Comparison of diagnostic accuracy among procalcitonin, C-reactive protein, and interleukin 6 for blood culture positivity in general ICU patients

Background: Febrile neutropenia (FN) is a medical emergency that requires urgent evaluation, timely administration of empiric broad-spectrum antibiotics and careful monitoring in order to optimize the patient’s outcome, especially in the setting of both allogeneic and autologous hematopoietic stem cell transplant (ASCT). Methods: In this real-life retrospective study, a total of 49 consecutive episodes of FN were evaluated in 40 adult patients affected by either multiple myeloma (thirty-eight) or lymphoma (eleven), following ASCT, with nine patients having fever in both of the tandem transplantations. Results: Febrile neutropenia occurred a median of 7 days from ASCT. Median duration of FN was 2 days, with 25% of population that had fever for at least four days. Ten patients had at least one fever spike superior to 39 °C, while the median number of daily fever spikes was two. Twenty patients had positive blood cultures with XDR germs, namely Pseudomonas aeruginosa and Klebsiella pneumoniae, present in seven cases. ROC analysis of peak C-reactive protein (CRP) values was conducted based on blood culture positivity and a value of 12 mg/dL resulted significant. Onset of prolonged fever with a duration greater than 3 days was associated with the presence of both a peak number of three or more daily fever spikes (p = 0.02) and a body temperature greater than 39 °C (p = 0.04) based on odds ratio (OR). Blood culture positivity and peak CRP values greater than 12 mg/dL were also associated with prolonged fever duration, p = 0.04, and p = 0.03, respectively. The probability of blood culture positivity was also greater in association with fever greater than 39 °C (p = 0.04). Furthermore, peak CRP values below the cut-off showed less probability of positive blood culture (p = 0.02). Conclusions: In our study, clinical characteristics of fever along with peak CRP levels were associated with a higher probability of both prolonged fever duration and positive blood culture, needing extended antibiotic therapy.

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Isolation and identification of Bacteria and their drug susceptibility pattern in children to establish the correlation between childhood Septicemia with C-reactive protein (CRP) levels

Journal of Bio-Science ◽

10.3329/jbs.v21i0.22524 ◽

2015 ◽

Vol 21 ◽

pp. 99-108

Author(s):

Al Jahidi Hasan Chowdhurya ◽

M Shahjahana ◽

Tanzima Yeasmin ◽

Mohammad Shariar Shovona ◽

M Mushfequr Rahman

Keyword(s):

