Comparison of procalcitonin and high-sensitivity C-reactive protein for the diagnosis of sepsis and septic shock in the oldest old patients

Hongmin Zhang,Qing Zhang,Dawei Liu,Ying Xia,Xiaoting Wang

doi:10.1186/s12877-017-0566-5

Abstract

BackgroundAlthough the role of serum procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of sepsis and septic shock is well studied, it has not been investigated among oldest old patients. The aim of our study is to determine the role of PCT and hs-CRP in the assessment of sepsis and septic shock in this specific group of patients in the ICU.MethodsThis is a prospective observational study. Patients >85 years of age admitted to the ICU from May 1st, 2016 to February 1st, 2017 were evaluated. Patients were divided into a sepsis and septic shock group(sepsis/SS) and a non-sepsis group. Serum levels of PCT, hs-CRP and the WBC were measured within 12 h of admission.ResultsA total of 70 patients aged 85 years and older were enrolled in this study. Fifty patients were labelled as sepsis/SS and the other 20 were labelled non-sepsis. A ROC analysis showed that the area under the curves (AUC) of hs-CRP and PCT for the discrimination of sepsis/SS patients were 0.825 (95% confidence interval[CI]: 0.73-0.92; P < 0.001) and 0.819 (95%CI:0.72-0.92; p < 0.001), respectively. In a subgroup analysis of the sepsis/SS group, 27 patients had sepsis, while the other 23 patients had septic shock. The ROC analysis showed that the AUCs of hs-CRP and PCT for the discrimination of septic shock patients from sepsis patients were 0.751 (95% CI: 0.62-0.88; P = 0.002) and 0.719 (95% CI:0.57-0.86; p = 0.007), respectively.ConclusionFor the oldest old patients, hs-CRP is not inferior to PCT in the diagnosis of sepsis and septic shock.

Highlights

The role of serum procalcitonin (PCT) and high-sensitivity C-reactive protein in the diagnosis of sepsis and septic shock is well studied, it has not been investigated among oldest old patients
The Receiver operating characteristic (ROC) analysis showed that high-sensitivity C-reactive protein (hs-CRP) was a good marker for the discrimination of sepsis/SS patients, with an area under the curve (AUC) of 0.825 (95% confidence interval[CI]: 0.73-0.92; P
In this study, we found that hs-CRP was as good as PCT for the diagnosis of sepsis and septic shock among the oldest old patients

Summary

Introduction

The role of serum procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the diagnosis of sepsis and septic shock is well studied, it has not been investigated among oldest old patients. The aim of our study is to determine the role of PCT and hs-CRP in the assessment of sepsis and septic shock in this specific group of patients in the ICU. As the geriatric population continues to grow, the number of oldest old patients admitted to the intensive care unit (ICU) will increase . Sepsis is the leading cause of mortality in critically ill patients. Procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) are the most frequently used biomarkers for critically ill patients in whom sepsis is suspected [6]. Whether PCT is still more useful than hs-CRP in diagnosing sepsis in oldest old patients has not been investigated.

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