Predictive Value Of Procalcitonin Research Articles

Combining Serum Procalcitonin Level, Thromboelastography, and Platelet Count to Predict Short-term Development of Septic Shock in Intensive Care Unit.

Despite the recent advances in diagnosis and treatment, sepsis continues to lead to high morbidity and mortality. Early diagnosis and prompt treatment are essential to save lives. However, most biomarkers can only help to diagnose sepsis, but cannot predict the development of septic shock in high-risk patients. The present study determined whether the combined measurement of procalcitonin (PCT), thromboelastography (TEG) and platelet (PLT) count can predict the development of septic shock. A retrospective study was conducted on 175 septic patients who were admitted to the intensive care unit between January 2017 and February 2021. These patients were divided into two groups: 73 patients who developed septic shock were assigned to the septic shock group, while the remaining 102 patients were assigned to the sepsis group. Then, the demographic, clinical and laboratory data were recorded, and the predictive values of PCT, TEG and PLT count for the development of septic shock were analyzed. Compared to the sepsis group, the septic shock group had statistically lower PLT count and TEG measurements in the R value, K value, α angle, maximum amplitude, and coagulation index, but had longer prothrombin time (DT), longer activated partial thromboplastin time (APTT), and higher PCT levels. Furthermore, the Sequential Organ Failure Assessment (SOFA) score was higher in the septic shock group. The multivariate logistic regression analysis revealed that PCT, TEG and PLT count were associated with the development of septic shock. The area under the curve analysis revealed that the combined measurement of PCT, TEG and PLT count can be used to predict the development of septic shock with higher accuracy, when compared to individual measurements. The combined measurement of PCT, TEG and PLT count is a novel approach to predict the development of septic shock in high-risk patients.

191. Predictive Value of Procalcitonin across Disease States within an Inpatient Veteran Population

Abstract Background Procalcitonin (PCT) can be elevated with certain bacterial infections. Debate continues as to how to best use this biomarker to guide antibiotic use. The primary objective of this study was to evaluate the correlation of PCT levels and the presence of bacterial infection on admission in the total population and in different disease states. Methods This was a multicenter retrospective cross-sectional study of patients admitted with specified infectious diagnoses to two VA Medical Centers from 4/1/2019 to 7/1/2021. Patients were stratified into 4 cohorts for analysis; those with COVID-19, sepsis from respiratory source_(S-R), sepsis from non-respiratory source (S-NR), and respiratory source without sepsis (R). Electronic medical records were reviewed to collect the following: initial procalcitonin, cultures, SIRS criteria, comorbidities (CKD, ESRD, HF, immunosuppressed, surgery within the 7 days), and c-reactive protein. PCT elevation was defined as ≥0.25 ng/mL. The frequency of positive cultures within 72 hours was evaluated for patients with elevated and normal PCT levels to determine the diagnostic performance of PCT overall and for each cohort. Results 632 of 664 patients were evaluated in this study. PCT is elevated twice as often in the septic groups as compared to the non-septic groups (figure 1). Positive predictive value (PPV) varies from 27% to 63% as compared to negative predictive value (NPV) 53%-79% among the disease state groups (figure 2). Although small numbers, the NPV of PCT improves to 83% in patients with elevated temperature and white blood cells (WBC) (figure 3). Figure 1Figure 2Figure 3 Conclusion The findings that NPV of PCT appears to be better than PPV, support current recommendations against using this as a diagnostic tool, but rather as a tool to assist with antibiotic de-escalation. Further studies are necessary to confirm whether there are specific markers such as temperature or WBC which may improve the NPV. Our data suggests PCT is less helpful in identifying the presence or absence of bacterial infection in septic versus non-septic patients. Disclosures All Authors: No reported disclosures.

