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Lee TG, Yu ST, So CH. Predictive value of C-reactive protein for the diagnosis of meningitis in febrile infants under 3 months of age in the emergency department. Yeungnam Univ J Med 2020; 37:106-111. [PMID: 31914719 PMCID: PMC7142029 DOI: 10.12701/yujm.2019.00402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/16/2019] [Indexed: 12/02/2022] Open
Abstract
Background Fever is a common cause of pediatric consultation in the emergency department. However, identifying the source of infection in many febrile infants is challenging because of insufficient presentation of signs and symptoms. Meningitis is a critical cause of fever in infants, and its diagnosis is confirmed invasively by lumbar puncture. This study aimed to evaluate potential laboratory markers for meningitis in febrile infants. Methods We retrospectively analyzed infants aged <3 months who visited the emergency department of our hospital between May 2012 and May 2017 because of fever of unknown etiology. Clinical information and laboratory data were evaluated. Receiver operating characteristic (ROC) curves were constructed. Results In total, 145 febrile infants aged <3 months who underwent lumbar punctures were evaluated retrospectively. The mean C-reactive protein (CRP) level was significantly higher in the meningitis group than in the non-meningitis group, whereas the mean white blood cell count or absolute neutrophil count (ANC) did not significantly differ between groups. The area under the ROC curve (AUC) for CRP was 0.779 (95% confidence interval [CI], 0.701–0.858). The AUC for the leukocyte count was 0.455 (95% CI, 0.360–0.550) and that for ANC was 0.453 (95% CI, 0.359–0.547). The CRP cut-off value of 10 mg/L was optimal for identifying possible meningitis. Conclusion CRP has an intrinsic predictive value for meningitis in febrile infants aged <3 months. Despite its invasiveness, a lumbar puncture may be recommended to diagnose meningitis in young, febrile infants with a CRP level >10 mg/L.
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Affiliation(s)
- Tae Gyoung Lee
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Seung Taek Yu
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
| | - Cheol Hwan So
- Department of Pediatrics, Wonkwang University School of Medicine, Iksan, Korea
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Anush MM, Ashok VK, Sarma RI, Pillai SK. Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis. Indian J Crit Care Med 2019; 23:11-14. [PMID: 31065202 PMCID: PMC6481256 DOI: 10.5005/jp-journals-10071-23105] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and aims It has been observed that after any injury which is acute and also in the setting of inflammation or infection, the synthesis and secretion of C-reactive protein (CRP) rises within a few hours. The current study monitors CRP in patients presenting with sepsis and attempts to prove that it is one of the most reliable tests in determining the resolution and predicting the outcome. Materials and methods During 12 months, 97 individuals with culture-proven sepsis were included, and a prospective observational study was done. Patients were assessed clinically by recording vitals, mean arterial pressure, Glasgow coma scale score, sequential organ failure assessment (SOFA) score as well as assessment of arterial blood gas and other blood investigations, which included CRP, total white cell count, differential count, serum creatinine, serum bilirubin on day 0, day 2 and day 5 after initiating antibiotics. To test the statistical significance of the difference in mean percentage changes of the different study variables between living and expired groups at day 2 and day 5, Wilcoxon's rank sum test was applied due to the non-normal distribution of values and small sample sizes. Results The percentage drop of the mean of CRP from day 0 to day 2 was 23.33% in the living group, and there was an increase of 4.73 % in the expired group. The percentage drop of the mean of CRP on day 5 when compared to day 0, was significant in the living group. Conclusion C-reactive protein (CRP) is a more useful tool in predicting improvement and outcome in patients admitted with sepsis when compared to scoring systems like SOFA score. Abbreviations AIMS: Amrita Institute of Medical Sciences, C1q: Complement 1q, CRP: C-reactive Protein, PCT: Procalcitonin, SOFA: Sequential organ failure assessment How to cite this article Anush MM, Ashok VK, Sarma RIN, Pillai SK. Role of C-reactive Protein as an Indicator for Determining the Outcome of Sepsis. Indian Journal of Critical Care Medicine, January 2019; 23(1):11-14.
