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Multicenter prospective study of procalcitonin as an indicator of sepsis

  • ORIGINAL ARTICLE
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Journal of Infection and Chemotherapy

Abstract

The clinical significance of serum procalcitonin (PCT) for discriminating between bacterial infectious disease and nonbacterial infectious disease (such as systemic inflammatory response syndrome (SIRS)), was compared with the significance of endotoxin, β-D-glucan, interleukin (IL)-6, and C-reactive protein (CRP) in a multicenter prospective study. The concentrations of PCT in patients with systemic bacterial infection and those with localized bacterial infection were significantly higher than the concentrations in patients with nonbacterial infection or noninfectious diseases. In addition, PCT, endotoxin, IL-6, and CRP concentrations were significantly higher in patients with bacterial infectious disease than in those with nonbacterial infectious disease (P < 0.001, P < 0.005, P < 0.001, and P < 0.001, respectively). The cutoff value of PCT for the discrimination of bacterial and nonbacterial infectious diseases was determined to be 0.5 ng/ml, which was associated with a sensitivity of 64.4% and specificity of 86.0%. Areas under the receiver operating characteristic curves (POCs) were 0.84 for PCT, 0.60 for endotoxin, 0.77 for IL-6, and 0.78 for CRP in the combined group of patients with bacterial infectious disease and those with nonbacterial infectious disease, and the area under the ROC for PCT was significantly higher than that for endotoxin (P < 0.001). In patients diagnosed with bacteremia based on clinical findings, the positive rate of diagnosis with PCT was 70.2%, while that of blood culture was 42.6%. PCT is thus essential for discriminating bacterial infection from SIRS, and is superior in this respect to conventional serum markers and blood culture.

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References

  1. LG Reimer ML Wilson MP Weinstein (1997) ArticleTitleUpdate on detection of bacteremia and fungemia Clin Microbiol Rev 10 444–65 Occurrence Handle1:STN:280:ByiA2s7msVM%3D Occurrence Handle9227861

    CAS  PubMed  Google Scholar 

  2. DC Angus WT Linde-Zwirble J Lidicker G Clermont J Carcillo MR Pinsky (2001) ArticleTitleEpidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care Crit Care Med 29 1303–10 Occurrence Handle10.1097/00003246-200107000-00002 Occurrence Handle1:STN:280:DC%2BD3Mvgs12gtg%3D%3D Occurrence Handle11445675

    Article  CAS  PubMed  Google Scholar 

  3. M Christ-Crain D Jaccard-Stolz R Bingisser MM Gencay PR Huber M Tamm et al. (2004) ArticleTitleEffect of procalcitonin-guided treatment on antibiotics use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial Lancet 363 600–7 Occurrence Handle10.1016/S0140-6736(04)15591-8 Occurrence Handle1:CAS:528:DC%2BD2cXhsVOnsLk%3D Occurrence Handle14987884

    Article  CAS  PubMed  Google Scholar 

  4. M Assicot D Gendrel H Carsin J Raymond J Guilbaud C Bohuon (1993) ArticleTitleHigh serum procalcitonin concentrations in patients with sepsis and infection Lancet 341 515–8 Occurrence Handle10.1016/0140-6736(93)90277-N Occurrence Handle1:STN:280:ByyC2s3otV0%3D Occurrence Handle8094770

    Article  CAS  PubMed  Google Scholar 

  5. D Gendrel J Raymond J Coste F Moulin M Lorrot S Guerin et al. (1999) ArticleTitleComparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differential of bacterial vs viral infections Pediatr Infect Dis 18 875–81 Occurrence Handle10.1097/00006454-199910000-00008 Occurrence Handle1:STN:280:DyaK1MvlvVWltA%3D%3D

    Article  CAS  Google Scholar 

  6. I Delevaux M Andre M Colombier E Albuisson F Meylheuc RJ Begue et al. (2003) ArticleTitleCan procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis 62 337–40 Occurrence Handle10.1136/ard.62.4.337 Occurrence Handle1:CAS:528:DC%2BD3sXjtVKksb0%3D Occurrence Handle12634233

    Article  CAS  PubMed  Google Scholar 

  7. D Gendrel C Bohuon (2000) ArticleTitleProcalcitonin in pediatrics for differentiation of bacterial and viral infections Intensive Care Med 26 S178–81 Occurrence Handle10.1007/s001340051140

    Article  Google Scholar 

  8. H Ugarte E Silva D Mercan AD Mendonca JL Vincent (1999) ArticleTitleProcalcitonin used as a marker of infection in the intensive care unit Crit Care Med 27 498–504 Occurrence Handle10.1097/00003246-199903000-00024 Occurrence Handle1:STN:280:DyaK1M3htlKhsg%3D%3D Occurrence Handle10199528