Procalcitonin in early allograft dysfunction after orthotopic liver transplantation: a retrospective single centre study

BackgroundIschemia–reperfusion injury (IRI) is the pathophysiological hallmark of hepatic dysfunction after orthotopic liver transplantation (OLT). Related to IRI, early allograft dysfunction (EAD) after OLT affects short- and long-term outcome. During inflammatory states, the liver seems to be the main source of procalcitonin (PCT), which has been shown to increase independently of bacterial infection. This study investigates the association of PCT, IRI and EAD as well as the predictive value of PCT during the first postoperative week in terms of short- and long-term outcome after OLT.MethodsPatients ≥ 18 years undergoing OLT between January 2016 and April 2020 at the University Hospital of Zurich were eligible for this retrospective study. Patients with incomplete PCT data on postoperative days (POD) 1 + 2 or combined liver-kidney transplantation were excluded. The PCT course during the first postoperative week, its association with EAD, defined by the criteria of Olthoff, and IRI, defined as aminotransferase level > 2000 IU/L within 2 PODs, were analysed. Finally, 90-day as well as 12-month graft and patient survival were assessed.ResultsOf 234 patients undergoing OLT, 110 patients were included. Overall, EAD and IRI patients had significantly higher median PCT values on POD 2 [31.3 (9.7–53.8) mcg/l vs. 11.1 (5.3–25.0) mcg/l; p < 0.001 and 27.7 (9.7–51.9) mcg/l vs. 11.5 (5.5–25.2) mcg/l; p < 0.001] and impaired 90-day graft survival (79.2% vs. 95.2%; p = 0.01 and 80.4% vs. 93.8%; p = 0.033). IRI patients with PCT < 15 mcg/l on POD 2 had reduced 90-day graft and patient survival (57.9% vs. 93.8%; p = 0.001 and 68.4% vs. 93.8%; p = 0.008) as well as impaired 12-month graft and patient survival (57.9% vs. 96.3%; p = 0.001 and 68.4% vs. 96.3%; p = 0.008), while the outcome of IRI patients with PCT > 15 mcg/l on POD 2 was comparable to that of patients without IRI/EAD.ConclusionGenerally, PCT is increased in the early postoperative phase after OLT. Patients with EAD and IRI have a significantly increased PCT maximum on POD 2, and impaired 90-day graft survival. PCT measurement may have potential as an additional outcome predictor in the early phase after OLT, as in our subanalysis of IRI patients, PCT values < 15 mcg/l were associated with impaired outcome.

Predictive Values of Procalcitonin and Presepsin for Acute Kidney Injury and 30-Day Hospital Mortality in Patients with COVID-19.

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with coronavirus disease 2019 (COVID-19). We investigated the values of procalcitonin (PCT) and presepsin (PSS) for predicting AKI and 30-day hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively evaluated 151 patients with COVID-19 who were admitted to the hospital via the emergency department. The diagnosis of AKI was based on the Kidney Disease: Improving Global Outcomes clinical practice guidelines. Results: The median patient age was 77 years, and 86 patients (57%) were male. Fifty-six patients (37.1%) developed AKI, and 19 patients (12.6%) died within 30 days of hospital admission. PCT and PSS levels were significantly higher in patients with AKI and non-survivors. The cutoff values of PCT levels for predicting AKI and mortality were 2.26 ng/mL (sensitivity, 64.3%; specificity, 89.5%) and 2.67 ng/mL (sensitivity, 68.4%; specificity, 77.3%), respectively. The cutoff values of PSS levels for predicting AKI and mortality were 572 pg/mL (sensitivity, 66.0%; specificity, 69.1%) and 865 pg/mL (sensitivity, 84.6%; specificity, 76.0%), respectively. Conclusion: PCT and PSS are valuable biomarkers for predicting AKI and 30-day hospital mortality in patients with COVID-19.

Predictive Value of Procalcitonin and Neutrophil-to-Lymphocyte Ratio Variations for Bloodstream Infection with Septic Shock.

BackgroundLittle is known of neutrophil-to-lymphocyte ratio (NLR) variations in septic shock. Hence, the predictive value of procalcitonin (PCT) and NLR variations for septic shock in bloodstream infection were explored.Material/MethodsWe analyzed 146 patients with bloodstream infection admitted to the Intensive Care Unit (ICU) of the First Affiliated Hospital of Anhui Medical University from October 2016 to May 2020. PCT and NLR were evaluated at 0 and 48 h after admission, and their variations (ΔPCT and ΔNLR) were calculated. The patients were divided into a shock group (n=80) and a non-shock group (n=66) and a gram-positive cocci group (n=69) and a gram-negative bacilli group (n=77). The predictive value of ΔPCT and ΔNLR was compared among groups.ResultsAUROC of NLR0h (0.756) higher than PCT0h (0.743).ΔPCT (0.561 vs 0.301) and ΔNLR (0.609 vs 0.361) were significantly higher in the shock group than in the non-shock group (P<0.05). No significant difference was seen in ΔPCT and ΔNLR in the gram-positive cocci infection group. However, the gram-negative bacilli infection group showed a significant difference in ΔPCT (0.606 vs 0.312) and ΔNLR (0.872 vs 0.508) between the shock and non-shock groups (P<0.05). ΔPCT+ΔNLR showed the best area under the curve (0.937), with a high sensitivity (78.80%) and specificity (90.80%), for predicting septic shock.ConclusionsThe prediction efficiency of initial NLR is higher than that of PCT. ΔPCT+ΔNLR best predicted septic shock in patients with bloodstream infections, with better accuracy for gram-negative infections.