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Affiliation(s)
- Meeval M Anush
- Kerala Institute of Medical Sciences Hospital, Trivandrum, Kerala, India
| | - Vijay K Ashok
- Department of Internal Medicine, MES Medical College, Perinthalmanna, Kerala, India
| | - Ramakrishna In Sarma
- Department of Internal Medicine, Pushpagiri Medical College, Thiruvalla, Kerala, India
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Lee IS, Park YJ, Jin MH, Park JY, Lee HJ, Kim SH, Lee JS, Kim CH, Kim YD, Lee JH. Usefulness of the procalcitonin test in young febrile infants between 1 and 3 months of age. KOREAN JOURNAL OF PEDIATRICS 2018; 61:285-290. [PMID: 30274506 PMCID: PMC6172517 DOI: 10.3345/kjp.2017.06170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 03/05/2018] [Indexed: 12/18/2022]
Abstract
Purpose To study the usefulness of the procalcitonin (PCT) test in young febrile infants between 1 and 3 months of age. Methods We evaluated the medical records of 336 febrile infants between 1 and 3 months of age who visited the Emergency Department or outpatient department of Samsung Changwon Hospital from May 2015 to February 2017, and analyzed the clinical characteristics between infants in the serious bacterial infection (SBI) group and non-SBI group. Results Among the 336 infants, 38 (11.3%) had definitive SBI (bacteremia, n=3; meningitis, n=1; urinary tract infection, n=34). The mean PCT (6.4±11.9 ng/mL) and C-reactive protein (CRP) level (3.8±2.6 mg/dL), and the absolute neutrophil count (ANC) (6,984±4,675) for patients in the SBI group were significantly higher than those for patients in the non-SBI group (PCT, 0.3±1.2 ng/mL; CRP, 1.3±1.6 mg/dL; ANC, 4,888±3,661). PCT had lower sensitivity (43.6%), but higher specificity (92.6%) and accuracy (86.9%) than CRP (92.3%, 25.3%, and 33.0%) for identifying SBI. The area under the receiver operating characteristic curves (AUCs) for definitive SBI were PCT 77.0%, CRP 80.8%, WBC 56.8%, ANC 67.8%, and PLT 48.1%. The AUCs for definitive SBI were PCT+CRP 85.4%, PCT+WBC 77.2%, PCT+ANC 81.3%, CRP+WBC 80.1%, and CRP+ANC 81.6%. Conclusion Our results suggest that the PCT test or a combination of PCT and CRP tests is a more accurate and specific biomarker to detect and rule out SBIs.
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Affiliation(s)
- In Sul Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Jin Park
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Mi Hyeon Jin
- Department of Biostatistics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ji Young Park
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hae Jeong Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sung Hoon Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Cheol Hong Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Young Don Kim
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jun Hwa Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Zhao Z, Li X, Zhao Y, Wang D, Li Y, Liu L, Sun T, Chen G. Role of C-reactive protein and procalcitonin in discriminating between infectious fever and tumor fever in non-neutropenic lung cancer patients. Medicine (Baltimore) 2018; 97:e11930. [PMID: 30113495 PMCID: PMC6112972 DOI: 10.1097/md.0000000000011930] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study assessed whether C-reactive protein (CRP) and procalcitonin (PCT) levels can discriminate between infectious fever and tumor fever (TF) in non-neutropenic patients with nonsmall cell lung cancer (NSCLC).This retrospective clinical study included 96 adults with NSCLC who were admitted to the Third Hospital of Hebei Medical University between July 2015 and July 2017. Febrile, non-neutropenic patients were enrolled. CRP and PCT levels, neutrophil count, and antimicrobial response were evaluated.This study included 26 patients with TF, 49 with localized bacterial infection (LBI), and 21 with bloodstream infection (BSI). CRP levels in BSI were significantly higher than in TF (P < .05) and LBI (P < .05). No statistically significant difference was found between patients with TF and LBI (P > .05). PCT levels were significantly higher in BSI and LBI than in TF (P < .05). CRP and PCT levels in patients with stage IV disease were significantly higher than in those with stage II to III disease (P < .05). CRP and PCT levels declined significantly in patients with BSI who were responding to antimicrobials (P < .05).Compared with CRP levels, PCT levels can discriminate between TF and infectious fever more accurately. PCT and CRP levels may predict different stages of lung cancer.
