Journals / Turkish Journal of Anaesthesiology and Reanimation / 2018 / Cilt: 46 - Sayı: 1
Diagnostic Accuracy of Procalcitonin for Differentiating Bacteraemic Gram-Negative Sepsis from Gram-Positive Sepsis
- Pages
- 38–43
- DOI
- —
Abstract
Objective: The identification of bacteraemia in patients with suspected sepsis is crucial for survival. A cheap, fast and reliable biomarker, which can predict the causative pathogen group, may be useful to confirm or exclude the presence of bacteraemia. This study aimed to evaluate the relationship between procalcitonin (PCT) and the causative pathogen in intensive care patients with sepsis and bacteraemia. Methods: Patients with diagnosed sepsis, a positive blood culture and measured serum procalcitonin levels during their intensive care unit stay were included in the study. Demographic data, PCT level, leukocyte count, C-reactive protein level, creatinine level, lymphocyte count, leukocyte/lymphocyte ratio and the group of the pathogen that detected in the blood culture were retrospectively recorded. Results: Overall, 136 sepsis patients who were diagnosed with bacteraemia were included in the study. The PCT level was 7.31 ng mL-1 in the gram-negative group and 0.46 ng mL-1 in the gram-positive group. For PCT, the sensitivity was 70.83% and the specificity was 84.21%, with the cut-off value being ≤1.3. The area under the receiver operating characteristics curve for PCT was 0.80. Conclusion: Patients with gram-negative sepsis had higher PCT values than those with gram-positive sepsis. Our results suggest that PCT value may be a useful tool for distinguishing between gram-negative and gram-positive bacteraemia.
Özet
Objective: The identification of bacteraemia in patients with suspected sepsis is crucial for survival. A cheap, fast and reliable biomarker, which can predict the causative pathogen group, may be useful to confirm or exclude the presence of bacteraemia. This study aimed to evaluate the relationship between procalcitonin (PCT) and the causative pathogen in intensive care patients with sepsis and bacteraemia. Methods: Patients with diagnosed sepsis, a positive blood culture and measured serum procalcitonin levels during their intensive care unit stay were included in the study. Demographic data, PCT level, leukocyte count, C-reactive protein level, creatinine level, lymphocyte count, leukocyte/lymphocyte ratio and the group of the pathogen that detected in the blood culture were retrospectively recorded. Results: Overall, 136 sepsis patients who were diagnosed with bacteraemia were included in the study. The PCT level was 7.31 ng mL-1 in the gram-negative group and 0.46 ng mL-1 in the gram-positive group. For PCT, the sensitivity was 70.83% and the specificity was 84.21%, with the cut-off value being ≤1.3. The area under the receiver operating characteristics curve for PCT was 0.80. Conclusion: Patients with gram-negative sepsis had higher PCT values than those with gram-positive sepsis. Our results suggest that PCT value may be a useful tool for distinguishing between gram-negative and gram-positive bacteraemia. Keywords: Sepsis, procalcitonin, bacteraemiaAmaç: Sepsisten şüphe edilen hastalarda bakteriyeminin tanınması sağ kalım açısından oldukça önemlidir. Bakteriyemi varlığını destekleyen veya dışlayan, etken patojen grubu hakkında fikir verebilen, ucuz, hızlı ve güvenilir bir biyobelirteç yararlı olabilir. Bu çalışmada, yoğun bakımda yatan, bakteriyemi saptanmış sepsis hastalarında prokalsitonin (PCT) düzeyinin etken olan patojen ile ilişkisinin değerlendirilmesi amaçlanmıştır. Yöntemler: Yoğun bakım yatışı sırasında sepsis tanısı alan, eş zamanlı kan kültürü ve prokalsitonin serum düzeyi gönderilen, kan kültüründe üreme olması ile bakteriyemi saptanan hastalar çalışmaya dahil edildi. Demografik veriler, PCT, lökosit, C-reaktif protein (CRP), kreatinin, lenfosit, lökosit/lenfosit oranı, kan kültüründe üreyen patojen grubu geriye dönük olarak kaydedildi. Bulgular: Bakteriyemi saptanan 136 sepsis hastası çalışmaya alındı. PCT düzeyi gram negatif grubunda 7,31 ng mL-1, gram pozitif grubunda 0,46 ng mL-1 bulundu. PCT için %70,83 duyarlılık ve %84,21 özgüllük ile eşik değer ≤1,3 olarak belirlendi. PCT değeri için receiver operating characteristics eğri altındaki alan 0,80 olarak hesaplandı. Sonuç: Gram negatif sepsis hastalarında gram pozitif sepsis hastalarına göre daha yüksek PCT değerleri bulunmuştur. Sonuçlarımız, Gram negatif ile gram pozitif kaynaklı bakteriyeminin ayrımında PCT değerlerinin yararlı bir araç olabileceği yönündedir.