Serum procalcitonin in children with suspected sepsis: A comparison with C-reactive protein and neutrophil count*

Casado‐Flores, Juan; Blanco‐Quirós, Alfredo; Asensio, J.I.; Arranz, Eduardo; Garrote, José Antonio; Nieto, Monserrat

doi:10.1097/01.pcc.0000059420.15811.2d

Cited by 97 publications

(66 citation statements)

References 19 publications

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“…In distinguishing between sepsis and noninfective causes of inflammation in children and adults, the results of our study are consistent with the literature in that the specificity of PCT was higher than that of CRP, but they differ from the literature in that the sensitivity of CRP was higher than that of PCT (14)(15)(16)(17)(18). It was found in many child and adult studies that sepsis severity was associated with PCT and IL-6 but not associated with CRP (15,17,(19)(20)(21)(22)(23)(24). The results of our study were consistent with the literature in terms of CRP, but differ from the literature in that there was no significant difference between PCT and IL-6 in distinguishing between sepsis and septic shock.…”

Section: Discussionsupporting

confidence: 79%

Role of hepcidin in the diagnosis of sepsis and septic shock in children

2018

Turk J Med Sci

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Section: Discussionsupporting

confidence: 79%

Role of hepcidin in the diagnosis of sepsis and septic shock in children

2018

Turk J Med Sci

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“…(11) Procalcitonin has good discrimination for bacterial infections and sepsis (12)(13)(14)(15), and three trials used low procalcitonin levels to withhold antibiotics in emergency department (ED) patients presenting with respiratory illnesses. (16)(17)(18) However, two recent meta-analyses concluded that procalcitonin could not reliably differentiate sepsis from noninfectious inflammation in critically ill patients (19), and had only moderate diagnostic performance for identifying bacteremia in ED patients.…”

Section: Importancementioning

confidence: 99%

Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia

Huang

Weissfeld

Kellum

et al. 2008

Annals of Emergency Medicine

196

136

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Objective-The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia (CAP), but have limitations. Procalcitonin, a biomarker of bacterial infection, may provide prognostic information in CAP. Our objective was to describe the pattern of procalcitonin in CAP, and determine if procalcitonin provides prognostic information beyond PSI and CURB-65.Methods-We conducted a multi-center prospective cohort study in 28 community and teaching emergency departments. Patients presenting with a clinical and radiographic diagnosis of CAP were enrolled. We stratified procalcitonin levels a priori into four tiers -I: < 0.1; II: ≥ 0.1 to <0.25; III: ≥ 0.25 to < 0.5; and IV: ≥ 0.5 ng/ml. Primary outcome was 30d mortality.Results-1651 patients formed the study cohort. Procalcitonin levels were broadly spread across tiers: 32.8% (I), 21.6% (II), 10.2% (III), 35.4% (IV). Used alone, procalcitonin had modest test characteristics: specificity (35%), sensitivity (92%), positive likelihood ratio (LR) (1.41), and negative LR (0.22). Adding procalcitonin to PSI in all subjects minimally improved performance. Adding procalcitonin to low risk PSI subjects (Class I-III) provided no additional information. However, subjects in procalcitonin tier I had low 30d mortality regardless of clinical risk, including those in higher risk classes (1.5% vs. 1.6% for those in PSI Class I-III vs. Class IV/V). Among high risk PSI subjects (Class IV/V), one quarter (126/546) were in procalcitonin tier I, and the negative LR of procalcitonin tier I was 0.09. Procalcitonin tier I was also associated with lower burden of other adverse outcomes. Similar results were seen with CURB-65 stratification. Reprints not available from the authors.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Selective use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients. NIH Public Access

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“…6 Most available data on procalcitonin come from adults, but there are some pediatric studies. [7][8][9][10][11][12] These data may look better than they are. In many studies, procalcitonin was not measured when practitioners needed to know whether the patient was infected or not: it was sometimes measured days after the infection was suspected, and such time lag may have allowed its further increase in blood, which could increase its apparent diagnostic validity.…”

mentioning

confidence: 99%