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Affiliation(s)
- Zhifang Zhao
- Department of Respiration, The Third Hospital of Hebei Medical University
| | - Xuze Li
- Department of Anesthesiology, The Second Hospital of Hebei Medical University
| | - Yunxia Zhao
- Department of Respiration, The Third Hospital of Hebei Medical University
| | - Dongchang Wang
- Department of Respiration, The Third Hospital of Hebei Medical University
| | - Yahua Li
- Department of Respiration, The Third Hospital of Hebei Medical University
| | - Le Liu
- Department of Respiration, The Third Hospital of Hebei Medical University
| | - Tao Sun
- Department of Orthopaedic Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Gang Chen
- Department of Respiration, The Third Hospital of Hebei Medical University
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Zhao Y, Li F, Liu Y, Shi Y, Li Z, Cao G, Zhu W. Comparison of efficiency of inhaled and intravenous corticosteroid on pregnant women with COPD and the effects on the expression of PCT and hs-CRP. Exp Ther Med 2018; 15:4717-4722. [PMID: 29805491 PMCID: PMC5952096 DOI: 10.3892/etm.2018.6011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 11/29/2022] Open
Abstract
The efficiency of inhaled and systemic corticosteroids on pregnant women with chronic obstructive pulmonary disease (COPD) was investigated. The study also compared the effects of the administration on the expression of inflammatory mediator procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP). A total of 120 pregnant COPD patients were recruited and randomly allocated into the following three groups: Intravenous corticosteroid treatment group (n=42), inhaled corticosteroid treatment group (n=38), and control group (without any corticosteroid treatment, n=40). Patients of the all three groups received symptomatic supportive treatments including oxygen therapy, anti-infection therapy, expectorant, and bronchodilator. The serum PCT and hs-CRP expression levels were measured before treatment and after 7 days of treatment. Moreover, the clinical parameters such as symptoms, blood gas analysis parameters, pulmonary function indexes, fasting blood glucose (FBG) and adverse reactions were recorded. The overall clinical effective rates of the group received budesonide inhalation and the group receiving systemic methylprednisolone treatment were comparable. Both treatments were able to reduce the levels of inflammatory mediators, hs-CRP and PCT. On the other hand, treatments increased PaO2 of arterial blood gas while reducing PaCO2, thereby improving the lung function (FEV1% pred and FEV1/FVC) (P>0.05). The study observed that the FBG levels in COPD patients receiving systemic corticosteroid treatment were significantly increased, while budesonide inhalation did not significantly affect the FBG levels. In addition, rates of adverse events (such as mouth dry, oral ulcers, hoarseness) of systemic corticosteroid treatment group were significantly higher than those in inhaled corticosteroid treatment group and control group (38.1% vs. 17.5% vs. 5.0%, comparison between groups: P<0.05). In conclusion, inhaled and systemic use of corticosteroid both significantly improved dyspnea and other clinical symptoms of pregnant COPD patients by increasing oxygen partial pressure, correcting hypoxemia, and enhancing lung function. Moreover, fewer adverse reactions were observed with inhaled corticosteroid treatment, suggesting that inhaled administration is a relatively good, safe and effective treatment for pregnant COPD patients.
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Affiliation(s)
- Yuliang Zhao
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Fei Li
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Yangwen Liu
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Yingjun Shi
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Zhihai Li
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Guangke Cao
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
| | - Wang Zhu
- Department of Intensive Care Union, The First People's Hospital of Xuzhou, Xuzhou, Jiangsu 221002, P.R. China
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R Nath S, Jayapalan S, Nair H, Kusumakumary P, Prema NS, Priyakumari T, Rajamohanan K. Comparative diagnostic test evaluation of serum procalcitonin and C-reactive protein in suspected bloodstream infections in children with cancer. J Med Microbiol 2017; 66:622-627. [PMID: 28504925 DOI: 10.1099/jmm.0.000478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compute diagnostic test properties of C-reactive protein (CRP) and serum procalcitonin (PCT) levels in bloodstream infections in children with cancer and suspected sepsis, in comparison with blood culture as the gold standard. METHODOLOGY Consecutive paediatric cancer patients, aged ≤14 years, with clinically suspected bloodstream infections were evaluated with blood culture and assay of PCT and CRP levels. Blood culture was taken as the gold standard for comparison. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratio (LR) and receiver operating characteristic (ROC) with area under ROC curve (AUC) were calculated to assess the diagnostic test performance for PCT and CRP.Results/Key findings. The ROC curve for PCT was better than that for CRP, with an AUC of 0.751 for PCT at a cut-off of 2.25 ng ml-1. The AUC for CRP was 0.638 at a cut-off of 8.0 mg dl-1. Among the three cut-off values of PCT selected from the ROC curve applicable to the patients under study, the cut-off value of ≥0.49 ng ml-1 had the maximum sensitivity of 81.4 % and an NPV of 94.67 %; ≥2.25 ng ml-1 had a sensitivity and specificity of 65.12 and 71.6 %, respectively, and ≥6.47 ng ml-1 had a maximum specificity of 82.10 %. For CRP, the cut-off value of ≥5.3 mg dl-1 had the maximum sensitivity of 72.09 %; ≥8.0 mg dl-1 had a sensitivity and specificity of 58.14 and 68.09 %, respectively, and ≥8.4 mg dl-1 had the maximum specificity of 70.04 %. CONCLUSION PCT is a better serological marker for excluding bloodstream infections than CRP. The cut-off value of 0.49 ng ml-1 with a negative predictive value of 94.67 % will be ideal in a clinical setting of immune-compromised children with suspected sepsis.
