Meta-analysis of procalcitonin for sepsis detection

Universitätsspital Basel, Bâle, Basel-City, Switzerland
The Lancet Infectious Diseases (Impact Factor: 22.43). 09/2007; 7(8):498-9; author reply 502-3. DOI: 10.1016/S1473-3099(07)70163-9
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Available from: Beat Müller, Jan 18, 2014
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    • "Pyuria criteria are derived from local data on female patients with UTIs [15]. PCT cutoffs are derived from data from our recent observational study and after extrapolation from patients with LRTIs and sepsis [36,41,42]. Patients with uncomplicated simple UTIs in the PCT group receive NSAIDs regardless of PCT values for symptom resolution given emerging data [43,44]. "
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    ABSTRACT: Urinary tract infections (UTIs) are among the most common infectious diseases and drivers of antibiotic use and in-hospital days. A reduction of antibiotic use potentially lowers the risk of antibiotic resistance. An early and adequate risk assessment combining medical, biopsychosocial and functional risk scores has the potential to optimize site-of-care decisions and thus allocation of limited health-care resources. The aim of this factorial design study is twofold: first, for Intervention A, it investigates antibiotic exposure of patients treated with a protocol based on the type of UTI, procalcitonin (PCT) and pyuria. Second, for Intervention B, it investigates the usefulness of the prognostic biomarker proadrenomedullin (ProADM) integrated into an interdisciplinary assessment bundle for site-of-care decisions. Methods and design This randomized controlled open-label trial has a factorial design (2 × 2). Randomization of patients will be based on a pre-specified computer-generated randomization list and independent for the two interventions. Adults with UTI presenting to the emergency department (ED) will be screened and enrolled after providing informed consent. For our first Intervention (A), we developed a protocol based on previous observational research to recommend initiation and duration of antibiotic use based on the clinical presentation of UTI, pyuria and PCT levels. For our second intervention (B), an algorithm was developed to support site-of care decisions based on the prognostic marker ProADM and distinct nursing factors on days 1 and 3. Both interventions will be compared with a control group conforming to the guidelines. The primary endpoints for the two interventions will be: (A) overall exposure to antibiotics and (B) length of physician-led hospitalization within a follow-up of 30 days. Endpoints are assessed at discharge from hospital, and 30 and 90 days after admission. We plan to screen 300 patients and enroll 250 for an anticipated estimated loss of follow-up of 20%. This will provide adequate power for the two interventions. This trial investigates two strategies for improved individualized medical care in patients with UTI. The minimally effective duration of antibiotic therapy is not known for UTIs, which is important for reducing the selection pressure for antibiotic resistance, costs and drug-related side effects. Triage decisions must be improved to reflect the true medical, biopsychosocial and functional risks in order to allocate patients to the most appropriate care setting and reduce hospital-acquired disability. Trial registration Trial registration number: ISRCTN13663741
    Full-text · Article · Mar 2013 · Trials
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    ABSTRACT: Procalcitonin (PCT) is a precursor peptide for the h ormone calcitonin and is frequently increased in overt sepsis. The aim of this study was to test diagnostic accuracy of procalcitonin among patients with positive systemic inflammatory response syndrome (SIRS) in identifying sepsis. In this cross sectional study, from 563 patients with positive SIRS admitted throug h the emergency department of a university hospital , we included 120 patients. Procalcitonin was measured s emi-quantitatively. Two groups of patients (with an d without infection) were defined based on clinical, laboratory and bacteriologic findings throughout th e admis- sion course; the serum PCT levels were compared between the two groups. Seventy two (60%) patients were male and 48 (40%) were female, and the mean age was 49.1 ± 20.2 years. Final diagnosis was infection i n 71 patients (59.2%) and 49 (40.8%) had non-infectious SIRS. When considering PCT > 0.5 �g/L as the cut-off point, PCT had a sensitivity of 88.7%, a specificity of 77.6%, a positive predictive value of 85.1% and a negative predictive value of 82.6%. Serum level of procalcitonin in infectious group was significantly higher than in non-infectious group ( P < 0.0001). PCT level was a predictor of mortality in patients with infectious SIRS. ( P = 0.01) In summary, PCT is a useful marker for diffe rentiating sepsis from other cause of SIRS. With change in the cut-off value of PCT in any situa tion its application can be maximized. Procalcitoni n can also be a good marker for predicting outcome in pat ients with infection.
    Full-text · Article · Jan 2009 · Acta medica Iranica
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    ABSTRACT: To assess the diagnostic value of procalcitonin (PCT), interleukin (IL)-6, IL-8, and standard measurements in identifying critically ill patients with sepsis, we performed prospective measurements in 78 consecutive patients admitted with acute systemic inflammatory response syndrome (SIRS) and suspected infection. We estimated the relevance of the different parameters by using multivariable regression modeling, likelihood-ratio tests, and area under the receiver operating characteristic curves (AUC). The final diagnosis was SIRS in 18 patients, sepsis in 14, severe sepsis in 21, and septic shock in 25. PCT yielded the highest discriminative value, with an AUC of 0.92 (CI, 0.85 to 1.0), followed by IL-6 (0.75; CI, 0.63 to 0.87), and IL-8 (0.71; CI, 0.59 to 0.83; p < 0.001). At a cutoff of 1.1 ng/ml, PCT yielded a sensitivity of 97% and a specificity of 78% to differentiate patients with SIRS from those with sepsis-related conditions. Median PCT concentrations on admission (ng/ ml, range) were 0.6 (0 to 5.3) for SIRS; 3.5 (0.4 to 6.7) for sepsis; 6.2 (2.2 to 85) for severe sepsis; and 21.3 (1.2 to 654) for septic shock (p < 0.001). The addition of PCT to a model based solely on standard indicators improved the predictive power of detecting sepsis (likelihood ratio test; p = 0.001) and increased the AUC value for the routine value-based model from 0.77 (CI, 0.64 to 0.89) to 0.94 (CI, 0.89 to 0.99; p = 0.002). In contrast, no additive effect was seen for IL-6 (p = 0.56) or IL-8 (p = 0.14). Elevated PCT concentrations appear to be a promising indicator of sepsis in newly admitted, critically ill patients capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection.
    Full-text · Article · Sep 2001 · American Journal of Respiratory and Critical Care Medicine
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