    Article  CAS  PubMed  Google Scholar 

  9. M Meisner K Tschaikowsky J Schmidt J Schuttler (1996) ArticleTitleProcalcitonin (PCT) – Indications for a new diagnostic parameter of severe bacterial infection and sepsis in transplantation, immunosuppression and cardiac assist devices Cardiovasc Eng 1 67–76

    Google Scholar 

  10. ES Nylen KT Whang RH Snider PM Steinwald JC White KL Becker (1998) ArticleTitleMortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis Crit Care Med 26 1001–6 Occurrence Handle10.1097/00003246-199806000-00015 Occurrence Handle1:STN:280:DyaK1c3pslGluw%3D%3D Occurrence Handle9635646

    Article  CAS  PubMed  Google Scholar 

  11. K Reinhart W Karzai M Meisner (2000) ArticleTitleProcalcitonin as a marker of the systemic inflammatory response to infection Intensive Care Med 26 1193–200 Occurrence Handle10.1007/s001340000624 Occurrence Handle1:STN:280:DC%2BD3MzgsFWjtA%3D%3D Occurrence Handle11089742

    Article  CAS  PubMed  Google Scholar 

  12. J Kambayashi M Yokota M Sakon E Shiba T Kawasaki T Mori et al. (1991) ArticleTitleA novel endotoxin-specific assay by turbidimetry with Limulus amoebocyte lysate containing β-glucan J Biochem Biophys Methods 22 93–100 Occurrence Handle10.1016/0165-022X(91)90022-O Occurrence Handle1:CAS:528:DyaK3MXhsFylsbw%3D Occurrence Handle2061565

    Article  CAS  PubMed  Google Scholar 

  13. T Mori H Ikemoto M Matsumura M Yoshida K Inada S Endo et al. (1997) ArticleTitleEvaluation of plasma (1 3)-β-d-glucan measurement by the kinetic turbidimetric Limulus test, for the clinical diagnosis of mycotic infections Eur J Clin Chem Clin Biochem 35 553–60 Occurrence Handle1:CAS:528:DyaK2sXltVGmsLk%3D Occurrence Handle9263735

    CAS  PubMed  Google Scholar 

  14. T Mori M Matsumura (1999) ArticleTitleClinical evaluation of diagnostic methods using plasma and/or serum for three mycoses: Aspergillosis, Candidosis, and Pneumocystosis Jpn J Med Mycol 40 223–30 Occurrence Handle1:CAS:528:DC%2BD3cXhvVKrsw%3D%3D

    CAS  Google Scholar 

  15. S Schwarz M Bertram S Schwab K Andrassy W Hacke (2000) ArticleTitleSerum procalcitonin levels in bacterial and abacterial meningitis Crit Care Med 28 1828–32 Occurrence Handle10.1097/00003246-200006000-00024 Occurrence Handle1:STN:280:DC%2BD3czks1KrsA%3D%3D Occurrence Handle10890628

    Article  CAS  PubMed  Google Scholar 

  16. D Gendrel J Raymond M Assicot F Moulin JL Iniguez P Lebon et al. (1997) ArticleTitleMeasurement of procalcitonin levels in children with bacterial or viral meningitis Clin Infect Dis 24 1240–2 Occurrence Handle1:STN:280:ByiA3sfltlQ%3D Occurrence Handle9195090

    CAS  PubMed  Google Scholar 

  17. C Chiesa A Panero N Rossi M Stegagno D De Giusti JF Osborn et al. (1998) ArticleTitleReliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates Clin Infect Dis 26 664–72 Occurrence Handle1:STN:280:DyaK1c7osFGhuw%3D%3D Occurrence Handle9524841

    CAS  PubMed  Google Scholar 

  18. ES Nylen W O’Neill MH Jordan RH Snider CF Moore M Lewis et al. (1992) ArticleTitleSerum procalcitonin as an index of inhalation injury in burns Horm Metab Res 24 439–42 Occurrence Handle1:STN:280:ByyD2M3gt1w%3D Occurrence Handle1427616

    CAS  PubMed  Google Scholar 

  19. S Russwurm M Wiederhold M Oberhoffer I Stonans PF Zipfel K Reinhart (1999) ArticleTitleMolecular aspects and natural source of procalcitonin Clin Chem Lab Med 37 789–97 Occurrence Handle10.1515/CCLM.1999.119 Occurrence Handle1:CAS:528:DyaK1MXmslCms74%3D Occurrence Handle10536927

    Article  CAS  PubMed  Google Scholar 

  20. B Muller JC White ES Nylen RH Snider KL Becker JF Habener (2001) ArticleTitleUbiquitous expression of the calcitonin-I gene in multiple tissues in response to sepsis J Clin Endocrinol Metab 86 396–404 Occurrence Handle10.1210/jc.86.1.396 Occurrence Handle1:CAS:528:DC%2BD3MXhtVGnt7w%3D Occurrence Handle11232031