Blood Culture ◽

Antimicrobial Therapy ◽

Salmonella Typhi ◽

Control Group ◽

C Reactive Protein ◽

E Coli ◽

Reactive Protein ◽

Culture Positivity ◽

Blood Culture Positivity ◽

Diagnostic And Prognostic Value

Context: Neonatal sepsis is one of the most important causes of morbidity and mortality and C-reactive protein (CRP) an excellent biomarker has significant diagnostic and prognostic value for the treatment of septicemia patient. Objectives: To isolate and identify viable pathogens from blood culture and their antibiogram and to correlate CRP levels with septicemic child. Materials and Methods: A total of 273 cases among which 233 were clinically suspected septicemia cases and 40 were healthy controls in age group 0 day to 15 years were selected from United Hospital Ltd., Dhaka Bangladesh. Blood culture was analyzed by the instrument BACTEC 9120 series. CRP was measured from blood serum by the auto biochemical analyzer OLYMPUS AU 640 followed by immuno-turbidimetric method. The organisms were isolated by inoculation on blood agar and MacConkey agar media. Identification of the organisms was done by colony morphology, gram staining and biochemical tests. Sensitivity of isolates was done against antimicrobial agents by disc diffusing method. Results: Blood samples in total 233 cases of suspected septicemia in children were studied between the ages of 0 day to 15 years. Culture proven septicemia 39 (16.74%), probable septicemia 136 (58.37%) and nonsepticemic febrile patients 58 (24.90%) were found. The highest rate of blood culture positivity found among 5-10 yrs. age group (25.64%). Salmonella typhi (41.03%) was the most common infective agent. The rate of blood culture positivity was significantly higher (p<0.001) among patients without antimicrobial therapy (23.74%) than those in patients with antimicrobial therapy (6.38%). S. typhi were 75% sensitive to Ceftriaxone while azithromycin showed high rate resistance (85.71%). E. coli and Klebsiella pneumoniae were highly sensitive (100%) to imipenem but E. coli resistant (100%) to amikacin, amoxyclavonic acid ciprofloxacin, gentamicin, Cefepime and netilmicin. Resistant (100%) to gentamicin was observed from K. pneumoniae. Mean CRP values (mg/l) of blood culture proven septicemia group, probable septicemia group, non-septicemic febrile group and control group were 70.42, 34.05, 3.08 and 0.98 respectively. Both proven septicemia and suspected septicemia cases showed CRP concentration above the cut-off value (>6 mg/l) and p value significant (p<0.001). Statistically significant difference (p<0.001) was found when mean CRP level of proven septicemia group, probable septicemia group and non-septicemic febrile group each compared with control group. CRP concentration were significantly (p < 0.001) different among three study group. Conclusion: Most of the gram negative bacteria isolated from blood culture showed resistance to commonly used antibiotics. The predominant infective isolate was Salmonella typhi. In this study, CRP level is high (cut-off value 6 mg/l) both in proven and probable septicemia group. CRP may have a good biomarker tools in diagnostic and prognostic value. Investigation of blood culture should be done before antimicrobial therapy, DOI: http://dx.doi.org/10.3329/jbs.v21i0.22524 J. bio-sci. 21: 99-108, 2013

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Comparison between procalcitonin and C-reactive protein to predict blood culture results in ICU patients

Critical Care ◽

10.1186/s13054-018-2183-x ◽

2018 ◽

Vol 22 (1) ◽

Cited By ~ 6

Author(s):

Matteo Bassetti ◽

Alessandro Russo ◽

Elda Righi ◽

Elisabetta Dolso ◽

Maria Merelli ◽

...

Keyword(s):

Blood Culture ◽

C Reactive Protein ◽

Icu Patients ◽

Reactive Protein

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Diagnostic accuracy of lipopolysaccharide-binding protein for predicting bacteremia/clinical sepsis in children with febrile neutropenia: comparison with interleukin-6, procalcitonin, and C-reactive protein

Supportive Care in Cancer ◽

10.1007/s00520-013-1978-1 ◽

2013 ◽

Vol 22 (1) ◽

pp. 269-277 ◽

Cited By ~ 18

Author(s):

Lidija Kitanovski ◽

Janez Jazbec ◽

Sergej Hojker ◽

Metka Derganc

Keyword(s):

Febrile Neutropenia ◽

Diagnostic Accuracy ◽

Interleukin 6 ◽

Binding Protein ◽

C Reactive Protein ◽

Lipopolysaccharide Binding Protein ◽

Clinical Sepsis ◽

Reactive Protein ◽

Lipopolysaccharide Binding

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Diagnostic Accuracy of C-Reactive Protein in Neonatal Sepsis

Journal of Bioresource Management ◽

10.35691/jbm.4102.0001 ◽

2014 ◽

Vol 1 (1) ◽

Cited By ~ 1

Author(s):

