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Discriminative procalcitonin values for diagnosis of systemic inflammatory response syndrome and sepsis in the ICU
Critical Care volume 12, Article number: P187 (2008)
No study has found a procalcitonin level that distinguishes between systemic inflammatory response syndrome (SIRS) and sepsis . The goal of our study was to determine a cutoff value of serum procalcitonin concentration for diagnosis of SIRS and sepsis.
In this prospective and observational study, we included all patients admitted to the ICU. The procalcitonin level was determined on day 0, day 2, day 4 and day 7 of hospitalization using the immunoluminometric method (PCT-lumin; Brahms Diagnostica, Berlin, Germany). Normal values are < 0.1 ng/ml. The detection limit was 0.3 ng/ml. P < 0.05 was considered significant. Time points were defined as the procalcitonin concentrations measured at different times in all patients. Time points were associated with SIRS, sepsis and septic shock (SS) according to the established ACCP/SCCM consensus definition. Statistical analysis was performed using SPSS software for windows version 10.
A total of 70 patients were included in our study. Two hundred and sixty-five time points were categorized into three groups (SIRS, sepsis and SS). The mean IGS II score was 32 ± 14; the mean APACHE II score 15 ± 7. The median procalcitonin levels in the SIRS group and the sepsis + SS group were, respectively, 0.325 and 1.115 ng/ml (P < 0.001). The area under the ROC curve to distinguish the presence or absence of sepsis was 0.745 (0.685–0.805). A cutoff value of 1.3 has a specificity and a sensitivity of 89% and 45%, respectively. If we exclude patient patients with SS, a cutoff value of 1.3 has the same specificity (89%) and was less sensitive (58%). A cutoff value of 0.265 had a specificity of 58% and a sensitivity of 80%.
According to these preliminary results a procalcitonin level between 0.265 and 1.3 ng/ml cannot distinguish between SIRS and sepsis. This can be explained by the fact that we considered different time points in the same patients and by the fact that we did not separate medical and surgical patients.
Simon L, Gauvin F, Amre DK, et al.: Clin Infect Dis. 2004, 39: 206-217. 10.1086/421997
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Gharsallah, H., Labbene, I., Fatthallah, B. et al. Discriminative procalcitonin values for diagnosis of systemic inflammatory response syndrome and sepsis in the ICU. Crit Care 12, P187 (2008). https://doi.org/10.1186/cc6408
- Public Health
- Detection Limit
- Inflammatory Response
- Observational Study
- Septic Shock