Abstract
We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups—those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.
Highlights
The systemic inflammatory response syndrome (SIRS) criteria comprising body temperature, heart rate, respiratory rate and white blood cell count, is used for sepsis diagnosis
A new recommended test, quick sequential organ failure assessment score, was introduced by the Sepsis-3 task force in 2016 [1]. qSOFA criteria consist of low blood pressure, increased respiratory rate (≥ 22 bpm) and altered mental status (Glasgow Coma Scale ≤ 14). qSOFA criteria show better specificity but lower sensitivity than SIRS criteria for predicting sepsis
Lactate was not included in the qSOFA model construction, the Sepsis-3 task force recommended serum lactate levels as a possible substitute for some qSOFA variables
Summary
The systemic inflammatory response syndrome (SIRS) criteria comprising body temperature, heart rate, respiratory rate and white blood cell count, is used for sepsis diagnosis. It has been argued that the sensitivity and specificity of SIRS criteria are limited in accuracy for the purpose of screening. A new recommended test, quick sequential organ failure assessment (qSOFA) score, was introduced by the Sepsis-3 task force in 2016 [1]. QSOFA criteria show better specificity but lower sensitivity than SIRS criteria for predicting sepsis. The addition of lactate level to qSOFA score performed better than qSOFA alone in emergency department (ED) patients with suspected sepsis [2]. Lactate was not included in the qSOFA model construction, the Sepsis-3 task force recommended serum lactate levels as a possible substitute for some qSOFA variables. A number of non-specific conditions can elevate serum lactate levels and serum lactate levels only cannot be used to predict bacterial sepsis without clinical judgment
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