Document Detail


Serial and panel analyses of biomarkers do not improve the prediction of bacteremia compared to one procalcitonin measurement.
MedLine Citation:
PMID:  22710263     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We evaluated the value of a single biomarker, biomarker panels, biomarkers combined with clinical signs of sepsis, and serial determinations of biomarkers in the prediction of bacteremia in patients with sepsis.
METHODS: Adult patients visiting the emergency department because of a suspected infection with at least two of the following symptoms: temperature >38.3°C or <36°C, heart rate >90/min, respiratory rate >20/min, chills, altered mental status, systolic blood pressure <90 mmHg, MAP <65 mmHg, and hyperglycemia in the absence of diabetes mellitus were included. Procalcitonin (PCT), interleukin-6 (IL-6), lipopolysaccharide-binding protein (LBP), C-reactive protein (CRP) were measured, and two blood cultures were taken. The analyses included: (1) determination of the biomarker with the highest predictive value for bacteremia and to examine the predictive value of this biomarker in combination with other biomarkers; (2) analysis of the best biomarker data in combination with clinical signs of sepsis; and (3) analysis of serial determinations of the best biomarker.
RESULTS: Of 342 included patients, PCT had the best predictive value for bacteremia with an area under the curve of 0.80, sensitivity 89%, specificity 58%. The predictive value of a combination of PCT plus a panel of other biomarkers, clinical signs, or analysis of serial PCT levels did not lead to a significant improvement of the predictive value of PCT alone.
CONCLUSIONS: The ability of PCT to predict bacteremia in patients with sepsis does not further improve when combined with IL-6, LBP, CRP, clinical signs, or serial measurements. Naturally, this does not exclude that a panel of other biomarkers may lead to different results.
Authors:
M Tromp; B Lansdorp; C P Bleeker-Rovers; J M Klein Gunnewiek; B J Kullberg; P Pickkers
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article     Date:  2012-06-15
Journal Detail:
Title:  The Journal of infection     Volume:  65     ISSN:  1532-2742     ISO Abbreviation:  J. Infect.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-11     Completed Date:  2013-01-23     Revised Date:  2014-10-26    
Medline Journal Info:
Nlm Unique ID:  7908424     Medline TA:  J Infect     Country:  England    
Other Details:
Languages:  eng     Pagination:  292-301     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Bacteremia / diagnosis*,  pathology
Biological Markers / blood*
Calcitonin / blood*
Decision Support Techniques
Female
Humans
Male
Middle Aged
Predictive Value of Tests
Protein Precursors / blood*
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Protein Precursors; 56645-65-9/procalcitonin; 9007-12-9/Calcitonin
Comments/Corrections
Comment In:
J Infect. 2014 Oct;69(4):410-2   [PMID:  24820656 ]

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