“CORRELATION OF PROCALCITONIN WITH SEPSIS SCREEN AND BLOOD CULTURE IN NEONATAL SEPSIS”

BACKGROUND – Sepsis in neonates may be difcult to differentiate from other conditions, because the clinical signs are non-specic. It is a common cause of morbidity and mortality amongst neonates in NICU. Neonatal sepsis is a clinical syndrome which is accompanied by signs and symptoms of infection during rst 4 weeks of life. Neonatal mortality accounts for about 40% deaths under ve years of age. Global incidence of neonatal deaths caused by sepsis is only 15% but in a developing country like our sepsis accounts for about 30% -50% of neonatal mortality. Delay of even few hours in initiating treatment can increase mortality and morbidity considerably. AIMS AND OBJECTIVESAIM- To correlate procalcitonin with sepsis screen and blood culture in neonatal sepsis. OBJECTIVESA. To compare procalcitonin and CRP with culture positivity in diagnosing neonatal sepsis. B. To Determine sensitivity, specicity and predictive value of Procalcitonin as an indicator of neonatal sepsis in comparison with blood culture. C. To predict the value of altered WBC and platelet counts in diagnosing neonatal sepsis. D. To correlate culture proven sepsis with maturity of neonate, birth weight and mode of delivery. Material: 100 clinically suspected cases of Sepsis in neonates admitted to MMIMSR, Mullana, Ambala. Methods: All neonates who were suspected clinically as a case of sepsis based on sepsis score and categorized into (0- 72 hours PNL) EOS or LOS (&gt;72hours PNL) depending on day of presentation of clinically suspected sepsis. Detailed history along with clinical ndings of neonates were noted. SERUM PROCALCITONIN, SEPSIS SCREEN with predetermined cut off values and during the same time blood culture was taken and sent. Depending on clinical condition CSF analysis, Urine analysis, Chest Xray were sent. Sensitivity, specicity and predictive values of procalcitonin, CRP and other parameters were assessed. RESULTS- In this study of 100 neonates with clinical suspicion of sepsis admitted in NICU in MMIMSR over a period of 16 months from JAN 2020 to JUNE 2021. Out of 100 cases of the number of male neonates included in this study was greater than the female neonates suggesting that in clinically suspected neonatal sepsis male neonates were affected more than female neonates. Out of 100 neonates 63 neonates were male (63%) and 37 were female (37%). Laboratory nding of positive blood culture of sepsis of male neonates is 10 (56%), whereas female neonates of positive blood culture of sepsis is 8 (44%). Culture positivity showed only a slight rise in male neonates than females which was not much of a difference. . About three-fold increase in culture positivity was seen in preterm neonates (55%) when compared to term neonates (19%). Laboratory nding of positive blood culture of SGA neonates is 10 (19%), AGA is 8 (17%). Culture positivity showed SGA neonates has greater sepsis cases than AGA neonates. Association of sepsis score with procalcitonin value. On applying regression analysis, we found there is no association with R square 0.004. Association of CRP value with procalcitonin value. On applying regression analysis, it was found very mild association with R square 0.028. shows Association of absolute leucocyte count value with procalcitonin value. On applying regression analysis, we found very mild association with R square 0.069. Association of blood culture with procalcitonin. On applying t test between positive and negative blood culture with procalcitonin value we found significant association of procalcitonin value (p value &lt;0.05). CONCLUSION-In this study the risk factors commonly associated with neonatal sepsis were found to be LBW, VLBW, ELBW, Prematurity, LSCS, instrumental delivery that is assisted vaginal. delivery. EONS was more common than LONS. Procalcitonin was found to be a sensitive tool for diagnosis and it also helps predicting the outcome of sepsis as compared to CRP but it cannot be used as a sole marker as its neither 100% sensitive and it's not 100% specic. The predictability can be achieved by a combination of markers of neonatal sepsis rather than a single marker but as of now BLOOD CULTURE remains the gold standard in diagnosis of neonatal sepsis.