Sidra Younis ◽

Muhammad Ali Sheikh ◽

Amjad Ali Raza

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Neonatal Sepsis ◽

High Sensitivity ◽

Operational Definition ◽

C Reactive Protein ◽

Capillary Refill ◽

Neonatal Deaths ◽

Reactive Protein ◽

Sensitivity Specificity

Sepsis is the most common cause of neonatal mortality and is responsible for 30-50% of total neonatal deaths each year in developing countries. The objective of the study was to determine the diagnostic accuracy of Creactive protein (CRP) in neonatal sepsis. Fifty nine consecutive patients with risk factors and clinical features suggestive of CRP sepsis were selected as per operational definition and fulfilling the inclusion and exclusion criteria. Detailed physical examination was carried out. Blood sample for culture and CRP was taken from all the patients. Results of blood culture and CRP were noted down in the performa. Statistical analysis was performed by SPSS software version 16. Among selected patients 31/59 (52.5%) were male whereas 28/59 (47.5%) were female. Mean age of all patients was 15.47+7.26 days and mean weight was 2.94+0.63Kg. Temperature instability was present in 79.7%, Tachypnea in 69.5%, Tachycardia in 66.1%, delayed capillary refill in 64.4% and oliguria in 55.9%. Blood cultures were positive in 64.4% and raised CRP was found in 64.5%. Sensitivity, specificity, positive predictive value and negative predictive of raised CRP was found to be 97.3%, 95.2%, 97.3% and 95.2% respectively. In conclusion this study show that C-reactive protein has high sensitivity and specificity for establishing the diagnosis of neonatal sepsis which is comparable to that of blood culture results.

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Diagnostic Accuracy of Immunologic Biomarkers for Accurate Diagnosis of Bloodstream Infection in Patients with Malignancy: Procalcitonin in Comparison with C-Reactive Protein

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2020/8362109 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Mansoureh Shokripour ◽

Navid Omidifar ◽

Kourosh Salami ◽

Mohsen Moghadami ◽

Babak Samizadeh

Keyword(s):

Blood Culture ◽

Diagnostic Accuracy ◽

Area Under The Curve ◽

Reference Method ◽

Diagnostic Value ◽

Clinical Suspicion ◽

Accurate Diagnosis ◽

C Reactive Protein ◽

Cutoff Value ◽

Reactive Protein

Purpose. To calculate the diagnostic value of C-reactive protein (CRP) and serum procalcitonin (PCT) levels for the pathologic presence of microbes in the bloodstream of patients with malignancy, in comparison with blood culture. Methodology. Blood culture (by reference method) and assay results of PCT and CRP of febrile patients, with clinical suspicion to blood infections, were collected. Statistical aspects of PCT and CRP tests were evaluated. Results. Data from 255 cases were gathered. The area under the curve for differentiating bacteremia from nonbacteremia for PCT (0.741) was superior to that of CRP (0.612). Amongst the different cutoffs of PCT and CRP, the cutoff of ≥1.17 ng/ml and >47 mg/l had the sensitivity of 75 and 58.3%, the best NPV of 91.5% and 81.3%, and the best specificity of 79.9% and 72.8%, respectively. Discussion. Despite statistically nonsignificant results, PCT seems to be a superior indicator to CRP for rejecting the presence of microorganism in bloodstream. For PCT, the cutoff value of 1.17 ng/ml (bacteremia from nonbacteremia) had the highest NPV value of 91.5% in malignant patients, suspicion of sepsis.

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Procalcitonin and interleukin 6 for predicting blood culture positivity in sepsis

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2013.12.058 ◽

2014 ◽

Vol 32 (5) ◽

pp. 448-451 ◽

Cited By ~ 19

Author(s):

Mohammad Naffaa ◽

Badira F. Makhoul ◽

Amjad Tobia ◽

Marielle Kaplan ◽

Doron Aronson ◽

...

Keyword(s):

Blood Culture ◽

Interleukin 6 ◽

Culture Positivity ◽

Blood Culture Positivity

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Diagnostic Accuracy of Procalcitonin Compared to C-Reactive Protein and Interleukin 6 in Recognizing Gram-Negative Bloodstream Infection: A Meta-Analytic Study

Disease Markers ◽

10.1155/2020/4873074 ◽

2020 ◽

Vol 2020 ◽

pp. 1-14 ◽

Cited By ~ 3

Author(s):

Liying Lai ◽

Yijie Lai ◽

Hao Wang ◽

Liang Peng ◽

Ning Zhou ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Receiver Operating Characteristic ◽

