Study of C-reactive protein, procalcitonin, and immunocyte ratios in 194 patients with sepsis

Tian Tian, Bing Wei, Junyu Wang, Tian Tian, Bing Wei, Junyu Wang

Abstract

Background: Evidence suggests that C-reactive protein (CRP), procalcitonin (PCT), and immune cells can predict sepsis severity in adult patients. However, the specific values of these indicators are not consistent in predicting prognosis.

Methods: A retrospective study analyzed the medical records of 194 patients based on the concept of sepsis in 2016 (Sepsis 3.0) from January 2017 to December 2019. A comparative analysis of inflammatory factors associated with patients in the sepsis survival and the non-survival group was performed. The concentrations of CRP and PCT, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were measured. ROC curve was used to assess the diagnosis and analysis of the selected indices of sepsis. According to each index's cut-off value of the ROC curve, the patients were divided into two groups, and the prognosis was calculated.

Results: Among the 194 patients, 32 died (16.49%), the median age of the patients was 79 (66.0, 83.3) years, and 118 were male (60.8%). Analysis of related inflammatory indicators showed that CRP, NLR, MLR, PLR, and CRP*PCT in the non-survival group were statistically higher than those in the survival group (all p values were < 0.05). Regression analysis showed that PCT, CRP, NLR, PLR, and CRP*PCT were all independent prognostic factors for patients. The ROC curve results showed that CRP*PCT had the best diagnostic value (AUC = 0.915). The cut-off values of PCT, CRP, NLR, PLR, MLR, and CRP*PCT were 0.25 ng/mL, 85.00 mg/L, 8.66, 275.51, 0.74%, and 5.85 (mg/L)2, respectively. Kaplan-Meier survival estimate showed that patient prognosis between the CRP, PCT, NLR, PLR, and CRP*PCT was statistically different (all values P < 0.05, respectively). However, there was no statistically significant difference in gender and MLR (all values P > 0.05, respectively), grouping based on diagnostic cut-off values.

Conclusions: In this study, inflammation-related markers PCT, CRP, NLR, MLR, PLR, and CRP*PCT can be used as independent risk factors affecting the prognosis of patients with sepsis. Furthermore, except for MRL, these indicators have cut-off values for predicting patient death.

Keywords: C-reactive protein; Diagnosis; Immunocyte; Procalcitonin; Sepsis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The ROC curve of C-reactive protein (CRP), procalcitonin (PCT), and different immunocyte ratios. NLR: the percentage of neutrophil to lymphocyte count; PLR: the percentage of platelet to lymphocyte ratio; MLR: the ratio of monocyte to lymphocyte count; MPV/PC: the ratio of mean platelet volume to platelet count; SOFA: Sequential Organ Failure Assessment; APACHE2: Acute Physiology and Chronic Health Evaluation
Fig. 2
Fig. 2
The prognosis of each factor (stratified by diagnostic cut-off value)