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Affiliation(s)
- Swapna R Nath
- Division of Microbiology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Sabeena Jayapalan
- Clinical Epidemiology Resource and Training Centre, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Harikumaran Nair
- Clinical Epidemiology Resource and Training Centre, Government Medical College, Thiruvananthapuram, Kerala, India
| | - P Kusumakumary
- Division of Paediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - N S Prema
- Clinical Epidemiology Resource and Training Centre, Government Medical College, Thiruvananthapuram, Kerala, India
| | - T Priyakumari
- Division of Paediatric Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - K Rajamohanan
- Clinical Epidemiology Resource and Training Centre, Government Medical College, Thiruvananthapuram, Kerala, India
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Liu S, Hou Y, Cui H. Clinical values of the early detection of serum procalcitonin, C-reactive protein and white blood cells for neonates with infectious diseases. Pak J Med Sci 2016; 32:1326-1329. [PMID: 28083019 PMCID: PMC5216275 DOI: 10.12669/pjms.326.11395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/16/2016] [Accepted: 11/17/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To discuss application values of serum procalcitonin (PCT), C-reactive protein (CRP) and white blood cells (WBC) count in early diagnosis and treatment of neonatal bacterial infectious diseases. METHODS Clinical data of one hundred and thirty-six newborns with infectious diseases who were admitted into the hospital were retrospectively analyzed. They were divided into bacterial infection group (N=70) and non-bacterial infection group (N=66). Additionally, sixty-six healthy newborns who underwent physical examination in our hospital in the same period were selected as controls. Subjects in the three groups were all detected for serum PCT, CRP and WBC levels. RESULTS The levels of PCT, CRP and WBC in the bacterial infection group were much higher than those of the non-bacterial infection group and the healthy control group, and the differences had statistical significance (P<0.05). The positive rates of PCT, CRP and WBC of the bacterial infection group were higher than those of the non-bacterial infection group (P<0.05); the specificity and sensitivity of the PCT level were obviously higher than those of the CRP and WBC levels in diagnosing bacterial infectious diseases (P<0.05). CONCLUSION Serum PCR, CRP and WBC levels are of high diagnostic values to neonatal infectious diseases. Compared to WBC and CRP, PCT is more sensitive index in the diagnosis of neonatal infectious diseases.
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Affiliation(s)
- Shiwen Liu
- Shiwen Liu, Central Laboratory, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Yunxiu Hou
- Yunxiu Hou, Health Management, Binzhou Medical University Hospital, Shandong, 256603, China
| | - Haili Cui
- Haili Cui, Central Laboratory, Binzhou Medical University Hospital, Shandong, 256603, China
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Fadel FI, Elshamaa MF, Elghoroury EA, Badr AM, Kamel S, El-Sonbaty MM, Raafat M, Farouk H. Usefulness of serum procalcitonin as a diagnostic biomarker of infection in children with chronic kidney disease. Arch Med Sci Atheroscler Dis 2016; 1:e23-e31. [PMID: 28905015 PMCID: PMC5421526 DOI: 10.5114/amsad.2016.59672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 04/09/2016] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Serum procalcitonin (PCT) levels are known to be low in healthy individuals in healthy subjects but are increased in patients with a severe bacterial infection. It has not been extensively studied in children with chronic kidney disease (CKD), treated either with hemodialysis (HD) or with renal transplantation. MATERIAL AND METHODS During a 6-month period, blood samples were taken from 102 (55 HD children and 47 renal transplant recipients) children with a strong clinical suspicion of infection. Procalcitonin levels were measured by ELISA. RESULTS Thirty-four/102 cases had proven infections as defined previously. Children with proven infections had a significantly higher PCT (0.920 ±0.24 ng/ml) than those without (0.456 ±0.53 ng/ml), p = 0.04. The ideal cutoff value derived for serum PCT was 0.5 ng/ml. This threshold value established a sensitivity of 94.1% and a specificity of 87.9%. CONCLUSIONS This study indicates that significantly increased PCT concentration is a promising predictor of systemic bacterial infection in children with CKD, with good sensitivity and specificity. This study proposes that serum PCT is a convenient index of infection in CKD children at a cutoff value of 0.5 ng/ml.
