Original Contributions
Diagnostic value of procalcitonin levels as an early indicator of sepsis,☆☆,

https://doi.org/10.1053/ajem.2002.33005Get rights and content

Abstract

Researchers and clinicians have been investigating and implementing various methods of early diagnosis for sepsis before documentation of infection. The aim of this study was to outline the efficiency of procalcitonin (PCT), C-reactive protein (CRP), and white blood cell count (WBC) in determining the early diagnosis of sepsis in the emergency department. Between January 1999 and September 2000, 34 patients with signs of systemic inflammatory response syndrome (SIRS) were enrolled in the study. The patients were divided into 2 groups according to nonsuspected sepsis and suspected sepsis clinically. Admission PCT was significantly higher in suspected sepsis group (median 68.7 μg/L; lower [L] = 15.24 μg/L, upper [U] = 120.54 μg/L) compared with the unsuspected sepsis group (.23 μg/L; L = .10 μg/L, U = .44 μg/L). PCT values were compared with WBC and CRP levels. Predictive accuracy for sepsis expressed as area under the receiver operating characteristic (ROC) curve was .88 for PCT, .44 for WBC, and .34 for CRP. PCT can probably be used as a predictive marker in bacterial infections in emergency departments. (Am J Emerg Med 2002;20:202-206. Copyright 2002, Elsevier Science (USA). All rights reserved.)

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Patients and methods

Ondokuz Mayis University Hospital is a secondary referral hospital in the middle Black Sea region of Turkey. Most patients are sent to the hospital by either a specialist or an emergency medicine clinician for further investigation. Many of them have risk factors for sepsis such as hospitalization, intravascular catheters, and urinary catheters. Therefore, complex cases and other life-threatening diseases are admitted to our ED from that area.

With approval from the local research ethical

Results

The demographics (ie, age, sex) were similar between the 2 groups except for underlying medical illness. The suspected sepsis group included 19 patients with a history of previous cerebrovascular disease, chronic obstructive pulmonary disease, and diabetes mellitus. A summary of these cases is provided in Table 1.

. Serial PCT and CRP Determinations in the Suspected Sepsis Group With Blood Culture Results and Concomitant Diseases

Case No.Blood IsolateAgeConcomitant DiseasePCT Level (μg/L)CRP Level

Discussion

The goals of emergency medicine physicians should be 2-fold: to distinguish sepsis from other causes of SIRS and start early therapy including an antibiotic regimen. The critical point in patients with sepsis is the absence of documented infection at admission to the ED. The use of cultures for identifying the presence of bacteria requires time, which makes it inaccessible for clinical use in the ED, and negative cultures do not exclude the sepsis. Some investigators have suggested that

References (26)

  • WJ Sibbald et al.

    Roundtable conference on clinical trials for the treatment of sepsis

    Chest

    (1995)
  • M Assicot et al.

    High serum procalcitonin concentrations in patients with sepsis and infection

    Lancet

    (1993)
  • B Clyne et al.

    The C-reactive protein

    J Emerg Med

    (1999)
  • EM Koscove

    Sepsis and septic shock

  • EH Carrillo et al.

    Early elevation of soluble CD14 may help identify trauma patients at high risk for infection

    J Trauma

    (2001)
  • B Katja et al.

    The value of immune modulating parameters in predicting the progression from peritonitis to septic shock

    Shock

    (2001)
  • TD Kane et al.

    The detection of microbial DNA in the blood: A sensitive method for diagnosing bacteremia and/or bacterial translocation in surgical patients

    Ann Surg

    (1998)
  • B Al-Nawas et al.

    Procalcitonin in patients with and without immunosuppression and sepsis

    Infection

    (1996)
  • PM Steinwald et al.

    Elevated calcitonin precursor levels are related to mortality in an animal model of sepsis

    Crit Care

    (1999)
  • M Oberhoffer et al.

    Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis

    Crit Care Med

    (1999)
  • H Ugarte et al.

    Procalcitonin used as a marker of infection in the intensive care unit

    Crit Care Med

    (1999)
  • 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

    Crit Care Med

    (1992)
  • CL Sprung

    Definitions of sepsis: Have we reached a consensus?

    Crit Care Med

    (1991)
  • Cited by (0)

    Supported by Ondokuz Mayis University Department of Research fund, grant no. T-257.

    ☆☆

    Address reprint requests to Hakan Guven, MD, Assistant Professor, Department of Emergency, Ondokuz Mayis University School of Medicine, 55139 Samsun, Turkey.

    0735-6757/02/2003-0012$35.00/0

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