Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study

Domonkos Trásy, Krisztián Tánczos, Márton Németh, Péter Hankovszky, András Lovas, András Mikor, Edit Hajdú, Angelika Osztroluczki, János Fazakas, Zsolt Molnár, Domonkos Trásy, Krisztián Tánczos, Márton Németh, Péter Hankovszky, András Lovas, András Mikor, Edit Hajdú, Angelika Osztroluczki, János Fazakas, Zsolt Molnár

Abstract

Purpose. To investigate whether absolute value of procalcitonin (PCT) or the change (delta-PCT) is better indicator of infection in intensive care patients. Materials and Methods. Post hoc analysis of a prospective observational study. Patients with suspected new-onset infection were included in whom PCT, C-reactive protein (CRP), temperature, and leukocyte (WBC) values were measured on inclusion (t 0) and data were also available from the previous day (t -1). Based on clinical and microbiological data, patients were grouped post hoc into infection- (I-) and noninfection- (NI-) groups. Results. Of the 114 patients, 85 (75%) had proven infection. PCT levels were similar at t -1: I-group (median [interquartile range]): 1.04 [0.40-3.57] versus NI-group: 0.53 [0.16-1.68], p = 0.444. By t 0 PCT levels were significantly higher in the I-group: 4.62 [1.91-12.62] versus 1.12 [0.30-1.66], p = 0.018. The area under the curve to predict infection for absolute values of PCT was 0.64 [95% CI = 0.52-0.76], p = 0.022; for percentage change: 0.77 [0.66-0.87], p < 0.001; and for delta-PCT: 0.85 [0.78-0.92], p < 0.001. The optimal cut-off value for delta-PCT to indicate infection was 0.76 ng/mL (sensitivity 80 [70-88]%, specificity 86 [68-96]%). Neither absolute values nor changes in CRP, temperature, or WBC could predict infection. Conclusions. Our results suggest that delta-PCT values are superior to absolute values in indicating infection in intensive care patients. This trial is registered with ClinicalTrials.gov identifier: NCT02311816.

Figures

Figure 1
Figure 1
Flow chart.
Figure 2
Figure 2
PCT, CRP, body temperature, and WBC count absolute values in the total cohort. Boxplots present median (interquartile range) 10th and 90th percentile. ∗ indicates p < 0.05.
Figure 3
Figure 3
The predictive value of the absolute values, percentage, and delta changes of PCT, CRP, temperature, and WBC count for infection in the total cohort.

