Procalcitonin

BackgroundThe revised definition of sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection (SEPSIS-3). The objective of this study was to evaluate procalcitonin (PCT) for the diagnosis and prognosis of sepsis using SEPSIS-3.MethodsWe enrolled 248 patients, who were admitted to the emergency department with suspected bacterial infection from June 2016 to February 2017. Definite bacterial infection was defined by proven culture results, and probable bacterial infection was based on diagnostic modalities other than culture. The sequential organ failure assessment (SOFA) score of 2 points or more from the baseline was diagnosed as sepsis. PCT was measured by the AFIAS-6 immunoassay system (Boditech Med Inc.) using whole blood. White blood cell (WBC), C-reactive protein (CRP), and erythrocyte sedimentation rate (ERS) were evaluated.ResultsThe final diagnosis was sepsis in 185 patients with infection of respiratory and genitourinary tract constituted 84.6%. The area under the receiver operating characteristic curve (AUROC) with 95% confidence interval (CI) was as follows: PCT, 0.682 (0.589-0.765); CRP, 0.583 (0.487-0.673); ESR, 0.540 (0.515-0.699); and WBC, 0.611 (0.455-0.633), respectively. In multivariate analysis, age, SOFA, and PCT (log scale) predicted non-survivors with an odds ratio with 95% confidence interval of 1.055 (1.008-1.105), 1.303 (1.142-1.486), and 2.004 (1.240-3.238), respectively. Among sepsis group, initial PCT was increased in non-survivor (23.2 ng/dL) compared to survivor group (8.1 ng/dL) with statistical significance (P = .005).ConclusionsPCT could support and predict the unfavorable prognosis of sepsis based on SEPSIS-3, whereas diagnostic potential of PCT requires further evaluations.

BackgroundThere is a lack of studies comparing PCT, CRP and WBC levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections. It is necessary to explore the correlation between above markers and different types of ARTI.Methods108 children with confirmed bacterial infection were regarded as group A, 116 children with virus infection were regarded as group B, and 122 children with mycoplasmal infection were regarded as group C. The levels of PCT, CRP and WBC of the three groups were detected and compared.ResultsThe levels of PCT, CRP and WBC in group A were significantly higher than those in groups B and C (p + bacterial infection and G- bacterial infection (p > 0.05). ROC curve results showed that the AUC of PCT, CRP and WBC for the diagnosis of bacterial respiratory infections were 0.65, 0.55, and 0.58, respectively.ConclusionsPCT, CRP and WBC can be combined as effective indicators for the identification of acute bacterial or no-bacterial infections in children. The levels of PCT and CRP have higher differential diagnostic value than that of WBC in infection, and the combined examination of the three is more valuable in clinic.

BackgroundPatients with a severe COVID-19 infection often require admission at an intensive care unit (ICU) when they develop acute respiratory distress syndrome (ARDS). Hyperinflammation plays an important role in the development of ARDS in COVID-19. Procalcitonin (PCT) is a biomarker which may be a predictor of hyperinflammation. When patients with COVID-19 are in the emergency department (ED), elevated PCT levels could be associated with severe COVID-19 infections. The goal of this study is to investigate the association between PCT levels and severe COVID-19 infections in the ED.MethodsThis was a retrospective cohort study including patients with a confirmed COVID-19 infection who visited the ED of Erasmus Medical Center in Rotterdam, the Netherlands, between March and December 2020. The primary outcome was a severe COVID-19 infection, which was defined as patients who required ICU admission, all cause in-hospital mortality and mortality within 30 days after hospital discharge. PCT levels were measured during the ED visit. We used logistic regression to calculate the odds ratio (OR) with 95% confidence interval (95% CI) and corresponding area under the curve (AUC) of PCT on a severe COVID-19 infection, adjusting for bacterial coinfections, age, sex, comorbidities, C-reactive protein (CRP) and D-dimer.ResultsA total of 332 patients were included in the final analysis of this study, of which 105 patients reached the composite outcome of a severe COVID-19 infection. PCT showed an unadjusted OR of 4.19 (95%CI: 2.52-7.69) on a severe COVID-19 infection with an AUC of 0.82 (95% CI: 0.76-0.87). Corrected for bacterial coinfection, the OR of PCT was 4.05 (95% CI: 2.45-7.41). Adjusted for sex, bacterial coinfection, age any comorbidity, CRP and D-dimer, elevated PCT levels were still significantly associated with a severe COVID-19 infection with an adjusted OR of 2.11 (95% CI: 1.36-3.61). The AUC of this multivariable model was 0.85 (95%CI: 0.81-0.90).ConclusionHigh PCT levels are associated with high rates of severe COVID-19 infections in patients with a COVID-19 infection in the ED. The routine measurement of PCT in patients with a COVID-19 infection in the ED may assist physicians in the clinical decision making process regarding ICU disposition.

IntroductionAntibiotics are a first-line treatment for sepsis, with guidelines recommending a 7- to 10-day course. Prolonged antibiotic use carries significant risks, prompting growing interest in using inflammatory biomarkers, such as procalcitonin or C-reactive protein, to guide clinical decision-making on the duration of antibiotic therapy in patients who are critically ill. This rapid systematic review aims to assess the effectiveness and safety of using procalcitonin- or C-reactive protein-guided protocols for antibiotic discontinuation in patients who are critically ill with sepsis.MethodsWe conducted systematic searches for articles published after January 2005 in relevant databases. Eligible studies included randomised controlled trials comparing procalcitonin- or C-reactive protein-guided protocols for antibiotic discontinuation with standard care, or with each other. Primary outcomes were duration of antibiotic therapy and mortality. Secondary outcomes included infection recurrences; secondary infections or superinfections; and the duration of intensive care and hospital stays.ResultsWe identified 21 eligible studies. Moderate certainty evidence from 19 trials, involving 6382 patients, indicated that procalcitonin-guided protocols probably reduced antibiotic therapy by, on average, 2.0 days (95%CI -2.6 to -1.4) compared with standard care. Moderate certainty evidence from 18 trials, involving 6228 patients, suggested an average 5% reduction in mortality risk when using procalcitonin-guided protocols compared with standard care (risk ratio 0.95, 95%CI 0.83-1.07). The evidence regarding C-reactive protein-guided protocols versus standard care approaches remained unclear, with very low to low certainty evidence available.DiscussionCombining relevant trials suggests that procalcitonin-guided discontinuation protocols may be both safe and effective for patients who are critically ill with sepsis, with no increased risk in mortality. In contrast, the evidence supporting C-reactive protein-guided protocols is limited. These findings underscore the potential importance of utilising procalcitonin to inform antimicrobial stewardship practices, particularly in critical care settings.