Clinical Usefulness of Procalcitonin and C-Reactive Protein as Outcome Predictors in Critically Ill Patients with Severe Sepsis and Septic Shock

Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n=10), sepsis (n=16), severe sepsis (n=18) and septic shock (n=41). Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day. PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25±43.08 and 37.15± 61.39 ng/ml) than patients with SIRS (0.73±1.37 ng/ml) (P<0.05 for each comparison). As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9±47.8 ng/ml), regardless of the degree of sepsis (P<0.001). PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.

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Faculty Opinions recommendation of Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718312921.793493679 ◽

2014 ◽

Author(s):

Niranjan Kissoon ◽

Srinivas Murthy

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

New Zealand ◽

Critically Ill ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

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Chronically critically ill patients: different behavior in severe sepsis and septic shock?

Intensive Care Medicine Experimental ◽

10.1186/2197-425x-3-s1-a83 ◽

2015 ◽

Vol 3 (S1) ◽

Author(s):

DH Prevedello ◽

A Rea-Neto ◽

HA Teive ◽

LA Tannous ◽

RAO Deucher ◽

...

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Chronically Critically Ill ◽

Sepsis And Septic Shock

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Population Pharmacokinetics and Monte Carlo Dosing Simulations of Meropenem during the Early Phase of Severe Sepsis and Septic Shock in Critically Ill Patients in Intensive Care Units

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04166-14 ◽

2015 ◽

Vol 59 (6) ◽

pp. 2995-3001 ◽

Cited By ~ 30

Author(s):

Sutep Jaruratanasirikul ◽

Suriyan Thengyai ◽

Wibul Wongpoowarak ◽

Thitima Wattanavijitkul ◽

Kanyawisa Tangkitwanitjaroen ◽

...

Keyword(s):

Septic Shock ◽

Monte Carlo ◽

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Early Phase ◽

Volume Of Distribution ◽

Therapeutic Success ◽

Altered Pharmacokinetic ◽

Sepsis And Septic Shock

ABSTRACTPathophysiological changes during the early phase of severe sepsis and septic shock in critically ill patients, resulting in altered pharmacokinetic (PK) patterns for antibiotics, are important factors influencing therapeutic success. The aims of this study were (i) to reveal the population PK parameters and (ii) to assess the probability of target attainment (PTA) for meropenem. The PK studies were carried out following administration of 1 g of meropenem every 8 h during the first 24 h of severe sepsis and septic shock in nine patients, and a Monte Carlo simulation was performed to determine the PTA of achieving 40% exposure time during which the free plasma drug concentration remains above the MIC (fT>MIC) and 80%fT>MIC. The volume of distribution (V) and total clearance (CL) of meropenem in these patients were 23.7 liters and 7.82 liters/h, respectively. For pathogens with MICs of 4 μg/ml, the PTAs of 40%fT>MICfollowing administration of meropenem as a 1-h infusion of 1 g every 8 h and a 4-h infusion of 0.5 g every 8 h were 92.52% and 90.29%, respectively. For pathogens with MICs of 2 μg/ml in immunocompromised hosts, the PTAs of 80%fT>MICfollowing administration of 1-h and 4-h infusions of 2 g of meropenem every 8 h were 84.32% and 94.72%, respectively. These findings indicated that theVof meropenem was greater and the CL of meropenem was lower than the values obtained in a previous study with healthy subjects. The maximum recommended dose, i.e., 2 g of meropenem every 8 h, may be required for treatment of life-threatening infections in this patient population.

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Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock

Journal of Cachexia Sarcopenia and Muscle ◽

10.1007/s13539-010-0010-6 ◽

2010 ◽

Vol 1 (2) ◽

pp. 147-157 ◽

Cited By ~ 109

Author(s):

Joerg C. Schefold ◽

Jeffrey Bierbrauer ◽

Steffen Weber-Carstens

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Severe Sepsis ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Muscle Wasting ◽

Sepsis And Septic Shock

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Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis

Scientific Reports ◽

10.1038/s41598-018-33361-7 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 14

Author(s):

Tak Kyu Oh ◽

In-Ae Song ◽

Jae Ho Lee

Keyword(s):

Retrospective Analysis ◽

Critically Ill ◽

Critically Ill Patients ◽

Clinical Usefulness ◽

C Reactive Protein ◽

Albumin Ratio ◽

Reactive Protein

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Dynamics of brain natriuretic peptide in critically ill patients with severe sepsis and septic shock

Saudi Journal of Anaesthesia ◽

10.4103/1658-354x.115347 ◽

2013 ◽

Vol 7 (3) ◽

pp. 270 ◽

Cited By ~ 5

Author(s):

AmrS Omar ◽

Masood ur Rahman ◽

GurdeepS Dhatt ◽

GubrilO Salami ◽

Said Abuhasna

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Brain Natriuretic Peptide ◽

Critically Ill ◽

Natriuretic Peptide ◽

Critically Ill Patients ◽

Sepsis And Septic Shock

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Prognostic Value And Daily Trend Of Interleukin-6, Neutrophil CD64 Expression, C-Reactive Protein And Lipopolysaccharide-Binding Protein In Critically Ill Patients: Reliable Predictors Of Outcome Or Not?