Clinical efficacy of cefoperazone-sulbactam in patients with acute myocardial infarction complicated with infection and effects on serum procalcitonin and serum inflammatory indicators Running tittle: Cefoperazone-sulbactam in acute myocardial infarction complicated with infection

This study aimed to investigate clinical efficacy of cefoperazone-sulbactam in patients with acute myocardial infarction complicated by infection and effects on serum procalcitonin and serum inflammatory indicators. Prospective analysis was used in this study. A total of 109 cases of patients with acute myocardial infarction complicated with infection were collected. They were admitted to our hospital from August 2018 to September 2019 and were divided into a control group and an experimental group according to different treatment methods. Patients (53 cases) in the control group received treatment of cefoperazone, while patients (56 cases) in the experimental group received treatment of cefoperazone-sulbactam. Therapeutic effect, bacterial clearance rate and adverse reaction of the two groups were compared. Serum procalcitonin (PCT) and serum hypersensitive C-reactive protein (hs-CRP) levels were observed and compared. ROC curve was used to analyze the predictive value of PCT, hs-CRP for the treatment of acute myocardial infarction complicated by infection. Logistic regression analysis was used to analyze the risk factors for the effect of acute myocardial infarction complicated by infection. The effective rates and bacterial clearance rates of treatment in the experimental group were higher than those in the control group (P&lt;0.05). After treatment, the PCT and hs-CRP levels of the experimental group were lower than those of the control group (P&lt;0.05). Age, hypertension, length of hospital stay, heart failure and hs-CRP were independent risk factors affecting the effective rate of treatment for acute myocardial infarction complicated by infection. In conclusion, cefoperazone-sulbactam has good therapeutic effect on acute myocardial infarction complicated with infection. It can reduce the level of PCT and serum inflammatory indicator hs-CRP; PCT and hs-CRP have certain predictive value on the therapeutic effect, which is worthy of promotion.

The Predictive Value of Procalcitonin and High-Sensitivity C-Reactive Protein for Early Bacterial Infections in Preterm Neonates

Introduction: Evidence on the reliability of using procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) as diagnostic markers for early-onset neonatal bacterial infections is still insufficient because of their physiological elevation during the early neonatal period. This study aimed to assess the respiratory influence of serum PCT and hs-CRP levels and evaluate their predictive value for bacterial infections during the first 72 h of life in preterm neonates. Methods: The preterm neonates enrolled in this single-center retrospective cohort study were categorized into 3 groups: reference, infection-unlikely respiratory failure, and probable bacterial infection; their serum PCT and hs-CRP levels were assessed. Subsequently, age-specific 95th percentile curves were plotted and the median and cutoff PCT and hs-CRP levels for predicting bacterial infections at birth and 7–18, 19–36, and 37–72 h after birth were determined. Moreover, the analysis of PCT and hs-CRP with a neonatal sequential organ failure assessment (nSOFA) score was performed in very low birth weight neonates. Results: Serum PCT levels were influenced by respiratory failure. A significant difference was found in the median PCT and hs-CRP levels among the 3 groups at each time point. PCT sensitivities for predicting bacterial infection were slightly higher than those of hs-CRP in each time frame during the first 72 h of life. In both PCT and hs-CRP, there was no significant difference between infants with nSOFA scores of >4 and those with nSOFA scores of ≤4. Discussion/Conclusion: Age-specific evaluation showed that PCT has better predictive value than hs-CRP for early-onset bacterial infections in preterm neonates.

Procalcitonin Level at 24 Hours of Age May be Predictive for Transient Tachypnea of the Newborn

