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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:  Publisher    
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; 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 Klein Gunnewiek; B J Kullberg; P Pickkers
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-15
Journal Detail:
Title:  The Journal of infection     Volume:  -     ISSN:  1532-2742     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7908424     Medline TA:  J Infect     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Ltd.
Affiliation:
Nijmegen Institute for Infection, Inflammation, and Immunity (N4i), Radboud University Nijmegen Medical Centre, the Netherlands; Dept of Internal Medicine, Radboud University Nijmegen Medical Centre, the Netherlands.
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