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Affiliation(s)
- Fatina I. Fadel
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - Eman A. Elghoroury
- Clinical and Chemical Pathology Department, National Research Centre, Cairo, Egypt
| | - Ahmed M. Badr
- Pediatrics Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Solaf Kamel
- Clinical and Chemical Pathology Department, National Research Centre, Cairo, Egypt
| | - Marwa M. El-Sonbaty
- Department of Child Health, National Research Centre, Cairo, Egypt
- Department of Pediatrics, College of Medicine, Taibah University, Al- Madinah Al- Munawwarah, Kingdom of Saudi Arabia
| | - Mona Raafat
- Clinical and Chemical Pathology Department, National Research Centre, Cairo, Egypt
| | - Hebatallh Farouk
- Clinical and Chemical Pathology Department, National Research Centre, Cairo, Egypt
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Joen JS, Ji SM. Diagnostic value of procalcitonin and CRP in critically ill patients admitted with suspected sepsis. J Dent Anesth Pain Med 2015; 15:135-140. [PMID: 28879270 PMCID: PMC5564169 DOI: 10.17245/jdapm.2015.15.3.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/22/2015] [Accepted: 09/22/2015] [Indexed: 11/15/2022] Open
Abstract
Background Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared. Methods A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves. Results Mean CRP levels varied among the five PCT categories at 0.31 ± 2.87, 5.65 ± 6.26, 13.78 ± 8.01, 12.15 ± 10.16, and 17.77 ± 10.59, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl; CRP: 11.5 ng/ml vs. 9.57 ng/ml; P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05). Conclusions Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.
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Affiliation(s)
- Jae-Sik Joen
- Department of Laboratory Medicine, College of Medicine, Dankook University, Cheonan, Korea
| | - Sung-Mi Ji
- Department of Anesthesiology and Pain Medicine, College of Medicine, Dankook University Hospital, Cheonan, Korea
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Lee WS, Kang DW, Back JH, Kim HL, Chung JH, Shin BC. Cutoff value of serum procalcitonin as a diagnostic biomarker of infection in end-stage renal disease patients. Korean J Intern Med 2015; 30:198-204. [PMID: 25750561 PMCID: PMC4351326 DOI: 10.3904/kjim.2015.30.2.198] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 04/03/2014] [Accepted: 05/27/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/AIMS Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level. METHODS Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20). RESULTS The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 ± 3.67 ng/mL vs. 0.50 ± 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL. CONCLUSIONS This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.
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Affiliation(s)
- Wan Soo Lee
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Dae Woong Kang
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Jong Hun Back
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Hyun Lee Kim
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Jong Hoon Chung
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
| | - Byung Chul Shin
- Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea
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Kim SY, Jeong TD, Lee W, Chun S, Min WK. Procalcitonin in the assessment of bacteraemia in emergency department patients: results of a large retrospective study. Ann Clin Biochem 2015; 52:654-9. [PMID: 25575698 DOI: 10.1177/0004563214568685] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the use of procalcitonin in the assessment of bacteraemia in patients in the emergency department, both alone and in conjunction with existing inflammatory markers of bacterial infection. METHODS We enrolled 3305 cases (range 20-90 years) for which we retrospectively compared procalcitonin concentration, blood culture results, body temperature, absolute neutrophil count, and C-reactive protein concentration. The positive predictive value and the negative predictive value of procalcitonin were established at different cut-off concentrations. Receiver operating characteristic curves were plotted, and the areas under the ROC curves calculated, to allow assessment of the diagnostic accuracy of (a) a combination of three existing inflammatory markers of bacterial infection (body temperature, C-reactive protein, absolute neutrophil count), and (b) this combination with procalcitonin. RESULTS Positive predictive values of procalcitonin using 0.1, 1, 2, and 5 ng/mL as the cut-off values were 21.2, 32.2, 34.2, and 37.0%, respectively. Negative predictive values of procalcitonin using 0.1, 1, 2, and 5 ng/mL as the cut-off values were 95.1, 92.2, 91.1, and 89.0%, respectively. Areas under the curve of three inflammatory markers (absolute neutrophil count, C-reactive protein, and body temperature) combined was 0.879; areas under the curve of these markers combined with procalcitonin was 0.932 (p = 0.018). CONCLUSIONS When procalcitonin is used as a serum marker for ruling out bacteraemia, a cut-off of 0.1 ng/mL may be used. Procalcitonin improves the diagnostic accuracy of existing markers of bacteraemia.
