Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Hoenigl, M; Raggam, RB; Wagner, J; Prueller, F; Grisold, AJ; Leitner, E; Seeber, K; Prattes, J; Valentin, T; Zollner-Schwetz, I; Schilcher, G; Krause, R.
Procalcitonin fails to predict bacteremia in SIRS patients: a cohort study.
Int J Clin Pract. 2014; 68(10):1278-1281
Doi: 10.1111/ijcp.12474
Web of Science
PubMed
FullText
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- Führende Autor*innen der Med Uni Graz
- Hönigl Martin
- Krause Robert
- Co-Autor*innen der Med Uni Graz
- Grisold Andrea
- Leitner-Meyer Eva
- Prattes Jürgen
- Prüller Florian
- Rabensteiner Jasmin
- Raggam Reinhard Bernd
- Schilcher Gernot
- Valentin Thomas
- Zollner-Schwetz Ines
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- Abstract:
- Procalcitonin (PCT) has previously been proposed as useful marker to rule out bloodstream-infection (BSI). The objective of this study was to evaluate the sensitivity of different PCT cut-offs for prediction of BSI in patients with community (CA)- and hospital-acquired (HA)-BSI. A total of 898 patients fulfilling systemic-inflammatory-response-syndrome (SIRS) criteria were enrolled in this prospective cohort study at the Medical University of Graz, Austria. Of those 666 patients had positive blood cultures (282 CA-BSI, 384 HA-BSI, enrolled between January 2011 and December 2012) and 232 negative blood cultures (enrolled between January 2011 and July 2011 at the emergency department). Blood samples for determination of laboratory infection markers (e.g. PCT) were collected simultaneously with blood cultures. Procalcitonin was significantly (p < 0.001) higher in SIRS patients with bacteremia/fungemia than in those without. Receiver operating characteristic curve analysis revealed an area under the curve (AUC) value of 0.675 for PCT (95% CI 0.636-0.714) for differentiating patients with BSI from those without. AUC for IL-6 was 0.558 (95% CI 0.515-0.600). However, even at the lowest cut-off evaluated (i.e. 0.1 ng/ml) PCT failed to predict BSI in 7% (n = 46) of patients. In the group of patients with SIRS and negative blood culture 79% (n = 185) had PCT levels > 0.1. Procalcitonin was significantly higher in patients with BSI than in those without and superior to IL-6 and CRP. The clinical importance of this is questionable, because a suitable PCT threshold for excluding BSI was not established. An approach where blood cultures are guided by PCT only can therefore not be recommended. © 2014 John Wiley & Sons Ltd.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged -
- Area Under Curve -
- Bacteremia - diagnosis
- Biomarkers - blood
- Calcitonin - blood
- Calcitonin Gene-Related Peptide -
- Cohort Studies -
- Female -
- Humans -
- Male -
- Middle Aged -
- Prospective Studies -
- Protein Precursors - blood
- Sensitivity and Specificity -
- Systemic Inflammatory Response Syndrome - blood
- Systemic Inflammatory Response Syndrome - complications
- Systemic Inflammatory Response Syndrome - diagnosis