Clinical Value Of Serum Procalcitonin Research Articles

Clinical Value of Serum Procalcitonin and C-reactive Protein in the Treatment of Patients with Respiratory Infection

Clinical Value of Serum Procalcitonin and C-reactive Protein in the Treatment of Patients with Respiratory Infection

Study on the clinical value of serum procalcitonin in early diagnosis of systemic bacterial infection

Objective To study the clinical value of serum procalcitonin(PCT) in early diagnosis of systemic bacterial infection. Methods 57 suspected bacterial infectious patients in our hospital were selected as observation group, and another 57 healthy subjects were selected as control group.Patients in the observation group were divided into sepsis group (A group, 19 cases), local bacterial infection group (B group, 19 cases) and bacterial infectious SIRS group (C group, 19 cases) according to ACCP/SCCM consensus conference and their clinical manifestations.The serum PCT levels in the 4 groups were detected and compared. Results There was no statistically significant differences in general situation (age, sex, height, weight and body mass index (BMI), etc.) between the two groups(P>0.05). After admission, the PCT level in the observation group was obviously higher than that in the control group, the level of PCT was the highest in group A, and the difference was statistically significant(F=94.88, P 0.05); the PCT level in the observation group was gradually decreased, the level of PCT in A group was still higher than that in the other three groups, and the differences were statistically significant(F=62.40, P<0.001; F=65.00, P<0.001; F=58.84, P<0.001; F=63.05, P<0.001). Conclusion Serum PCT has a certain advantage in sensitivity and specificity, it can reflect the severity of disease, it also has certain clinical significance in judging the development and prognosis of disease.Therefore, it can be considered as one of the first choice for clinical detection of bacterial infection. Key words: Procalcitonin; Bacterial infection; Early diagnosis; Clinical value

The clinical value of serum procalcitonin in diagnosis and treatment of community acquired pneumonia

Objective To investigate the clinical significance of serum level of the diagnosis and treatment of community acquired pneumonia. Methods 42 hospital patients with pneumonia obtained from community were slected as the observation group.According to patient outcome, they were divided into improvement group and aggravated group. Another selection during the same period in hospital for treatment of acute upper respiratory tract infection in patients with 30 cases was the control group. Respectively, in the 1 day,3 days,7 days the results of serum calcitonin angiotensinogen(PCT)and CRP were compared and analyzed. Results In observation group,PCT of first day,third days and seventh days were respectively(1.18±0.32)μg/L,(0.78±0.12)μg/L and(0.18±0.04)μg/L;CRP were respectively(154.15±21.58)mg/L,(67.42±20.35)mg/L and(15.43±7.76)mg/L.In the control group,PCT of first days,third days and seventh days were respectively(0.05±0.01)μg/L,(0.04±0.02)μg/L and(0.05±0.02)μg/L,while CRP were respectively(9.39±2.22)mg/L,(8.83±2.91)mg/L and(7.06±3.03)mg/L. There were significant differences between the two groups(t=6.15,10.85,4.86,58.69,16.79,11.99, all P<0.05).In the aggravated group,PCT levels of first days,third days and seventh days were significantly higher than that of the improved group, the differences were statistically significant(t=17.86,18.21,20.65,all P<0.05). Conclusion As a monitoring marker,PCT showed higher sensibility and specificity than CRP in diagnosis and treatment of CAP, and it would be helpful to make early diagnosis and certain the therapeutic schedule to use antibiotics. Key words: Procalcitonin; C-reaction protein; Community acquired pneumonia

Role of serum procalcitonin assay for diagnosis of spontaneous bacterial peritonitis in end-stage liver diseases

To explore the clinical value of serum procalcitonin (PCT) for predicting spontaneous bacterial peritonitis (SBP) in end-stage liver diseases. The clinical data of 362 ascitic inpatients with end-stage liver diseases who had underwent serum PCT assay in our department from March 2011 to June 2013 were analyzed retrospectively. These patients were then divided into SBP group (n=178) and non-SBP group (n=184). The dynamic changes of the PCT values upon admission and after antibiotic treatment were compared. The receiver operating characteristic curve was drawn to identify the optimal cut-off value of serum PCT in diagnosing SBP. The positive rate of bacteria culture in ascites was only 4.6% (4/87) in SBP group. The median value of serum PCT was 0.73 and 0.15 ng/ml in SBP group and non-SBP group (Z=-11.9, U=0.000), respectively, before antibiotic treatment. In the SBP group, the median value of serum PCT was 1.73 ng/ml in 13 patients with positive culture findings, which was higher than the overall median value in SBP group. Among patients who were responsive to the antibiotic therapy, the median values of serum PCT were 0.40(n=46), 0.32(n=19), and 0.33 ng/ml(n=25), respectively, 3, 5, and 7 days after the effective antibiotics treatment, which were significantly lower than the pre-treatment levels [0.86(Z=-5.91, U=0.000), 0.72(Z=-3.10, U=0.002), and 0.79 ng/ml(Z=-4.37, U=0.000), respectively]. ROC analysis showed that a serum PCT value of more than 0.462 ng/ml had a sensitivity of 83.7% and a specificity of 94.9%(AUC:0.95, 95%CI:0.93-0.97, P=0.00) in diagnosing SBP in patients with end-stage liver diseases. Ascitic fluid positive rate is low in SBP patients. Serum PCT is a sensitive and specific marker for predicting peritoneal bacteria infection in end-stage liver disease patients with ascites. Higher serum PCT can be expected in these patients with heavier infections, it can also be used to evaluate the effectiveness of anti-bacteria therapies.