    Article  CAS  PubMed  Google Scholar 

  21. P Dandona D Nix MF Wilson A Aljada J Love M Assicot et al. (1994) ArticleTitleProcalcitonin increase after endotoxin injection in normal subjects J Clin Endocrinol Metab 79 1605–8 Occurrence Handle10.1210/jc.79.6.1605 Occurrence Handle1:CAS:528:DyaK2MXislWitLg%3D Occurrence Handle7989463

    Article  CAS  PubMed  Google Scholar 

  22. M Oberhoffer I Stonans S Russwurm E Stonane H Vogelsang U Junker et al. (1999) ArticleTitleProcalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis related cytokines in vitro J Lab Clin 134 49–55 Occurrence Handle10.1016/S0022-2143(99)90053-7 Occurrence Handle1:CAS:528:DyaK1MXkslOmsbk%3D

    Article  CAS  Google Scholar 

  23. G Fleischhack I Kambeck D Cipic C Hasan U Bode (2000) ArticleTitleProcalcitonin in paediatric cancer patients: its diagnostic relevance is superior to that of C-reactive protein, interleukin 6, interleukin 8, soluble interleukin 2 receptor and soluble tumor necrosis factor receptor II Br J Haematol 111 1093–102 Occurrence Handle10.1046/j.1365-2141.2000.02458.x Occurrence Handle1:STN:280:DC%2BD3M7ktFSktA%3D%3D Occurrence Handle11167745

    Article  CAS  PubMed  Google Scholar 

  24. J Schroder KH Staubach P Zabel F Stuber B Kremer (1999) ArticleTitleProcalcitonin as marker of severity in septic shock Langenbecks Arch Surg 384 33–8 Occurrence Handle10.1007/s004230050170 Occurrence Handle1:STN:280:DyaK1M3psVSntQ%3D%3D Occurrence Handle10367627

    Article  CAS  PubMed  Google Scholar 

  25. B Al-Nawas I Krammer PM Shah (1995/96) ArticleTitleProcalcitonin in diagnosis of severe infections Eur J Med Res 1 331–3

    Google Scholar 

  26. S Liaudat E Dayer G Praz J Bille N Troillet (2001) ArticleTitleUsefulness of procalcitonin serum level for the diagnosis of bacteremia Eur J Microbiol Infect Dis 20 524–7 Occurrence Handle10.1007/s100960100548 Occurrence Handle1:STN:280:DC%2BD3MrnsVSjtA%3D%3D

    Article  CAS  Google Scholar 

  27. American College of Chest Physicians/Society (1992) ArticleTitleof Critical Care Medicine Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20 864–74

    Google Scholar 

  28. S Endo K Inada K Okamoto M Kuboi T Kasai Y Yamada et al. (2000) ArticleTitleProcalcitonin level was not elevated in patients with deep-seated mycosis (in Japanese Jpn Soc Surg Infect 12 141–5

    Google Scholar 

  29. CB Chiwakata C Manegold L Bonicke I Waase C Julch M Dietrich (2001) ArticleTitleProcalcitonin as a parameter of disease severity and risk of mortality in patients with Plasmodium falciparum malaria J Infect Dis 183 1161–4 Occurrence Handle10.1086/319283 Occurrence Handle1:STN:280:DC%2BD3M3ks1Kksw%3D%3D Occurrence Handle11237849

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan

    Naoki Aikawa & Seitaro Fujishima

  2. Critical Care and Emergency Center, Iwate Medical University, Iwate, Japan

    Shigeatu Endo

  3. Department of Pediatrics, National Defense Medical College Hospital, Saitama, Japan

    Isao Sekine & Kazuhiro Kogawa

  4. Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan

    Yasuhiro Yamamoto & Shigeki Kushimoto

  5. Department of Emergency and Critical Care Medicine, Osaka City University, Medical School, Osaka, Japan

    Hidekazu Yukioka & Noboru Kato

  6. Department of Infectious Diseases, Tokyo Women’s Medical University, Tokyo, Japan

    Kyoichi Totsuka & Ken Kikuchi

  7. Hachioji Medical Center, Tokyo Medical University, Tokyo, Japan

    Toshiaki Ikeda & Kazumi Ikeda

  8. New Diagnostics Business and Technology Development Operations, Wako Pure Chemical Industries, Ltd., Osaka, Japan

    Kazuaki Harada & Shinji Satomura

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  1. Naoki Aikawa
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Correspondence to Naoki Aikawa.

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Aikawa, N., Fujishima, S., Endo, S. et al. Multicenter prospective study of procalcitonin as an indicator of sepsis. J Infect Chemother 11, 152–159 (2005). https://doi.org/10.1007/s10156-005-0388-9

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  • DOI: https://doi.org/10.1007/s10156-005-0388-9

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