Τίτλος:
Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Tsangaris, I.
Plachouras, D.
Kavatha, D.
Gourgoulis, G.M.
Tsantes, A.
Kopterides, P.
Tsaknis, G.
Dimopoulou, I.
Orfanos, S.
Giamarellos-Bourboulis, E.
Giamarellou, H.
Armaganidis, A.
Περιοδικό:
BMC Infectious Diseases
Λέξεις-κλειδιά:
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
DOI:
10.1186/1471-2334-9-213