Journal of Medical Biochemistry ◽

10.1515/jomb-2015-0002 ◽

2015 ◽

Vol 34 (4) ◽

pp. 431-439 ◽

Cited By ~ 8

Author(s):

Dragan Djordjevic ◽

Janko Pejovic ◽

Maja Surbatovic ◽

Jasna Jevdjic ◽

Sonja Radakovic ◽

...

Keyword(s):

Severe Sepsis ◽

Critically Ill ◽

Critically Ill Patients ◽

Interleukin 6 ◽

Prognostic Value ◽

C Reactive Protein ◽

Lipopolysaccharide Binding Protein ◽

Cd64 Expression ◽

Reactive Protein ◽

Lipopolysaccharide Binding

SummaryBackground:Severe sepsis and/or trauma complicated by multiple organ dysfunction syndrome are the leading causes of death in critically ill patients. The aim of this prospective single-centre study was to assess the prognostic value and daily trend of interleukin-6 (IL-6), neutrophil CD64 expression, C-reactive protein (CRP) and lipopolysaccharide-binding protein (LBP) regarding outcome in critically ill patients with severe trauma and/or severe sepsis. Outcome measure was hospital mortality.Methods:One hundred and two critically ill patients admitted to the intensive care unit of a tertiary university hospital were enrolled in this prospective study. Blood samples were collected on admission (day 1), days 2 and 3.Results:CD64 index was 1.6-fold higher on day 1 and 1.78-fold higher on day 2 in non-survivors (p<0.05). The area under the curve (AUC) for the CD64 index on day 1 for outcome was 0.727. At a cut-off level of 2.80 sensitivity was 75% and specificity was 65%. Patients with CD64 index level on day 1 higher than 2.80 had 2.4-fold higher probability of dying. Odds ratio is 2.40; 95% CI 0.60–9.67.Conclusions:CD64 index on day 1 is a fairly good predictor of outcome. AUCs for IL-6, CRP and LBP were < 0.55, suggesting these biomarkers failed to predict outcome.

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Evaluation of eosinophil count and neutrophil-lymphocyte count ratio versus C-reactive protein levels in patients with sepsis

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174686 ◽

2017 ◽

Vol 5 (11) ◽

pp. 4754

Author(s):

Rahul Khajuria ◽

Vinu Jamwal ◽

Anil K. Gupta ◽

Abhinav Gupta

Keyword(s):

Septic Shock ◽

Severe Sepsis ◽

Critically Ill Patients ◽

Eosinophil Count ◽

Lymphocyte Count ◽

Sepsis Group ◽

C Reactive Protein ◽

Protein Levels ◽

Reactive Protein ◽

Count Ratio

Background: One major problem encountered in the intensive care unit is differentiating the inflammatory response from an infective process. Clinical and standard laboratory tests are not very helpful because most critically ill patients develop some degree of inflammatory response, whether or not they have sepsis. Numerous biomarkers have been evaluated to predict mortality in critically ill patients, although none have proved entirely useful. Objective of the study was to evaluate eosinophil count and neutrophil-lymphocyte count ratio with C-reactive protein levels in patients with sepsis.Methods: 71 patients >18 years of age of either sex with a diagnosis of sepsis were enrolled in this one-year observational study. Patients were classified according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine into sepsis group (n=50) and no sepsis group (n=21). Sepsis group were further divided into subgroups: sepsis (n=19), severe sepsis (n=16) and septic shock (n=15). Absolute eosinophil cell, neutrophil and lymphocyte counts for first 4 consecutive days and then on alternate days up to one week were also noted down. C-reactive protein levels on day 3 were also noted down.Results: In the sepsis group, mean eosinophil count was significantly (p<0.0001) low, mean neutrophil/lymphocyte count ratio was significantly (p<0.0001) high, mean CRP count was significantly (p=0.019) more as compared to that of no sepsis group. Among 16 mortalities, significant (p<0.05) decrease was noted in mean eosinophil count from day 3 onwards in patients of sepsis and septic shock subgroups. Mean N/L ratio showed no significant difference in patients of sepsis, severe sepsis or septic shock. Mean CRP count showed significant (p<0.05) increase in severe sepsis patients and mean Apache II score showed significant (p<0.05) deterioration in patients of septic shock.Conclusions: Neutrophil/lymphocyte count ratio (NLCR) and absolute eosinophil count (AEC) came out as better independent biomarker of sepsis in critically ill patients with infection admitted in intensive care unit. Diagnostic performance was better in these two diagnostic markers as compared to CRP marker. NLCR presented with sensitivity of 89.58%, AEC with 82.35% and CRP with 80.77%. Outcomes of NLCR and AEC were quick, easy and economical in establishing diagnosis of sepsis.

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