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Affiliation(s)
- So-Young Kim
- Department of Medicine, Graduate School, Kyung Hee University, Seoul, South Korea
| | - Tae Dong Jeong
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Woochang Lee
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Sail Chun
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Won-Ki Min
- Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
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12
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Nargis W, Ibrahim M, Ahamed BU. Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient. Int J Crit Illn Inj Sci 2014; 4:195-9. [PMID: 25337480 PMCID: PMC4200544 DOI: 10.4103/2229-5151.141356] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Early diagnosis and appropriate therapy of sepsis is a daily challenge in intensive care units (ICUs) despite the advances in critical care medicine. Procalcitonin (PCT); an innovative laboratory marker, has been recently proven valuable worldwide in this regard. Objectives: This study was undertaken to evaluate the utility of PCT in a resource constrained country like ours when compared to the traditional inflammatory markers like C - reactive protein (CRP) to introduce PCT as a routine biochemical tool in regional hospitals. Materials and Methods: PCT and CRP were simultaneously measured and compared in 73 medico-surgical ICU patients according to the American College of Chest Physicians (ACCP) criteria based study groups. Results: The clinical presentation of 75% cases revealed a range of systemic inflammatory responses (SIRS). The diagnostic accuracy of PCT was higher (75%) with greater specificity (72%), sensitivity (76%), positive and negative predictive values (89% and 50%), positive likelihood ratio (2.75) as well as the smaller negative likelihood ratio (0.33). Both serum PCT and CRP values in cases with sepsis, severe sepsis and septic shock were significantly higher from that of the cases with SIRS and no SIRS (P < 0.01). Conclusion: PCT is found to be superior to CRP in terms of accuracy in identification and to assess the severity of sepsis even though both markers cannot be used in differentiating infectious from noninfectious clinical syndrome.
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Affiliation(s)
- Waheeda Nargis
- Department of Biochemistry, Uttara Adhunik Medical College Hospital, Uttara, Bangladesh
| | - Md Ibrahim
- Department of Laboratory Medicine, Apollo Hospital, Dhaka, Bangladesh
| | - Borhan Uddin Ahamed
- Department of Forensic Medicine, Dhaka Community Medical College and Hospital, Moghbazar, Dhaka, Bangladesh
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Ronco C, Legrand M, Goldstein SL, Hur M, Tran N, Howell EC, Cantaluppi V, Cruz DN, Damman K, Bagshaw SM, Di Somma S, Lewington A. Neutrophil gelatinase-associated lipocalin: ready for routine clinical use? An international perspective. Blood Purif 2014; 37:271-85. [PMID: 25012891 DOI: 10.1159/000360689] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Acute kidney injury (AKI) remains a challenge in terms of diagnosis and classification, its morbidity and mortality remaining high in the face of improving clinical protocols. Current clinical criteria use serum creatinine (sCr) and urine output to classify patients. Ongoing research has identified novel biomarkers that may improve the speed and accuracy of patient evaluation and prognostication, yet the route from basic science to clinical practice remains poorly paved. International evidence supporting the use of plasma neutrophil gelatinase-associated lipocalin (NGAL) as a valuable biomarker of AKI and chronic kidney disease (CKD) for a number of clinical scenarios was presented at the 31st International Vicenza Course on Critical Care Nephrology, and these data are detailed in this review. NGAL was shown to be highly useful alongside sCr, urinary output, and other biomarkers in assessing kidney injury; in patient stratification and continuous renal replacement therapy (CRRT) selection in paediatric AKI; in assessing kidney injury in conjunction with sCr in sepsis; in guiding resuscitation protocols in conjunction with brain natriuretic peptide in burn patients; as an early biomarker of delayed graft function and calcineurin inhibitor nephrotoxicity in kidney transplantation from extended criteria donors; as a biomarker of cardiovascular disease and heart failure, and in guiding CRRT selection in the intensive care unit and emergency department. While some applications require further clarification by way of larger randomised controlled trials, NGAL nevertheless demonstrates promise as an independent biological marker with the potential to improve earlier diagnosis and better assessment of risk groups in AKI and CKD. This is a critical element in formulating quick and accurate decisions for individual patients, both in acute scenarios and in long-term care, in order to improve patient prognostics and outcomes.
