Impact of previous sepsis on the accuracy of procalcitonin for the early diagnosis of blood stream infection in critically ill ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2008-12-02

AUTHORS

Pierre Emmanuel Charles, Sylvain Ladoire, Aurélie Snauwaert, Sébastien Prin, Serge Aho, André Pechinot, Niels-Olivier Olsson, Bernard Blettery, Jean-Marc Doise, Jean-Pierre Quenot

ABSTRACT

BackgroundBlood stream infections (BSI) are life-threatening infections in intensive care units (ICU), and prognosis is highly dependent on early detection. Procalcitonin levels have been shown to accurately and quickly distinguish between BSI and noninfectious inflammatory states in critically ill patients. It is, however, unknown to what extent a recent history of sepsis (namely, secondary sepsis) can affect diagnosis of BSI using PCT.Methodsreview of the medical records of every patient with BSI in whom PCT dosage at the onset of sepsis was available between 1st September, 2006 and 31st July, 2007.Results179 episodes of either primary (n = 117) or secondary (n = 62) sepsis were included. Procalcitonin levels were found to be markedly lower in patients with secondary sepsis than in those without (6.4 [9.5] vs. 55.6 [99.0] ng/mL, respectively; p < 0.001), whereas the SOFA score was similar in the two groups. Although patients in the former group were more likely to have received steroids and effective antibiotic therapy prior to the BSI episode, and despite a higher proportion of candidemia in this group, a low PCT value was found to be independently associated with secondary sepsis (Odd Ratio = 0.33, 95% Confidence Interval: 0.16–0.70; p = 0.004). Additional patients with suspected but unconfirmed sepsis were used as controls (n = 23). Thus, diagnostic accuracy of PCT as assessed by the area under the receiver-operating characteristic curves (AUROCC) measurement was decreased in the patients with secondary sepsis compared to those without (AUROCC = 0.805, 95% CI: 0.699–0.879, vs. 0.934, 95% CI: 0.881–0.970, respectively; p < 0.050).ConclusionIn a critically ill patient with BSI, PCT elevation and diagnosis accuracy could be lower if sepsis is secondary than in those with a first episode of infection. More... »

PAGES

163

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/1471-2334-8-163

DOI

http://dx.doi.org/10.1186/1471-2334-8-163

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1014617071

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/19055740


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32 schema:description BackgroundBlood stream infections (BSI) are life-threatening infections in intensive care units (ICU), and prognosis is highly dependent on early detection. Procalcitonin levels have been shown to accurately and quickly distinguish between BSI and noninfectious inflammatory states in critically ill patients. It is, however, unknown to what extent a recent history of sepsis (namely, secondary sepsis) can affect diagnosis of BSI using PCT.Methodsreview of the medical records of every patient with BSI in whom PCT dosage at the onset of sepsis was available between 1st September, 2006 and 31st July, 2007.Results179 episodes of either primary (n = 117) or secondary (n = 62) sepsis were included. Procalcitonin levels were found to be markedly lower in patients with secondary sepsis than in those without (6.4 [9.5] vs. 55.6 [99.0] ng/mL, respectively; p < 0.001), whereas the SOFA score was similar in the two groups. Although patients in the former group were more likely to have received steroids and effective antibiotic therapy prior to the BSI episode, and despite a higher proportion of candidemia in this group, a low PCT value was found to be independently associated with secondary sepsis (Odd Ratio = 0.33, 95% Confidence Interval: 0.16–0.70; p = 0.004). Additional patients with suspected but unconfirmed sepsis were used as controls (n = 23). Thus, diagnostic accuracy of PCT as assessed by the area under the receiver-operating characteristic curves (AUROCC) measurement was decreased in the patients with secondary sepsis compared to those without (AUROCC = 0.805, 95% CI: 0.699–0.879, vs. 0.934, 95% CI: 0.881–0.970, respectively; p < 0.050).ConclusionIn a critically ill patient with BSI, PCT elevation and diagnosis accuracy could be lower if sepsis is secondary than in those with a first episode of infection.
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41 MethodsReview
42 PCT
43 PCT elevation
44 PCT values
45 SOFA score
46 accuracy
47 accuracy of procalcitonin
48 additional patients
49 antibiotic therapy
50 area
51 blood stream infections
52 candidemia
53 care unit
54 characteristic curve measurements
55 control
56 curve measurements
57 detection
58 diagnosis
59 diagnosis accuracy
60 diagnostic accuracy
61 early detection
62 early diagnosis
63 effective antibiotic therapy
64 elevation
65 episodes
66 extent
67 first episode
68 former group
69 group
70 higher proportion
71 history
72 ill patients
73 impact
74 infection
75 inflammatory state
76 intensive care unit
77 levels
78 life-threatening infections
79 low PCT values
80 measurements
81 medical records
82 onset
83 onset of sepsis
84 patients
85 previous sepsis
86 procalcitonin
87 procalcitonin levels
88 prognosis
89 proportion
90 recent history
91 records
92 scores
93 secondary sepsis
94 sepsis
95 state
96 steroids
97 therapy
98 units
99 values
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