References

    1. Koch T, Geiger S, Ragaller MJR. Monitoring of organ dysfunction sepsis/systemic inflammatory response syndrome: novel strategies. JASN. 2001;12(Suppl 17):S53–S59. doi: 10.1681/ASN.V12suppl_1s53.
    1. Yegenaga I, Hoste E, Biesen WV, Vanholder R, Benoit D, Kantarci G, Dhondt A, Colardyn F, Lameire N. Clinical characteristics of patients developing ARF due to sepsis/systemic inflammatory response syndrome: results of a prospective study. Am J Kidney Dis. 2004;43(5):817–824. doi: 10.1053/j.ajkd.2003.12.045.
    1. Kell DB, Pretorius E. To what extent are the terminal stages of Sepsis, septic Shock, systemic inflammatory response syndrome, and multiple organ dysfunction syndrome actually driven by a prion/amyloid form of fibrin? Semin Thromb Hemost. 2018;44(03):224–238. doi: 10.1055/s-0037-1604108.
    1. Wang C, Chi C, Guo L, Wang X, Guo L, Sun J, Sun B, Liu S, Chang X, Li E. Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and meta-analysis. Crit Care. 2014;18(5):1–9. doi: 10.1186/s13054-014-0563-4.
    1. Li D, Sha M, Chen L, Xiao Y, Lu J, Shao Y. A preliminary study: the role of preoperative procalcitonin in predicting postoperative fever after mini-percutaneous nephrolithotomy in patients with a negative baseline urine culture. Urolithiasis. 2019;47(5):455–460. doi: 10.1007/s00240-019-01115-3.
    1. Cekin Y, Cekin AH, Duman A, Yilmaz U, Yesil B, Yolcular BO. The role of serum Procalcitonin levels in predicting Ascitic fluid infection in hospitalized cirrhotic and non-cirrhotic patients. Int J Med Sci. 2013;10(10):1367–1374. doi: 10.7150/ijms.6014.
    1. Lee SH, Chan RC, Wu JY, Chen HW, Chang SS, Lee CC. Diagnostic value of procalcitonin for bacterial infection in elderly patients - a systemic review and meta-analysis. Int J Clin Pract. 2013;67(12):1350–1357. doi: 10.1111/ijcp.12278.
    1. Higashikawa T, Okuro M, Ishigami K, Mae K, Sangen R, Mizuno T, et al. Procalcitonin and albumin as prognostic biomarkers in elderly patients with a risk of bacterial infection. J Int Med Res. 2018;46(7):2606-14. 10.1177/0300060518766640.
    1. Dinarello CA. Targeting the pathogenic role of interleukin 1β in the progression of smoldering/indolent myeloma to active disease. Mayo Clin Proc. 2009;84(2):114–22.Campaign S: Managing Sepsis and Septic Shock
    1. Asseray N, Leconte C, Kouri DE, Touzé MD, Potel G. Utilité du dosage de la CRP pour la prise en charge des infections bactériennes aux urgences. La Presse Medicale. 2005;34(8):561–565. doi: 10.1016/S0755-4982(05)83979-X.
    1. Goulart A, Ferreira C, Estradea A, Nogueira F, Martins S, Mesquita-Rodrigues A, Sousa N, Le?O P: Early Inflammatory Biomarkers as Predictive Factors for Freedom from Infection after Colorectal Cancer Surgery: A Prospective Cohort Study. Surg Infect. 2018;19(4):446–50. 10.1089/sur.2017.294.
    1. Puo A. C-reactive protein in viral and bacterial infections. Pediatr Res. 1e985. .
    1. Jian-Fang HE, Shu-Feng XU, Huang J, Guan LP, Fan Z, Hua-Hua WU, et al. Value of serum PCT. Chinese Journal of Nosocomiology: CRP and platelet parameters in bronchial asthma children complicated with infections. 2018. .
    1. Nikolaos-Dimitrios P. Christina, Platanaki, Charalampos, Pierrako, Vasilios, Karamouzos, Dimitrios, Velissaris: APACHE II%SOFA%community acquired pneumonia (CAP)%neutrocyte-to-lymphocyte ratio (NLR)%sepsis. Journal of Translational Internal Medicine. 2018.
    1. Elbaset MA, Zahran MH, Hashem A, Ghobrial FK, Ibrahim MA. Could platelet to leucocytic count ratio (PLR) predict sepsis and clinical outcomes in patients with emphysematous pyelonephritis? J Infect Chemother. 2019;25(10):791–796. doi: 10.1016/j.jiac.2019.04.008.
    1. Detournay O, Mazouz N, Goldman M, Toungouz M: IL-6 produced by type IIFN DC controls IFN-gamma production during the MLR by blocking the suppressive effect of regulatory T cells. Blood. 20e04;104(1e1). .
    1. Dragan D, Goran R, Maja S, Ivan S, Ivo U, Tamara A, Snjezana Z, Snezana M, Nikola S, Dzihan A. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients: which ratio to choose to predict outcome and nature of Bacter. Mediat Inflamm. 2018;2018:1–15.
    1. Hayashida K, Kondo Y, Hara Y, Aihara M, Yamakawa K. Head-to-head comparison of procalcitonin and presepsin for the diagnosis of sepsis in critically ill adult patients: a protocol for a systematic review and meta-analysis. BMJ Open. 2017;7(3):e014305. doi: 10.1136/bmjopen-2016-014305.