Abstract Objective It is an important problem to differentiate transient tachypnea of the newborn (TTN) from bacterial pneumonia or other conditions in patients admitted to Neonatal Intensive Care Unit. The aim of this study was to evaluate the predictive value of procalcitonin (PCT) for TTN. Methods A total of 52 infants were contained in the study. The patients were divided into three groups. Group 1 consisted of patients with pronounced grunting at more than 2 hours postnatal age (n = 16). Group 2 consisted of patients whose grunt was reduced or gone at 2 hours postnatal age but in whom tachypnea persisted until 24 hours postnatal age (n = 18). Group 3 consisted of patients with minimal or no respiratory distress at 24 hours postnatal age (n = 18). In all groups, PCT concentrations were determined at birth and 24 hours postnatal age. Results PCT concentrations at birth were significantly higher in Group 1 than other groups, but there was no difference between Groups 2 and 3. PCT concentrations at 24 hours postnatal age were significantly higher in Groups 1 and 2 than Group 3. No difference was found between Group 1 and Group 2 at 24 hours postnatal age. All PCT concentrations in Group 3 were significantly lower than other groups. PCT thresholds for the diagnosis of TTN were 0.44 ng/mL at birth (sensitivity 58%, specificity 50%) and 5.11 ng/mL at 24 hours postnatal age (sensitivity 79.4%, specificity 89.1%). Conclusion Serial PCT measurements at birth and postnatal 24 hours may be helpful in differentiating between pneumonia and TTN. Further researches are needed to confirm this initial study.

Changes of serum procalcitonin level in patients with severe trauma and its relationship with multiple organ failure

Objective To investigate the changes of serum procalcitonin (PCT) level in patients with severe trauma, and to analyze its relationship with multiple organ failure (MODS). Methods From October 2013 to October 2018, the serum PCT levels were measured in 40 patients with severe trauma complicated with MODS (MODS group: 40 cases) and 62 patients without MODS (non-MODS group: 62 cases) in Yuncheng Central Hospital.The relationship between PCT and severity of trauma score (ISS), sequential organ failure (SOFA), acute physiology and chronic health status score (APACHE Ⅱ) and prognosis was analyzed.The predictive value of PCT in the prognosis of patients with MODS and severe trauma combined with MODS was analyzed by ROC. Results The serum PCT levels of the MODS group were (8.25±2.35)μg/L, (7.26±2.49)μg/L, (3.62±1.75)μg/L on the 1st, 3rd and 7th day after admission, respectively, which were higher than those of the control group (t=7.561, 9.561, 8.251, all P<0.05). The serum PCT level in the MODS group increased with the increase of APACHE Ⅱ score and ISS score (F=12.108, 9.173, all P<0.05). The serum PCT level in the death group was higher than that in the survival group[(11.82±3.75)μg/L vs.(4.92±1.26)μg/L], and the difference was statistically significant (t=7.959, P<0.05). The area under MODS curve predicted by PCT for severe trauma patients was 0.848, with sensitivity and specificity of 80.00%(32/40), 82.50%(33/40), respectively.The area under MODS curve predicted by PCT was 0.747, with sensitivity and specificity of 77.50%(31/40), 72.50%(29/40), respectively. Conclusion The serum PCT level in patients with severe trauma complicated with MODS is significantly higher than that in patients without MODS, and its level is closely related to trauma, disease progression and prognosis.It is of great value to predict the occurrence and prognosis of MODS. Key words: Wounds and injuries; Procalcitonin; Multiple organ failure; Injury severity score; ROC curve; Prognosis; Diagnosis

Assessment of procalcitonin as a diagnostic marker of infection in pediatrics with cancer complicated by fever and neutropenia

Background: Febrile neutropenia is still one of the most important complications of treatment in cancer patients. These patients become prone to infection and consequently higher mortality and morbidity. This study aimed to determine the accuracy of serum procalcitonin (PCT) level in the detection of infection in pediatric cancer patients complicated with febrile neutropenia.&#x0D; Materials and Methods: In this cross-sectional study, all pediatric patients affected by cancer and febrile neutropenia following chemotherapy (n=107) were investigated from August 2014 to August 2015. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum levels of PCT, as well as blood and urine culture, were evaluated in all patients.&#x0D; Results: The mean age of the patients was 78 ± 55 months (3 - 214 months), and in terms of gender, 53 patients (49.5%) were male. Overall, 25 patients (23.4%) and 13 patients (12%) showed positive blood and urine culture, respectively. The area under the curve (AUC) receiver operating characteristic (ROC) curve was illustrated to determine how much PCT can couldpredict infection.(AUC =0.74, 95% CI: 0.61-0.87, P&lt;0.001). Considering the cut-off of serum PCT levels as 0.70ng/mL, sensitivity, specificity, and positive and negative predictive valueof PCT were 0.76, 0.744, 0.475, and 0.91, respectively. In addition, PCT showed significant correlations with CRP (rs=0.415, P&lt;0.001) and ESR (rs =0.262, P=0.009).&#x0D; Conclusion: According to the findings of this study, serum PCT levels can be used as a diagnostic test with acceptable sensitivity and specificity and high negative predictive value, but the low positive predictive value in the evaluation of infections in patients affected by cancer and complicated with fever and neutropenia.

