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Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.

Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, Olsson NO, Blettery B - BMC Infect. Dis. (2008)

Bottom Line: However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia.In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de DIJON, France. pierre-emmanuel.charles@chu-dijon.fr

ABSTRACT

Background: In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.

Methods: Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.

Results: 97 episodes of either GN bacteremia (n = 52) or GP bacteremia (n = 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71-0.88).

Conclusion: In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

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Related in: MedlinePlus

Receiver operating characteristic curve of serum procalcitonin (PCT) for the diagnosis of gram negative bacteremia in critically ill patients with clinical sepsis and blood cultures proven positive for bacterial species. Plain circles indicate PCT values and dashes represents the corresponding ROC curve assuming a normal distribution of the variable.
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Figure 2: Receiver operating characteristic curve of serum procalcitonin (PCT) for the diagnosis of gram negative bacteremia in critically ill patients with clinical sepsis and blood cultures proven positive for bacterial species. Plain circles indicate PCT values and dashes represents the corresponding ROC curve assuming a normal distribution of the variable.

Mentions: In addition, the corresponding ROC curve was constructed in order to assess to what extent PCT could differentiate between GP and GN bacteremia (Figure 2). The area under the ROC curve was 0.79 (95% CI, 0.71–0.88). A sensitivity of 75.0% and a specificity of 82.2%, a positive predictive value of 83.0% and a negative predictive value of 74.0% were achieved with a PCT cutoff value of 16.0 ng/mL (Table 4). The likelihood ratio of a positive test (LR+) was 4.21. The LR- was 0.30.


Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria.

Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, Olsson NO, Blettery B - BMC Infect. Dis. (2008)

Receiver operating characteristic curve of serum procalcitonin (PCT) for the diagnosis of gram negative bacteremia in critically ill patients with clinical sepsis and blood cultures proven positive for bacterial species. Plain circles indicate PCT values and dashes represents the corresponding ROC curve assuming a normal distribution of the variable.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2289831&req=5

Figure 2: Receiver operating characteristic curve of serum procalcitonin (PCT) for the diagnosis of gram negative bacteremia in critically ill patients with clinical sepsis and blood cultures proven positive for bacterial species. Plain circles indicate PCT values and dashes represents the corresponding ROC curve assuming a normal distribution of the variable.
Mentions: In addition, the corresponding ROC curve was constructed in order to assess to what extent PCT could differentiate between GP and GN bacteremia (Figure 2). The area under the ROC curve was 0.79 (95% CI, 0.71–0.88). A sensitivity of 75.0% and a specificity of 82.2%, a positive predictive value of 83.0% and a negative predictive value of 74.0% were achieved with a PCT cutoff value of 16.0 ng/mL (Table 4). The likelihood ratio of a positive test (LR+) was 4.21. The LR- was 0.30.

Bottom Line: However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia.In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

View Article: PubMed Central - HTML - PubMed

Affiliation: Service de Réanimation Médicale, Hôpital Le Bocage, C.H.U. de DIJON, France. pierre-emmanuel.charles@chu-dijon.fr

ABSTRACT

Background: In the ICU, bacteremia is a life-threatening infection whose prognosis is highly dependent on early recognition and treatment with appropriate antibiotics. Procalcitonin levels have been shown to distinguish between bacteremia and noninfectious inflammatory states accurately and quickly in critically ill patients. However, we still do not know to what extent the magnitude of PCT elevation at the onset of bacteremia varies according to the Gram stain result.

Methods: Review of the medical records of every patient treated between May, 2004 and December, 2006 who had bacteremia caused by either Gram positive (GP) or Gram negative (GN) bacteria, and whose PCT dosage at the onset of infection was available.

Results: 97 episodes of either GN bacteremia (n = 52) or GP bacteremia (n = 45) were included. Procalcitonin levels were found to be markedly higher in patients with GN bacteremia than in those with GP bacteremia, whereas the SOFA score value in the two groups was similar. Moreover, in the study population, a high PCT value was found to be independently associated with GN bacteremia. A PCT level of 16.0 ng/mL yielded an 83.0% positive predictive value and a 74.0% negative predictive value for GN-related bacteremia in the study cohort (AUROCC = 0.79; 95% CI, 0.71-0.88).

Conclusion: In a critically ill patient with clinical sepsis, GN bacteremia could be associated with higher PCT values than those found in GP bacteremia, regardless of the severity of the disease.

Show MeSH
Related in: MedlinePlus