Procalcitonin in early rule-in/rule-out of sepsis in SIRS patients admitted to a medical ward
-
Nicola Fiotti
,
Maurizio Ruscio
Abstract
Background: A relevant amount of patients with clinical suspect of sepsis is admitted and treated in medical wards (MW). These patients have a better prognosis but are older and with more comorbidities compared to those admitted to intensive care units (ICU). Procalcitonin (PCT) is extensively used in emergency departments for the diagnosis of sepsis, but its accuracy in the setting of a MW has not been thoroughly investigated. Predicted low PCT levels also call for the comparison of immunomagnetic-chemiluminescent (L-PCT) and time-resolved amplified cryptate emission (TRACE, K-PCT) technologies, in PCT determination.
Methods: In 80 patients with systemic inflammatory response syndrome (SIRS) diagnostic criteria and suspect of sepsis newly admitted to a MW, PCT was determined with L- and K-PCT method.
Results: Sixty patients were diagnosed as sepsis (20 microbiologically and 40 clinically proven) and 20 with non-infective SIRS. The sepsis group had significantly higher levels of both PCTs, with no differences between the clinically and microbiologically proven subgroups. The areas under ROC curves for L- and K-PCT were 0.72 and 0.78 (p<0.001 for each), respectively. Based on MW customized cut-off values of 0.150 (L-PCT) and 0.143 ng/mL (K-PCT), overall accuracies were 66.8 (95% CI 58.7–78.9) and 78.2% (69.8–87.2), respectively, compared to the 55% (44.2–66) of 0.5 ng/mL canonical cut-off. Neither PCT-L nor -K held prognostic value on survival.
Conclusions: In MW patients, customized PCT cut-off levels provide better accuracy than customary levels adopted from ICU, and TRACE technology seems to offer a wider analysis range.
Acknowledgments
We are indebted to Paola Pitacco and Dr. Ilaria De Fabris for their excellent technical support. The study has been supported by SIRS group: Marina De Roia, Alessandra Ludicello, Silvia Marizza, Giulia Montanari, Irene Paoli, Denis Valentini.
Conflict of interest statement
Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
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©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
- Preface
- Biomarkers in the emergency department. Handle with care
- Editorial
- Copeptin in critical illness
- Reviews and Mini Reviews
- Role of presepsin for the evaluation of sepsis in the emergency department
- Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making
- How galectin-3 changes acute heart failure decision making in the emergency department
- Galectin-3 in diabetic patients
- Practical experience using galectin-3 in heart failure
- Novel biomarkers in acute heart failure: MR-pro-adrenomedullin
- The role of glycemia in acute heart failure patients
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- Original Articles
- Copeptin decrease from admission to discharge has favorable prognostic value for 90-day events in patients admitted with dyspnea
- Comparison between white blood cell count, procalcitonin and C reactive protein as diagnostic and prognostic biomarkers of infection or sepsis in patients presenting to emergency department
- Procalcitonin in early rule-in/rule-out of sepsis in SIRS patients admitted to a medical ward
- May thrombopoietin be a useful marker of sepsis severity assessment in patients with SIRS entering the emergency department?
- Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department
- Acute metformin intoxication: 2012 experience of Emergency Departement of Lodi, Italy
- Structural myocardial alterations in diabetes and hypertension: the role of galectin-3
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Articles in the same Issue
- Frontmatter
- Preface
- Biomarkers in the emergency department. Handle with care
- Editorial
- Copeptin in critical illness
- Reviews and Mini Reviews
- Role of presepsin for the evaluation of sepsis in the emergency department
- Opinion paper on utility of point-of-care biomarkers in the emergency department pathways decision making
- How galectin-3 changes acute heart failure decision making in the emergency department
- Galectin-3 in diabetic patients
- Practical experience using galectin-3 in heart failure
- Novel biomarkers in acute heart failure: MR-pro-adrenomedullin
- The role of glycemia in acute heart failure patients
- Copeptin (CTproAVP), a new tool for understanding the role of vasopressin in pathophysiology
- Original Articles
- Copeptin decrease from admission to discharge has favorable prognostic value for 90-day events in patients admitted with dyspnea
- Comparison between white blood cell count, procalcitonin and C reactive protein as diagnostic and prognostic biomarkers of infection or sepsis in patients presenting to emergency department
- Procalcitonin in early rule-in/rule-out of sepsis in SIRS patients admitted to a medical ward
- May thrombopoietin be a useful marker of sepsis severity assessment in patients with SIRS entering the emergency department?
- Bleeding prevalence and transfusion requirement in patients with thrombocytopenia in the emergency department
- Acute metformin intoxication: 2012 experience of Emergency Departement of Lodi, Italy
- Structural myocardial alterations in diabetes and hypertension: the role of galectin-3
- A new device for the prompt diagnosis of urinary tract infections