The Predictive Value of Procalcitonin in the Prognosis of Patients with Acute Coronary Syndrome

The Predictive Value of Procalcitonin in the Prognosis of Patients with Acute Coronary Syndrome

Predictive value of serum procalcitonin for both initial and repeated immunoglobulin resistance in Kawasaki disease: a prospective cohort study

BackgroundIntravenous immunoglobulin (IVIG) resistance prediction is one pivotal topic of interests in Kawasaki disease (KD) since those patients with KD resistant to IVIG might improve of an early-intensified therapy. Data regarding predictive value of procalcitonin (PCT) for IVIG resistance, particularly for repeated IVIG resistance in KD was limited. This study aimed to testify the predictive validity of PCT for both initial and repeated IVIG resistance in KD.MethodsA total of 530 KD patients were prospectively recruited between January 2015 and March 2019. The clinical and laboratory data were compared between IVIG-responsive and IVIG-resistant groups. Multivariate logistic regression analysis was applied to determine the association between PCT and IVIG resistance. Receiver operating characteristic (ROC) curves analysis was further performed to assess the validity of PCT in predicting both initial and repeated IVIG resistance.ResultsThe serum PCT level was significantly higher in initial IVIG-resistance group compared with IVIG-response group (p = 0.009), as well as between repeated IVIG responders and nonresponders (p = 0.017). The best PCT cutoff value for initial and repeated IVIG resistance prediction was 1.48 ng/ml and 2.88 ng/ml, respectively. The corresponding sensitivity was 53.9 and 51.4%, while the specificity were 71.8 and 73.2%, respectively. Multivariate logistic regression analysis failed to identify serum PCT level as an independent predictive factor for both initial and repeated IVIG resistance in KD.ConclusionsSerum PCT levels were significantly higher in IVIG nonresponders, but PCT may not be suitable as a single marker to accurately predict both initial and repeated IVIG resistance in KD.

Predictive value of procalcitonin in chronic allograft dysfunction in kidney transplant recipients.

The present study was designed to determine the potential role of circulating procalcitonin (PCT) in predicting chronic allograft dysfunction (CAD) in kidney transplant recipients (KTRs). A total of 87 KTRs were retrospectively analyzed and divided into a CAD and a non-CAD (normal renal function) group. Clinical features and inflammatory markers were compared between the groups, including PCT, white blood cell count, C-reactive protein, neutrophil percentage (N%) and lipoprotein(a) [Lp(a)], and the receiver operating characteristic (ROC) curve for CAD prediction was plotted. Univariate and multivariate logistic regression analyses were used to analyze the relevant risk factors for CAD. The results indicated that i) the values of these indicators in the CAD group, including the male ratio, years after transplantation, PCT, N% and Lp(a), were significantly higher than those in the non-CAD group, while the body mass index, aspartate aminotransferase, high-density lipoprotein and low-density lipoprotein were significantly lower; ii) PCT and Lp(a) were able to predict CAD with an area under the ROC curve of 0.893 and 0.770, respectively; iii) multivariate logistic regression analysis of factors influencing CAD in KTRs suggested that elevated PCT was an independent risk factor. In KTRs, PCT was identified as a potential biomarker for predicting CAD.

Utility of procalcitonin for diagnosis of bacterial infection-related systemic inflammatory response in the acute neurologic injury population