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Affiliation(s)
- Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy
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14
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Hur M, Kim H, Lee S, Cristofano F, Magrini L, Marino R, Gori CS, Bongiovanni C, Zancla B, Cardelli P, Di Somma S. Diagnostic and prognostic utilities of multimarkers approach using procalcitonin, B-type natriuretic peptide, and neutrophil gelatinase-associated lipocalin in critically ill patients with suspected sepsis. BMC Infect Dis 2014; 14:224. [PMID: 24761764 PMCID: PMC4006080 DOI: 10.1186/1471-2334-14-224] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 04/03/2014] [Indexed: 12/30/2022] Open
Abstract
Background We investigated the diagnostic and prognostic utilities of procalcitonin (PCT), B-type natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically or based on PCT concentrations. Methods PCT, BNP, and NGAL concentrations were measured in 340 patients and were followed up in 109 patients. All studied biomarkers were analyzed according to the diagnosis, severity, and clinical outcomes of sepsis. Results Clinical sepsis and PCT-based sepsis showed poor agreement (kappa = 0.2475). BNP and NGAL showed significant differences between the two groups of PCT-based sepsis (P = 0.0001 and P < 0.0001), although there was no difference between the two groups of clinical sepsis. BNP and NGAL were significantly different according to the PCT staging and sepsis-related organ failure assessment subscores (P < 0.0001, all). BNP and PCT concentrations were significantly higher in the non-survivors than in the survivors (P = 0.0002) and showed an equal ability to predict in-hospital mortality (P = 0.0001). In the survivors, the follow-up NGAL and PCT concentrations were significantly lower than the initial values (148.7 ng/mL vs. 214.5 ng/mL, P < 0.0001; 0.61 ng/mL vs. 5.56 ng/mL, P = 0.0012). Conclusions PCT-based sepsis diagnosis seems to be more reliable and discriminating than clinical sepsis diagnosis. Multimarker approach using PCT, BNP, and NGAL would be useful for the diagnosis, staging, and prognosis prediction in the critically ill patients with suspected sepsis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Salvatore Di Somma
- Department of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology 'Sapienza' University of Rome, Emergency Medicine, Sant' Andrea Hospital, Rome, Italy.
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Kim H, Hur M, Cruz DN, Moon HW, Yun YM. Plasma neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in critically ill patients with suspected sepsis. Clin Biochem 2013; 46:1414-8. [PMID: 23747960 DOI: 10.1016/j.clinbiochem.2013.05.069] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 05/28/2013] [Accepted: 05/29/2013] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the diagnostic utility of plasma neutrophil gelatinase-associated lipocalin (NGAL) as an early objective biomarker to predict acute kidney injury (AKI) in critically ill patients with suspected sepsis, for whom procalcitonin (PCT) was used for the diagnosis and staging of sepsis. DESIGN AND METHODS Plasma NGAL was measured using the Triage NGAL Test (Alere, Inc., San Diego, CA, USA) in 231 samples obtained from patients with suspected sepsis. The results of NGAL were compared with those of Elecsys BRAHMS PCT (Roche Diagnostics, Basel, Switzerland). Renal failure was assessed using the renal subscore of Sepsis-related Organ Failure Assessment (SOFA) score. AKI was defined according to the Acute Kidney Injury Network criteria. RESULTS The concentrations of plasma NGAL were significantly different according to the five groups of PCT concentration (P<0.0001) and the renal subscore of SOFA score (P<0.0001). Plasma NGAL was significantly increased in the patients with AKI compared with those without AKI (416.5 ng/mL vs. 181.0 ng/mL, P=0.0223). CONCLUSION Plasma NGAL seems to be a highly sensitive and objective predictor of AKI in patients with sepsis. Plasma NGAL can be added for the diagnosis and staging of renal failure in sepsis.
