TY - JOUR
TI - Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay
AU - Tsangaris, I.
AU - Plachouras, D.
AU - Kavatha, D.
AU - Gourgoulis, G.M.
AU - Tsantes, A.
AU - Kopterides, P.
AU - Tsaknis, G.
AU - Dimopoulou, I.
AU - Orfanos, S.
AU - Giamarellos-Bourboulis, E.
AU - Giamarellou, H.
AU - Armaganidis, A.
JO - BMC Infectious Diseases
PY - 2009
VL - 9
TODO - null
SP - null
PB - 
SN - 1471-2334
TODO - 10.1186/1471-2334-9-213
TODO - C reactive protein;  procalcitonin;  biological marker;  calcitonin;  procalcitonin;  protein precursor, adult;  aged;  article;  clinical article;  controlled study;  critical illness;  diagnostic accuracy;  diagnostic value;  disease marker;  female;  fever;  human;  intensive care;  intensive care unit;  length of stay;  leukocyte;  male;  prognosis;  protein blood level;  sepsis;  survival;  systemic inflammatory response syndrome;  area under the curve;  bacterial infection;  blood;  critical illness;  fever;  middle aged;  prediction and forecasting;  prospective study;  sensitivity and specificity;  systemic inflammatory response syndrome, Adult;  Aged;  Aged, 80 and over;  Area Under Curve;  Bacterial Infections;  Biological Markers;  Calcitonin;  Critical Illness;  Female;  Fever;  Humans;  Intensive Care Units;  Length of Stay;  Male;  Middle Aged;  Predictive Value of Tests;  Prospective Studies;  Protein Precursors;  Sensitivity and Specificity;  Systemic Inflammatory Response Syndrome
TODO - Background: Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.Methods: Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38°C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.Results: Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).Conclusion: The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients. © 2009 Tsangaris et al; licensee BioMed Central Ltd.
ER -