ObjectiveInflammation and bacterial infection are common complicating factors in the treatment of patients with stroke. Inflammatory responses can manifest as systemic inflammatory response syndrome (SIRS), a condition with both infectious and non-infectious etiologies. Accurately identifying patients with infection-related SIRS is important for determining the correct treatment plan. Here, we investigated the use of the glycopeptide procalcitonin (PCT) as a potential biomarker for identifying patients with bacterial infections in the setting of SIRS. Patients and methodsA retrospective chart review was performed for adult patients admitted to United Hospital with an admission or discharge diagnosis of stroke for whom PCT testing was ordered between January 2011 and December 2014. Medical records were searched for the timing of PCT tests, and the previous 24 h was assessed for markers of SIRS, inflammation, and disease severity. ResultsPCT levels were negatively correlated with Glasgow Coma Scale scores (ρ=-0.27, p < 0.0001) and glomerular filtration rates (ρ=-0.22, p < 0.001), but demonstrated a positive correlation with white blood cell (WBC) count (ρ = 0.13, p = 0.031) and creatinine levels (ρ = 0.33, p < 0.0001). PCT levels were significantly higher in samples that corresponded to the presence of at least one infection (p < 0.0001) and in SIRS + samples (p < 0.001). However, even with the addition of a SIRS + diagnosis, the predictive value of PCT did not reach levels that would indicate clinical utility for the identification of patients with bacterial infections. ConclusionsPCT was not a viable biomarker for distinguishing between infectious and non-infections etiologies of SIRS in acute brain injury in this population. However, our results do indicate potential utility for PCT as an indicator for the cessation of antibiotic use in acute brain injury patients with bacterial infections.

Clinical significance of procalcitonin in early diagnosis of acute left heart failure complicated with pulmonary infection in the elderly

Objective To investigate clinical significance of procalcitonin(PCT)in the early diagnosis of acute left heart failure complicated with pulmonary infection in the elderly. Methods A total of 113 patients with acute left heart failure or acute left heart failure complicated with pulmonary infection who were admitted into our emergency department from August 2012 to February 2018 were retrospectively analyzed.Data of serum concentration of PCT were collected on the first and third days after admission.The diagnostic values of serum PCT and C-reaction protein(CRP)were evaluated based on the patient's diagnostic data.ROC curves were plotted for PCT, and its cut-off value was calculated. Results Serum levels of PCT on the first and third days after admission were higher in pulmonary infection group than in left heart failure group[(2.45±0.42) μg/L vs.(0.54±0.03) μg/L, (1.25±0.17) μg/L vs.(0.43±0.03) μg/L, t=34.27 and 35.78, P=0.000 and 0.000]. The diagnostic specificity, positive predictive value, and negative predictive value of PCT were better than those of CRP(χ2=4.97, 4.76 and 4.17, P=0.030, 0.030 and 0.040). There was no significant difference in the diagnostic sensitivity between PCT and CRP(χ2=3.05, P=0.080). The best diagnostic cut-off value of PCT was 0.597 μg/L in which the sensitivity of diagnosis of heart failure complicated with pneumonia was 91.07% and the specificity was 90.77%. Conclusions Serum PCT test can assist the early diagnosis of acute left heart failure complicated with pulmonary infection in elderly patients with high sensitivity and specificity.The best diagnostic cut-off value of PCT is 0.597 μg/L.Based on serum PCT test, early rational use of antibiotics for controlling acute left heart failure complicated with pulmonary infection in elderly patients is worthy of generalization. Key words: Calcitonin; Heart failure; Early diagnosis; Pneumonia

Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia

The aim of this study was to explore the predictive value of procalcitonin (PCT) in Gram-negative bloodstream infections (BSIs) in hematological patients with febrile neutropenia. A total of 1466 samples (396 blood culture (BC)-positive, 1052 BC-negative, and 18 contaminated specimens) were included, comprising 268 Gram-negative, 88 Gram-positive, 19 fungal, and 21 polymicrobial BSIs. Median PCT value (0.72 ng/mL; IQR: 0.23–3.87) was significantly higher in Gram-negative than Gram-positive (0.34 ng/mL; IQR: 0.14–2.23; p < .01), or fungal (0.27 ng/mL; IQR: 0.13–0.40; p < .01) BSIs. In mono-microbial BSIs, the best PCT cutoff distinguishing Gram-negative BSIs from all other fever causes was 0.56 ng/ml, with a specificity of 76.8%. PCT levels were significantly higher in BSIs from multidrug-resistant (MDR) Gram-negative strains than from non-MDR (p < .01). This study confirms that elevated PCT may predict Gram-negative BSIs in hematological patients with febrile neutropenia, and demonstrates higher PCT levels in MDR Gram-negative BSIs in these patients.

Biomarkers and risk factors for sepsis in stage 5 chronic kidney disease: a retrospective case-control study.