The clinical value of serum procalcitonin in diagnosis and treatment for the patients with acute fever

Objective To investigate the clinical value of serum procalcitonin (PCT) in the diagnosis and treatment of the patients with high fever of acute illness.Methods A total of 285 febrile patients suffered from acute illness were divided into the conventional group (n =122) and the PCT group (n =163).The routine blood examination and serum level of C-reactive protein (CRP) detection were carried out for the dignosis of these febrile patiens of two groups,and in addition,serum PCT determination was carried out in the patients of PCT group.The diagnosis was comnfirmed by etiology or immunologic assays.Routine guidelines of administrating antibiotics were used for treatment in the conventional group.Whereas the antibiotic therapy given to patients of PCT group was guided by the serum PCT levels.Two groups were compared in respect of the antibiotics costs,duration of treatment with antibiotics,percentage of patients treated with antibiotics,efficiency of antibiotics treatment and the mortality rate.The patients of PCT group were further divided as per inflammatory markers of bacterial infection into three subgroups,namely bacterial infection group,viral infection group and non-infection group.At last,the relationship between serum PCT level and the prognosis of patients was analyzed.Results The cost of antibiotics,percentage of patients treated with antibiotics,and course of antibiotics treatment were (Y) (3586.5 ± 703.3),95.08％ and (15.01 ± 11.21) days,respectively in conventional group,whereas (Y) (1871.2 ± 433.5),54.60％,(11.22 ±7.10) days in PCT group with statistically significant difference between two groups (P ＜ 0.01),but there were no significant differences in clinical efficiency and mortality between groups (P ＞ 0.05).Serum PCT (1.12 ± 0.88) ng/ml in bacterial infection group was higher than that in both virus infected group (0.21 ± 0.1 1) ng/ml and non-infected group (0.18 ± 0.13) ng/ml.There was no statistics difference in serum PCT level between virus infected group and non-infected group (P ＞ 0.05).The diagnosis of bacterial infection with serum PCT was better than other inflammatory markers because serum PCT had high sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV).Conclusions Serum PCT level was reliable to differentiate the nature of acute infection with high fever and to evaluate the prognosis by emergency physicians.There was an important significance for rational use of antibiotics by the guidance of PCT levels. Key words: Acute fever; procalcitonin ; Infections

Clinical value of serum procalcitonin in the diagnosis of bacterial infections in the critical patients

Objective To evaluate the clinical value of serum procalcitonin (PCT) in the diagnosis of bacte-rial infections in the critically ill patients. Methods A loud d 100 cases of critical patients were divided into bacteri-al infection group(56 cases) and non-bacterial infection group(44 cases). Serum PCT was measured by immunolu-minometric assay. Results The concentration of PCT in bacterial infection group(21.54 ±5.72) μg/L, was signifi-cantly higher than non-bacterial infection group (11. 95±4. 58)μg/L (t =2.291,P<0.05);The APACHE Ⅲ score of bacterial infection group(62. 44 ± 19. 55) cent was significantly higher than non-bacterial infection group(44. 56 ± 25. 88) cent(t = 2. 195 ,P < 0. 05). The concentration of PCT of 1.0μg/L and 2. 0 p.g/L compared to the former sensitivity (96. 5) % higher than the latter (55.2) % (X2 = 3. 94, P < 0. 05), the former specificity (41.7) % lower than the latter (95.8)% (X2 = 4. 02 ,P < 0. 05);1.5μg/L as a positive standard Youden index and the Agreement (83.0 % ,0. 65), were significantly higher than 1 μg/L and 2 μg/L(71.7%, 0. 38 ;73.6% ,0. 51) (X2 = 3.84, X2=3. 90,X2 = 3.992 = 3.91 ,P < 0. 05);The concentration of PCT in death group (38. 9 ±12. 6)μg/L was signifi-canfly higher than the survival group(11.8± 8. 3) μg/L(t =2. 398 ,P <0. 05). Conclusion Serum PCT has clinical values in the diagnosis and therapy of bacterial infections in the critical patients. Key words: critical illness; bacterial infections; proealcitonin; values

The clinical value of procalcitonin in the prediction of infected necrois in acute pancreatitis

Infection of pancreatic necrosis (IN) has a major impact on management and outcome in acute pancreatitis (AP). Currently, guided fine-needle aspiration (FNA) is the only means for an accurate diagnosis of IN. Procalcitonin (PCT), a 116 amino acid pro-peptide of calcitonin has been found in high concentrations in patients with sepsis. In the present study we analyzed the clinical value of serum PCT for predicting IN in AP and compared the results to guided FNA. Clinical study. A collaborative study between the Departments of General Surgery and Clinical Chemistry/ Pathobiochemistry of the University of Ulm, Germany. 61 patients with AP entered this study and were stratified into three groups according to morphological and bacteriological data: I. 22 patients with edematous pancreatitis (AIP), II. 18 patients with sterile necrosis (SN), III. 21 patients with IN. During an observation period of 14 days PCT was measured by immunoluminometry, CRP was determined by lasernephelometry on a routine base. In patients with IN overall PCT concentrations were significantly higher than in those with SN, whereas CRP levels did not differ in both groups. In contrast, only low concentrations of both parameters were found in patients with AIP. By ROC analysis the best PCT cut-off level for predicting IN or persisting pancreatic sepsis was obtained at > or =1.8 ng/ml. If this cut-off was reached on at least two consecutive days, IN could be predicted with a sensitivity of 95%, a specificity, of 88%, and an accuracy of 90%. Guided FNA achieved a sensitivity, specificity, and accuracy of 91%. 79%, and 84% in differentiating IN from SN, respectively. After surgical treatment of IN median PCT values continued to be significantly higher in patients with persisting pancreatic sepsis (n=12) compared to those with an uneventful postoperative course (n=7). Our results demonstrate that monitoring of serum PCT could serve as a noninvasive and accurate method to predict IN in AP as well as to select patients with persisting septic complications after surgical debridement.