References

    1. Angus D. C., Linde-Zwirble W. T., Lidicker J., Clermont G., Carcillo J., Pinsky M. R. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Critical Care Medicine. 2001;29(7):1303–1310. doi: 10.1097/00003246-200107000-00002.
    1. Levy M. M., Artigas A., Phillips G. S., et al. Outcomes of the surviving sepsis campaign in intensive care units in the USA and Europe: a prospective cohort study. The Lancet Infectious Diseases. 2012;12(12):919–924. doi: 10.1016/s1473-3099(12)70239-6.
    1. Bone R. C., Fisher C. J., Jr., Clemmer T. P., Slotman G. J., Metz C. A., Balk R. A. A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. The New England Journal of Medicine. 1987;317(11):653–658. doi: 10.1056/nejm198709103171101.
    1. Lai N. A., Kruger P. The predictive ability of a weighted systemic inflammatory response syndrome score for microbiologically confirmed infection in hospitalised patients with suspected sepsis. Critical Care and Resuscitation. 2011;13(3):146–150.
    1. Galicier C., Richet H. A prospective study of postoperative fever in a general surgery department. Infection Control. 1985;6(12):487–490.
    1. Kumar A., Roberts D., Wood K. E., et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Critical Care Medicine. 2006;34(6):1589–1596. doi: 10.1097/01.CCM.0000217961.75225.E9.
    1. Carlet J., Jarlier V., Harbarth S., Voss A., Goossens H., Pittet D. Ready for a world without antibiotics? The Pensières antibiotic resistance call to action. Antimicrobial Resistance and Infection Control. 2012;1, article 11 doi: 10.1186/2047-2994-1-11.
    1. Pierrakos C., Vincent J. L. Sepsis biomarkers: a review. Critical Care. 2010;14, article R15
    1. Meisner M. Procalcitonin-Biochemistry and Clinical Diagnosis. 1st. Bremen, Germany: Uni-med; 2010.
    1. Garnacho-Montero J., Huici-Moreno M. J., Gutiérrez-Pizarraya A., et al. Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis. Critical Care. 2014;18(3, article R116) doi: 10.1186/cc13908.
    1. Wacker C., Prkno A., Brunkhorst F. M., Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2013;13(5):426–435. doi: 10.1016/s1473-3099(12)70323-7.
    1. Clec'h C., Ferriere F., Karoubi P., et al. Diagnostic and prognostic value of procalcitonin in patients with septic shock. Critical Care Medicine. 2004;32(5):1166–1169. doi: 10.1097/01.CCM.0000126263.00551.06.
    1. Mimoz O., Benoist J. F., Edouard A. R., Assicot M., Bohuon C., Samii K. Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome. Intensive Care Medicine. 1998;24(2):185–188. doi: 10.1007/s001340050543.
    1. Sponholz C., Sakr Y., Reinhart K., Brunkhorst F. Diagnostic value and prognostic implications of serum procalcitonin after cardiac surgery: a systematic review of the literature. Critical Care. 2006;10(5, article R145) doi: 10.1186/cc5067.
    1. Schuetz P., Affolter B., Hunziker S., et al. Serum procalcitonin, C-reactive protein and white blood cell levels following hypothermia after cardiac arrest: A Retrospective Cohort Study. European Journal of Clinical Investigation. 2010;40(4):376–381. doi: 10.1111/j.1365-2362.2010.02259.x.
    1. Tsangaris I., Plachouras D., Kavatha D., et al. Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay. BMC Infectious Diseases. 2009;9, article 213 doi: 10.1186/1471-2334-9-213.
    1. Trásy D., Tánczos K., Németh M., et al. Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients. Journal of Critical Care. 2016;34:50–55. doi: 10.1016/j.jcrc.2016.04.007.
    1. American college of chest Physicians/Society of critical care medicine consensus conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Critical Care Medicine. 1992;20:820–864.
    1. Calandra T., Cohen J. International Sepsis Forum Definition of Infection in the ICU Consensus Conference. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Critical Care Medicine. 2005;33:1538–1548.
    1. Dellinger R. P., Levy M. M., Rhodes A., et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Critical Care Medicine. 2013;41(2):580–637. doi: 10.1097/ccm.0b013e31827e83af.
    1. Luyt C.-E., Bréchot N., Trouillet J.-L., Chastre J. Antibiotic stewardship in the intensive care unit. Critical Care. 2014;18(5, article 480) doi: 10.1186/s13054-014-0480-6.
    1. Manek K., Williams V., Callery S., Daneman N. Reducing the risk of severe complications among patients with Clostridium difficile infection. Canadian Journal of Gastroenterology. 2011;25(7):368–372. doi: 10.1155/2011/153020.
    1. Bozkurt F., Kaya S., Tekin R., et al. Analysis of antimicrobial consumption and cost in a teaching hospital. Journal of Infection and Public Health. 2014;7(2):161–169. doi: 10.1016/j.jiph.2013.09.007.
    1. Levy M. M., Fink M. P., Marshall J. C., et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Medicine. 2003;29(4):530–538. doi: 10.1007/s00134-003-1662-x.
    1. Shehabi Y., Sterba M., Garrett P. M., et al. Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis: a randomized controlled trial. American Journal of Respiratory and Critical Care Medicine. 2014;190(10):1102–1110. doi: 10.1164/rccm.201408-1483oc.
    1. Fry D. E. Sepsis syndrome. American Surgeon. 2000;66(2):126–132.
    1. Coburn B., Morris A. M., Tomlinson G., Detsky A. S. Does this adult patient with suspected bacteremia require blood cultures? The Journal of the American Medical Association. 2012;308(5):502–511. doi: 10.1001/jama.2012.8262.
    1. Zhang Q., Raoof M., Chen Y., et al. Circulating mitochondrial DAMPs cause inflammatory responses to injury. Nature. 2010;464(7285):104–107. doi: 10.1038/nature08780.
    1. Uzzan B., Cohen R., Nicolas P., Cucherat M., Perret G.-Y. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Critical Care Medicine. 2006;34(7):1996–2003. doi: 10.1097/01.ccm.0000226413.54364.36.
    1. Layios N., Lambermont B., Canivet J.-L., et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Critical Care Medicine. 2012;40(8):2304–2309. doi: 10.1097/CCM.0b013e318251517a.
    1. Jensen J. U., Hein L., Lundgren B., et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Critical Care Medicine. 2011;39(9):2048–2058. doi: 10.1097/ccm.0b013e31821e8791.

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