    1. Tavaré A, O’Flynn N. Recognition, diagnosis, and early management of sepsis: NICE guideline. Br J Gen Pract J R Coll Gen Pract. 2017;67(657):185–186. doi: 10.3399/bjgp17X690401.
    1. Napolitano LM. Sepsis 2018: definitions and guideline changes. Surg Infect. 2018;19(2):117–125. doi: 10.1089/sur.2017.278.
    1. Campaign SS, Shock S. Shock S. Campaign S: Managing Sepsis and Septic Shock: Current Guidelines and Definitions.
    1. Braber A, van Zanten AR. Unravelling post-ICU mortality: predictors and causes of death. EJA. 2010;27(5):486–490. doi: 10.1097/EJA.0b013e3283333aac.
    1. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4–11. doi: 10.4161/viru.27372.
    1. None: Sustainable changes are needed to reduce preventable sepsis deaths. Nurs Child Young People. 2017;29(2):19–19. .
    1. Arellano-Navarro CE, Huerta-Ramírez S, Elizalde-Barrera CI, Rubio-Guerra AF, González-Moreno FJ. Value of C-reactive protein (CRP)/ albumin index in the diagnosis of sepsis. Medicina Interna De Mexico. 2018;34(2):188–195.
    1. Tang BMP, Eslick GD, Craig JC, Mclean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7(3):210–217. doi: 10.1016/S1473-3099(07)70052-X.
    1. Lin Z, Guo KP, Yi M, Yi SW, Mo LY. Predictive value of red blood cell distribution width for acute kidney injury in children with sepsis. Chin J Contemp Pediatr. 2018;20(7):559.
    1. Póvoa P, Teixeira-Pinto AM, Carneiro AH, Group PC-ASS C-reactive protein, an early marker of community-acquired sepsis resolution: a multi-center prospective observational study. Crit Care. 2011;15(4):R169. doi: 10.1186/cc10313.
    1. Nie X, Wu B, He Y, Huang X, Dai Z, Miao Q, Song H, Luo T, Gao B, Wang L. Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection. Clin Chem Lab Med. 2013;51(8):1655–1661. doi: 10.1515/cclm-2012-0822.
    1. Hugle T, Schuetz P, Mueller B, Laifer G, Tyndall A, Regenass S, Daikeler T. Serum procalcitonin for discrimination between septic and non-septic arthritis. Clin Exper Rheumatol. 2008;26(3):453–456.
    1. Yang A-P, Liu J, Yue L-H, Wang H-Q, Yang W-J, Yang G-H. Neutrophil CD64 combined with PCT, CRP and WBC improves the sensitivity for the early diagnosis of neonatal sepsis. CCLM. 2016;54(2):345–351. doi: 10.1515/cclm-2015-0277.
    1. Kocabas E, Sarikcioglu A, Aksaray N, Seydaoglu G, Seyhun Y, Yaman A. Role of procalcitonin, C-reactive protein, interleukin-6, interleukin-8 and tumor necrosis factor-alpha in the diagnosis of neonatal sepsis. Turk J Pediatr. 2007;49(1):7–20.
    1. Barati M, Alinejad F, Bahar MA, Tabrisi MS, Shamshiri AR, Karimi H. Comparison of WBC, ESR, CRP and PCT serum levels in septic and non-septic burn cases. Burns. 2008;34(6):770–774. doi: 10.1016/j.burns.2008.01.014.
    1. Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol. 2003;56(11):1129–1135. doi: 10.1016/S0895-4356(03)00177-X.
    1. Plamen M. Maya, Gulubova. The Position of Neutrophils-To-Lymphocytes and Lymphocytes-To-Platelets Ratio as Predictive Markers of Progression and Prognosis in Patients with Non-Small Cell Lung Cancer. Open Access Macedonian Journal of Medical Sciences: Petar, Chilingirov, Julian, Ananiev; 2018.
    1. Caziuc A, Schlanger D. Amarinei G. Neutrophils-to-lymphocytes, lymphocytes to-monocytes and platelets-to-lymphocytes ratios - predictive biomarkers for response to neoadjuvant chemotherapy in breast cancer: Dindelegan GC; 2020.
    1. Zhao C, Wei Y, Chen D, Jin J, Chen H. Prognostic value of an inflammatory biomarker-based clinical algorithm in septic patients in the emergency department: an observational study. Int Immunopharmacol. 2020;80:106145. doi: 10.1016/j.intimp.2019.106145.
    1. Jones H, Qasem E, Dilaver N, Egan R, Bodger O, Kokelaar R, Evans M, Davies M, Beynon J, Harris D. Inflammatory cell ratios predict major septic complications following rectal cancer surgery. Int J Color Dis. 2018;33(7):857–862. doi: 10.1007/s00384-018-3061-3.
    1. Schmitt C, Strazielle N, Ghersi-Egea JFO. Brain leukocyte infiltration initiated by peripheral inflammation or experimental autoimmune encephalomyelitis occurs through pathways connected to the CSF-filled compartments of the forebrain and midbrain. J Neuroinflammation. 2012;9(1):187–7.
    1. Tüysüz ME, Dedemoğlu M. High mean platelet volume to platelet count ratio as a predictor on poor outcomes after CABG. Gen Thorac Cardiovasc Surg. 2020;68(5):459–66. 10.1007/s11748-019-01202-7.

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