Interleukin 6 ◽

Operating Characteristic ◽

Clinical Settings ◽

C Reactive Protein ◽

Summary Receiver Operating Characteristic ◽

Gram Negative ◽

Reactive Protein ◽

Receiver Operating

Objective. Gram-negative bloodstream infections (GNBSIs), especially those caused by antibiotic-resistant species, have become a public health challenge. Procalcitonin (PCT) showed promising potential in early diagnosis of GNBSI; however, little was known about its performance under different clinical settings. We here systematically assessed the diagnostic accuracy of PCT in recognizing GNBSI and made direct comparisons with C-reactive protein (CRP) and interleukin 6 (IL-6). Methods. PubMed, Embase, ISI Web of Knowledge, and Scopus were searched from inception to March 15th, 2019. Area under the summary receiver operating characteristic curve (AUC), pooled sensitivity, specificity, and diagnostic odds ratio (DOR) were calculated. Hierarchical summary receiver operating characteristic (HSROC) model was used for the investigation of heterogeneity and for comparisons between markers. Results. 25 studies incorporating 50933 suspected BSI episodes were included. Pooled sensitivity and specificity for PCT were 0.71 and 0.76, respectively. The overall AUC was 0.80. The lowest AUCs were found in patients with febrile neutropenia (0.69) and hematological malignancy (0.69). The highest AUC was found in groups using electrochemiluminescence immunoassay (0.87). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.85 (95% CI 0.81–0.87) for PCT and 0.78 (95% CI 0.74–0.81) for CRP, but the relative DORs varied with thresholds between PCT and CRP (p<0.001). No significant difference was found either in threshold (p=0.654) or in accuracy (p=0.480) between PCT and IL-6 in diagnosing GNBSI. Conclusions. PCT was helpful in recognizing GNBSI, but the test results should be interpreted carefully with knowledge of patients’ medical condition and should not serve as the only criterion for GNBSI. Further prospective studies are warranted for comparisons between different clinical settings.

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Diagnostic accuracy of three biomarkers in identifying serious bacterial infections in children younger than 36 months with fever without source / Acurateţea diagnostică a trei biomarkeri în identificarea infecţiilor bacteriene severe la copiii cu vârsta sub 36 luni cu febră fără focar

Revista Romana de Medicina de Laborator ◽

10.1515/rrlm-2015-0032 ◽

2015 ◽

Vol 23 (3) ◽

pp. 313-322

Author(s):

Diana Aniela Moldovan ◽

Maria Despina Baghiu ◽

Alina Balas ◽

Emese Rozalia Fabian-Frast ◽

Cristian Boeriu

Keyword(s):

Emergency Department ◽

Diagnostic Accuracy ◽

Interleukin 6 ◽

Bacterial Infections ◽

Screening Tool ◽

University Hospital ◽

C Reactive Protein ◽

Reactive Protein ◽

Serious Bacterial Infections ◽

Better Than

Abstract Objectives: Our study aimed to evaluate and compare the accuracy of C-reactive protein, Procalcitonin and Interleukine-6 in identifying serious bacterial infections (SBI) in children with fever without source. Methods: 139 children, aged 7 days to 36 months, addressing the Emergency Department from a Romanian university hospital, were prospectively enrolled during 2013. C-reactive protein, Procalcitonin and Interleukin-6 were determined for every patient. SBI diagnosis was based on cultures results and chest radiographs. Results: 31 patients (22.3%) had SBI. C-reactive protein [AUC: 0.87 (95%CI: 0.81-0.92)] and Procalcitonin [AUC: 0.83 (95%CI: 0.76-0.89)] proved strong prediction value for SBI and performed better than Interleukin-6 [AUC: 0.77 (95%CI: 0.69-0.84)]. For the group of children with the duration of fever less than 8 hours, Interleukin- 6 was the best predictor [AUC: 0.88 (0.76-0.95)]. Conclusions: Both C-reactive protein and Procalcitonin are strong and similar predictors for SBI, and Interleukin- 6 might be a better SBI screening tool for children with shorter duration of fever.

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