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Affiliation(s)
- Hanah Kim
- Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
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JUNG YJ, KIM JH, PARK YJ, KAHNG J, LEE H, LEE KY, KIM MY, HAN K, LEE W. Evaluation of cell population data on the UniCel DxH 800 Coulter Cellular Analysis system as a screening for viral infection in children. Int J Lab Hematol 2012; 34:283-9. [DOI: 10.1111/j.1751-553x.2011.01392.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Joo K, Park W, Lim MJ, Kwon SR, Yoon J. Serum procalcitonin for differentiating bacterial infection from disease flares in patients with autoimmune diseases. J Korean Med Sci 2011; 26:1147-51. [PMID: 21935268 PMCID: PMC3172650 DOI: 10.3346/jkms.2011.26.9.1147] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 07/01/2011] [Indexed: 01/09/2023] Open
Abstract
Early differentiation between bacterial infections and disease flares in autoimmune disease patients is important due to different treatments. Seventy-nine autoimmune disease patients with symptoms suggestive of infections or disease flares were collected by retrospective chart review. The patients were later classified into two groups, disease flare and infection. C-reactive protein (CRP) and serum procalcitonin (PCT) levels were measured. The CRP and PCT levels were higher in the infection group than the disease flare group (CRP,11.96 mg/dL ± 9.60 vs 6.42 mg/dL ± 7.01, P = 0.003; PCT, 2.44 ng/mL ± 6.55 vs 0.09 ng/mL ± 0.09, P < 0.001). The area under the ROC curve (AUC; 95% confidence interval) for CRP and PCT was 0.70 (0.58-0.82) and 0.84 (0.75-0.93), which showed a significant difference (P < 0.05). The predicted AUC for the CRP and PCT levels combined was 0.83, which was not significantly different compared to the PCT level alone (P = 0.80). The best cut-off value for CRP was 7.18 mg/dL, with a sensitivity of 71.9% and a specificity of 68.1%. The best cut-off value for PCT was 0.09 ng/mL, with a sensitivity of 81.3% and a specificity of 78.7%. The PCT level had better sensitivity and specificity compared to the CRP level in distinguishing between bacterial infections and disease flares in autoimmune disease patients. The CRP level has no additive value when combined with the PCT level when differentiating bacterial infections from disease flares.
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Affiliation(s)
- Kowoon Joo
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Won Park
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Mie-Jin Lim
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Seong-Ryul Kwon
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Jiyeol Yoon
- Division of Rheumatology, Department of Internal Medicine, Inha University Hospital, Incheon, Korea
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Kim MH, Lim G, Kang SY, Lee WI, Suh JT, Lee HJ. Utility of procalcitonin as an early diagnostic marker of bacteremia in patients with acute fever. Yonsei Med J 2011; 52:276-81. [PMID: 21319346 PMCID: PMC3051230 DOI: 10.3349/ymj.2011.52.2.276] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Procalcitonin (PCT) is a current, frequently used marker for severe bacterial infection. The aim of this study was to assess the ability of PCT levels to differentiate bacteremic from nonbacteremic patients with fever. We assessed whether PCT level could be used to accurately rule out a diagnosis of bacteremia. MATERIALS AND METHODS Serum samples and blood culture were obtained from patients with fever between August 2008 and April 2009. PCT was analyzed using a VIDAS® B.R.A.H.M.S PCT assay. We reviewed the final diagnosis and patient histories, including clinical presentation and antibiotic treatment. RESULTS A total of 300 patients with fevers were enrolled in this study: 58 with bacteremia (positive blood culture) (group I); 137 with local infection (group II); 90 with other diseases (group III); and 15 with fevers of unknown origin (group IV). PCT levels were significantly higher in patients with bacteremia than in those with non-bacteremia (11.9 ± 25.1 and 2.5 ± 14.7 ng/mL, respectively, p < 0.001). The sensitivity and specificity were 74.2% and 70.1%, respectively, at a cut-off value of 0.5 ng/mL. A serum PCT level of < 0.4 ng/mL accurately rules out diagnosis of bacteremia. CONCLUSION In febrile patients, elevated PCT may help predict bacteremia; furthermore, low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore, PCT assessment could help physicians limit the number of prescriptions for antibiotics.
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Affiliation(s)
- Myeong Hee Kim
- Department of Laboratory Medicine, Kyung Hee University Hospital at Gandong, Seoul, Korea
| | - Gayoung Lim
- Department of Laboratory Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - So Young Kang
- Department of Laboratory Medicine, Kyung Hee University Hospital at Gandong, Seoul, Korea
| | - Woo-In Lee
- Department of Laboratory Medicine, Kyung Hee University Hospital at Gandong, Seoul, Korea
| | - Jin-Tae Suh
- Department of Laboratory Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
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PARK DH, PARK K, PARK J, PARK HH, CHAE H, LIM J, OH EJ, KIM Y, PARK YJ, HAN K. Screening of sepsis using leukocyte cell population data from the Coulter automatic blood cell analyzer DxH800. Int J Lab Hematol 2011; 33:391-9. [DOI: 10.1111/j.1751-553x.2011.01298.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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