Introduction/Objective: Sepsis is one of the leading causes of mortality in the intensive care unit (ICU). Its diagnosis is often complex and represents a real clinical challenge. The objective of this study was to evaluate the usefulness of procalcitonin (PCT) as a diagnostic marker of sepsis.
Methods: This prospective cohort study included 65 patients hospitalized in the ICU. Demographic and clinical data were collected according to a specific information sheet. All patients underwent an inflammatory assessment including PCT, hypersensitive C - reactive protein (hsCRP), and complete blood count. The Sequential Organ Failure Assessment (SOFA) score was calculated. Patients were classified into septic (SOFA ≥ 2 points) and non-septic (SOFA < 2 points). The Receiver Operating Characteristic (ROC) curve was used to evaluate the diagnostic performance of inflammatory parameters.
Results: Of 65 included patients, 46 had developed sepsis. Among the investigated inflammatory markers, PCT has the best discriminative capacity; its area under the curve (AUC), of 0.78, was the highest, followed by the neutrophils to lymphocytes ratio (NLR) and hsCRP with a lower but statically significant AUC. The optimal PCT threshold for sepsis diagnosis was 4.5ng/ml with a specificity of 83% and a sensitivity of 60%. A positive correlation between the PCT levels and the SOFA score was also found (p=0.002).
Conclusion: This study provides additional evidence of the performance of PCT in the diagnosis of septic states in patients admitted to ICU. The newly established cut-off value provides the best balance between specificity and sensitivity. Its superiority over conventional inflammatory markers has been demonstrated.
Downes KJ, Fitzgerald JC, Weiss SL. Utility of Procalcitonin as a Biomarker for Sepsis in Children. J Clin Microbiol. 2020;58(7). https://doi.org/10.1128/jcm.01851-19
Vijayan AL, Vanimaya, Ravindran S, Saikant R, Lakshmi S, Kartik R, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care. 2017;5(1). https://doi.org/10.1186/s40560-017-0246-8
Annane D, Bellissant E, Cavaillon J-M. Septic shock. Lancet. 2005;365(9453):63–78. https://doi.org/10.1016/S0140-6736(04)17667-8
Jämsä J, Ala-Kokko T, Huotari V, Ohtonen P, Savolainen E-R, Syrjälä H. Neutrophil CD64, C-reactive protein, and procalcitonin in the identification of sepsis in the ICU — Post-test probabilities. J Crit Care. 2018;43:139–42. https://doi.org/10.1016/j.jcrc.2017.08.038
Jiang L, Feng B, Gao D, Zhang Y. Plasma concentrations of copeptin, C-reactive protein and procalcitonin are positively correlated with APACHE II scores in patients with sepsis. The J Int Med Res. 2015;43(2):188–95. https://doi.org/10.1177/0300060514561136
BeqjaLika A, BuloKasneci A, Refatllari E, HetaAlliu N, RucajBarbullushi A, Mone I, et al. Serum Procalcitonine Levels as an Early Diagnostic Indicator of Sepsis. Mat Soc Med. 2013;25(1):23. https://doi.org/10.5455/msm.2013.25.23-25
van der Geest PJ, Mohseni M, Linssen J, Duran S, de Jonge R, Groeneveld ABJ. The intensive care infection score - a novel marker for the prediction of infection and its severity. Crit Care (London, England). 2016;20(1):180. https://doi.org/10.1186/s13054-016-1366-6
Maruna P, Nedelníková K, Gürlich R. Physiology and genetics of procalcitonin. Physiol Res. 2000;49 Suppl 1:S57-61. https://doi.org/10.1186/s13054-016-1366-6
Ljungström L, Pernestig A-K, Jacobsson G, Andersson R, Usener B, Tilevik D. Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis. Azevedo LCP, editor. PLoS One. 2017;12(7):e0181704. https://doi.org/10.1371/journal.pone.0181704
Zhang H, Wang X, Zhang Q, Xia Y, Liu D. Comparison of procalcitonin and high-sensitivity C-reactive protein for the diagnosis of sepsis and septic shock in the oldest old patients. BMC Geriatr. 2017;17(1). https://doi.org/10.1186/s12877-017-0566-5
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):801–10. https://doi.org/10.1001/jama.2016.0287
Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation*. Crit Care Med. 2009 May;37(5):1649–54. https://doi.org/10.1097/ccm.0b013e31819def97
Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B,Grau Georges E, et al. Diagnostic Value of Procalcitonin, Interleukin-6, and Interleukin-8 in Critically Ill Patients Admitted with Suspected Sepsis. Am J Respir Crit Care Med. 2001;164(3):396–402. https://doi.org/10.1164/ajrccm.164.3.2009052
Müller B, Becker KL, Schächinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000;28(4):977–83. https://doi.org/10.1097/00003246-200004000-00011
Jekarl DW, Lee S, Kim M, Kim Y, Woo SH, Lee WJ. Procalcitonin as a prognostic marker for sepsis based on SEPSIS‐3. J Clin Lab Anal. 2019;33(9). https://doi.org/doi.org/10.1002/jcla.22996
Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A. Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med. 2003;31(6):1737–41. https://doi.org/10.1097/01.ccm.0000063440.19188.ed
Kyriazopoulou E, Liaskou-Antoniou L, Adamis G, Panagaki A, Melachroinopoulos N, Drakou E, et al. Procalcitonin to Reduce Long-Term Infection-associated Adverse Events in Sepsis. A Randomized Trial. Am J Respir Crit Care Med. 2021;203(2):202–10. https://doi.org/10.1164/rccm.202004-1201oc
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