels and PCT non-clearance were related with an increased risk of sepsis and a higher mortality rate [13]. PCT is accurate for sepsis diagnosis, and its kinetics exhibit good correlation with sepsis severity [14]. Therefore, PCT is recommended in diverse clinical settings, including the exclusion of a bacterial cause in lower respiratory infections [15] as well as the diagnosis, stratification, prognosis [16, 17] and antimicrobial administration guidance in septic patients [18] and the diagnosis of postoperative infections [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

et al. 2018

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BackgroundEarly sepsis diagnosis is crucial for the correct management of burn patients, and it clearly influences outcomes. The systemic inflammatory response triggered by burns mimics sepsis presentation and complicates early sepsis diagnosis. Biomarkers were advocated to aid the diagnosis of early sepsis. Serum procalcitonin (PCT) exhibits fair accuracy and good correlation with sepsis severity, being used in diverse clinical settings. However, few studies have evaluated perioperative changes in PCT levels in burn patients. The present study evaluated PCT kinetics during the first days after burn injury and subsequent surgical interventions to assess PCT utility in distinguishing septic from non-septic inflammatory responses.MethodsThis study was a retrospective observational study of all burn patients admitted to the Coimbra Burns Unit (Portugal) between January 2011 and December 2014 who presented with a total burn surface area ≥ 15% and who underwent subsequent surgery. PCT kinetics were investigated a) during the first five days after burn injury and b) preoperatively during the five days after surgery in three subsets of patients, including those with no preoperative and no postoperative sepsis (NN), no preoperative but postoperative sepsis (NS), and preoperative and postoperative sepsis (SS). A total of 145 patients met the selection criteria and were included in the analysis.ResultsPCT levels in the first five days after burn injury were significantly higher in patients who developed at least one sepsis episode (n = 85) compared with patients who did not develop sepsis (n = 60). PCT values > 1.00 ng/mL were clearly associated with sepsis. Study participants (n = 145) underwent a total of 283 surgical interventions. Their distribution by preoperative/postoperative sepsis status was 142 (50.2%) in NN; 62 (21.9%) in NS; and 79 (27.9%) in SS. PCT values exhibited a parallel course in the three groups that peaked on the second postoperative day and returned to preoperative levels on the third day or later. The lowest PCT values were found in NN, and the highest values were observed in SS; the NS values were intermediate.ConclusionsPCT kinetics coupled with a clinical examination may be helpful for sepsis diagnosis during the first days after burn injury and burn surgery.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0585-6) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

et al. 2018

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“…It may be that restorative immunotherapy, in which adjuvants that stimulate host immunity would be the centerpiece for response modification, offers the most promise. To guide sepsis immunotherapy, new methods to determine the health of the various components of a patient’s immune system are being developed and may direct the application of targeted immune-adjuvant therapies in the future ( 15 ).…”

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confidence: 99%

Getting sepsis therapy right

Hotchkiss

Sherwood

2015

Science

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“…In this regard, our results confirm those obtained by Koya et al 18 in a small series of 28 patients, demonstrating that persistent low values of biomarkers, particularly CRP and proADM, almost certainly rule out a bacterial-fungal infection as the etiologic agent of the RI in these patients, information that may encourage the physician in charge to withhold specific antibiotic prescriptions with potential serious adverse effects. 34 Other authors have found that levels of PCT allow for discrimination between episodes of fever caused by bacteria, fungi and parasites from fever of viral etiologies. 35 Reasons for the absence of elevation of these biomarkers in viral infections are not well understood, but it has been shown that, by secreting interferongamma, viruses induce an inhibitory effect on PCT gene transcription.…”

Section: Discussionmentioning

confidence: 99%

The clinical value of biomarkers in respiratory complications in hematopoietic SCT

Lucena

Rovira

Gabarrús

et al. 2016

Bone Marrow Transplant

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To determine the role of biomarkers in the clinical management of respiratory complications (RC) in hematopoietic stem cell transplantation (HSCT) recipients, we have prospectively evaluated a cohort of 175 patients followed-up for 1 year after HSCT. To avoid misinterpretation, we have excluded both unidentified respiratory infections (RI) and mixed RI. A total of 64 RC were included. Plasma levels of C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) were measured at diagnosis and on day 3 and 7. Different cytokines were evaluated in serum on the first day. No HSCT recipients without RC were included as a control group. Compared with RI, non-infectious RC showed a significant increase in CRP, proADM and interleukin 6 on day 0 (P=0.005; P=0.03 and P=0.04, respectively). When only RI were considered, we observed that bacterial-fungal PI showed higher levels of CRP (P=0.02), PCT (P=0.04) and proADM (P<0.01). Persistent low levels of proADM biomarkers suggest viral infection (specificity and positive predictive value 100%). Patients dying of RC had PCT and proADM levels higher than survivors (P=0.002 and P=0.03, respectively). In HSCT recipients biomarkers increase in both infectious and non-infectious RC. They may have utility in the assessment of the severity of RC and in suspecting a viral etiology.

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Sepsis Biomarkers. Value and Limitations

Cited by 29 publications

References 13 publications

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

Procalcitonin kinetics after burn injury and burn surgery in septic and non-septic patients – a retrospective observational study

Getting sepsis therapy right

The clinical value of biomarkers in respiratory complications in hematopoietic SCT

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