To assess the predictive value of procalcitonin (PCT) in the risk of sepsis in patients with stage 5 chronic kidney disease (CKD). A total of 373 inpatients with stage 5 CKD were retrospectively analyzed. The patients were divided into non-infection group, local infection group, and sepsis group. The clinical characteristics and inflammatory parameters including PCT, C-reactive protein (CRP), white blood cell count (WBC), and neutrophil percentage (NEU%) were compared and the receiver operating characteristic (ROC) curves to predict sepsis were plotted. Related risk factors of sepsis were analyzed by logistic regression analysis. (1) The hemodialysis ratio of sepsis group was the highest at 92.3%. PCT, CRP, and NEU% were significantly different among the three subgroups (P < 0.05 for all). Total cholesterol and low density lipoprotein (LDL) levels in sepsis group were significantly lower than that in local infection group (P < 0.05 for both). (2) CRP and WBC were unable to predict sepsis (P > 0.05 for all), while PCT and NEU% could predict sepsis with areas under the curve (AUC) of 0.838 and 0.691, respectively (P < 0.05 for all). (3) Multivariate logistic regression analysis showed that PCT > 1.650ng/mL was a risk factor (OR = 6.926, P = 0.002) while LDL was probably a protective factor (OR = 0.336, P = 0.040) of sepsis in patients with stage 5 CKD. At stage 5 CKD, the predictive value of PCT for sepsis is best among inflammatory markers, and PCT and LDL levels are independent factors of sepsis.

The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia.

Özdemir ZC, Düzenli-Kar Y, Canik A, Küskü-Kiraz Z, Özen H, Bör Ö. The predictive value of procalcitonin, C-reactive protein, presepsin, and soluble-triggering receptor expressed on myeloid cell levels in bloodstream infections in pediatric patients with febrile neutropenia. Turk J Pediatr 2019; 61: 359-367. The present study investigates the predictive value of procalcitonin (PCT), C-reactive protein (CRP), presepsin (PRE-SEP) and soluble-triggering receptor, as expressed on myeloid cells (sTREM-1) levels in bloodstream infections in pediatric patients with febrile neutropenia. A total of 47 episodes of febrile neutropenia that developed in 30 children with malignancy were analyzed in this study, while the control group comprised 27 children who had undergone chemotherapy for malignancy (completed ≥2 years ago) without neutropenia, fever or drug use. Median PCT, CRP, PRE-SEP and sTREM-1 levels on admission were found to be significantly higher in the patient group than in the control group, while in the blood cultures, the microbiological agent was isolated in 13 (27.7%) of the 47 episodes. Median PCT and CRP levels on days 1, 2 and 7 were higher in the blood culture-positive episodes than in the blood culture-negative episodes. There was no significant difference in the PRE-SEP and sTREM-1 levels on days 1, 2 and 7 between the blood culture-positive and blood culture-negative episodes. The results of the study suggest that PRESEP and sTREM-1 are at measurable levels upon admission in children with febrile neutropenia, but that these markers may not be appropriate for the predicting of bloodstream infections, although CRP and PCT levels within the first 24 hours may serve as a guide for clinicians.

Predictive value of PCT and IL-6 for bacterial infection in children with cancer and febrile neutropenia

PurposeOnly a third of children with cancer and febrile neutropenia (FN) have a proven bacterial infection; nevertheless, most children are hospitalized and treated with intravenous antibiotics. Several biomarkers have been proposed as predictive markers for bacterial infection in this population. We aimed to evaluate the role of interleukin-6 (IL-6) and procalcitonin (PCT) in diagnosing bacterial infection in children with cancer and FN.MethodsThe study population was derived from a prospective database (2006–2013, IL-8 study) comprising children with cancer who presented with FN. From stored plasma samples (taken at admission and/or at 12–24 h), we determined the PCT and IL-6 levels. Consequently, we explored their relation with the presence of bacterial infection (positive blood culture, radiologically documented infection or clinical bacterial focus). We predefined cutoff values at 60 ng/L for IL-6 and 0.25 ng/mL for PCT.ResultsSeventy-seven FN episodes in 55 children with cancer were included. In 18 episodes (23.4%), a bacterial infection was documented. Both at presentation and after 12–24 h, median values of IL-6 and PCT were significantly higher in patients with a bacterial infection compared to patients without a bacterial infection. With both biomarkers above cutoff values, sensitivity was 93% (with either one, this was even 100%). The identified group at low risk for bacterial infection comprised 41% of the population.ConclusionPCT and IL-6 are promising markers in identifying bacterial infection in children with cancer and FN. In a subsequent project, we will incorporate these biomarkers in a risk assessment model that we will test prospectively in a clinical trial.