Infectious agent's influence on serum procalcitonin concentration in patients with sepsis
Abstract
Abstract
Theoretical background: Procalcitonin (PCT) is diagnostic and prognostic biomarker of sepsis. The objective of this study was to evaluate the correlation between sepsis causative agent and serum PCT concentration, since it would influence the initial empirical antimicrobial therapy selection.
Methods: This retrospective study included 96 patients with sepsis who were admitted to Intensive Care Unit of Department of Infectious Diseases and Febrile Illnesses of University Clinical Center Ljubljana from September of 2011 through March of 2013. Sepsis was established clinically and defined aetiologically by haemoculture growth. Statistical evaluation was conducted in 76 patients who had not received proper antimicrobial therapy prior to blood collection. ForPCT determination imunoluminometric method was used and concentrations above 5 mg/L were considered elevated. Results: Serum PCT concentration was significantly higher in Gram-negative sepsis (PCT median was 26,3 μg/L) compared to Gram-positive sepsis (PCT median was 11,2 μg/L) (p = 0,016). Differences in PCT concentrations between Gram-positive pathogens were not statistically significant (p = 0,09), however, S. aureus sepsis is linked to higher serum PCT concentration (median PCT 12,8 μg/L) than all other Gram-positive agents put together (median PCT of 5,9 μg/L) (p = 0,016). Difference in PCT concentration in E. coli sepsis (median PCT of 38,2 μg/L) compared to other enterobacteria (median PCT of 26,3 μg/L) is not statistically significant (p = 0,902).
Conclusions: Causative agent has a significant effect on serum PCT concentration in patients with sepsis. Higher values were present in Gram-negative than in Gram-positive sepsis. Amongst Gram-positive pathogens, S. aureus caused greater rise in PCT than other Gram-positive bacteria put together.
Downloads
References
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 2003; 348: 1546 54.
Esteban A, Frutos-Vivar F, Ferguson ND, Peñuelas O, Lorente JA, Gordo F, et al. Sepsis incidence and outcome: contrasting the intensive care unit with the hospital ward. Crit Care Med 2007; 35: 1284-9.
Finfer S, Bellomo R, Lipman J, French C, Dobb G, Myburgh J. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units. Intensive Care Med 2004; 30: 589-96.
Padkin A, Goldfrad C, Brady AR, Young D, Black N, Rowan K. Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland. Crit Care Med 2003; 31: 2332-8.
Beovic B, Hladnik Z, Pozenel P, Siuka D. Epidemiology of severe sepsis in Slovenian intensive care units for adults. J Chemother 2008; 20: 134-6.
Pavon A, Binquet C, Kara F, Martinet O, Ganster F, Navellou JC, et al. Profile of the risk of death after septic shock in the present era: an epidemiologic study. Crit Care Med 2013; 41: 2600-9.
Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC. Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother 2005; 49: 760-6.
Shorr AF, Tabak YP, Killian AD, Gupta V, Liu LZ, Kollef MH. Healthcare-associated bloodstream infection: A distinct entity? Insights from a large U.S. database. Crit Care Med 2006; 34: 2588-95.
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit. Care. Med 2006; 34: 1589-96.
Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003; 31: 2742-51.
Lueangarun S, Leelarasamee A. Impact of Inappropriate Empiric Antimicrobial Therapy on Mortality of Septic Patients with Bacteremia: A Retrospective Study. Interdiscip Perspect Infect Dis. 2012; 2012: 765205.
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: A systematic review and meta-analysis. Clin Infect Dis 2004; 39: 206–17.
Jereb M, Muzlovič I, Hojker S, Strle F. Predictive value of serum and cerebrospinal fluid procalcitonin levels for the diagnosis of bacterial meningitis. Infection 2001; 29: 209–12.
Müller B, White JC, Nylen ES, Snider RH, Becker KL, Habener JF. Ubiquitus expression of the calcitonin-I gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab 2001; 86: 396-404.
Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, et al. Procalcitonin increase after endotoxin injection in normal subject. J Clin Endocrinol Metab 1994; 79: 1605–8.
Hausfater P, Garric S, Ben Ayed S, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: A prospective study. Clin Infect Dis 2002; 34: 895-901.
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. 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. Chest 1992; 101: 1644-55.
Meisner M. Procalcitonin – Biochemistry and Clinical Diagnosis. Bremen: UNI-MED, 2010.
Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti Infect Ther 2012; 10: 701-6.
Danese MD, Griffiths RI, Dylan M, Yu HT, Dubois R, Nissenson AR. Mortality differences among organisms causing septicemia in hemodialysis patients. Hemodial Int. 2006;10: 56-62.
Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, et al. Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria. BMC Infect Dis 2008; 8: 38.
Zahar JR, Timsit JF, Garrouste-Orgeas M, Français A, Vesin A, Descorps-Declere A, et al. Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Crit Care Med 2011; 39: 1886-95.
Phua J, Ngerng WJ, See KC, Tay CK, Kiong T, Lim HF, et al. Characteristics and outcomes of culture-negative versus culture-positive severe sepsis. Crit care 2013; 17: 1-12.
Burnkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R. Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med 2000; 26: 148-52.
Jereb M, Kotar T, Jurca T, Lejko Zupanc T. Usefulness of procalcitonin for diagnosis of infective endocarditis. Intern Emerg Med 2009; 4:221-6.
Al-Nawas B, Krammer I, Shah PM. Procalcitonin in diagnosis of severe infections. Eur J Med Res 1996; 1: 331-3.
Casey LC, Balk RA, Bone RC. Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome. Ann Intern Med 1993; 119: 771-8.
Gao H, Evans TW, Finney SJ. Bench-to-bedside review: sepsis, severe sepsis and septic shock—does the nature of the infecting organism matter? Crit Care 2008; 12: 213.
Fleischhack G, Cipic D, Juettner J, Hasan C, Bode U. Procalcitonin – a sensitive inflammation marker of febrile episodes in neutropenic children with cancer. Intensive Care Med 2000; 26: 202-11.
Brodska H, Maličkova K, Adamkova V, Benakova H, Štastna MM, Zima T. Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis. 2013; 13: 165-70.
Cuculi F, Toggweiler S, Auer M, der Maur ChA, Zuber M, Erne P. Serum procalcitonin has the potential to identify Staphylococcus aureus endocarditis. Eur J Clin Microbiol Infect Dis 2008; 27: 1145-9.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
