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Evaluation of the relationship between procalcitonin level and the causative pathogen in intensive care patients with sepsis

    Melek Bilgin

    Department of Microbiology, Samsun Training & Research Hospital, Ilkadim, Samsun, 55090, Turkey

    ,
    Recai Aci

    *Author for correspondence: Tel.: +90 530 660 6428;

    E-mail Address: recaiaci35@gmail.com

    Department of Biochemistry, Samsun Training & Research Hospital, Ilkadim, Samsun, 55090, Turkey

    ,
    Adem Keskin

    Department of Medicinal Biochemistry, Institute of Health Sciences, Aydin Adnan Menderes University, Efeler, Aydın, 09100, Turkey

    ,
    Esmeray M Yilmaz

    Department of Clinical Microbiology & Infectious Diseases, Samsun Training & Research Hospital, Ilkadim, Samsun, 55090, Turkey

    &
    Ebru Polat

    Department of Anesthesiology & Reanimation, Samsun Training & Research Hospital, Ilkadim, Samsun, 55090, Turkey

    Published Online:https://doi.org/10.2217/fmb-2023-0010

    Aim: This study was designed to investigate how procalcitonin (PCT) levels are affected by different pathogens in patients with sepsis. Materials & methods: A total of 110 Gram-positive sepsis, 62 Gram-negative sepsis and 27 fungal sepsis patients were included in the study. Kaplan–Meier and ROC curve analysis was performed to assess PCT levels. Results: PCT levels were 2.36 ng/ml in Gram-negative patients, 0.79 ng/ml in Gram-positive patients and 0.89 ng/ml in fungal patients. The area under the curve for PCT was 0.608, the cutoff value was 1.34, sensitivity was 56.50% the specificity was 56.50%. Conclusion: PCT survival levels of 7.71 ng/ml in Gram-negative patients, 2.65 ng/ml in Gram-positive patients and 1.16 ng/ml in fungal patients can be evaluated to predict survival.

    Tweetable abstract

    PCT levels can distinguish Gram-negative sepsis patients from other sepsis patients with different pathogens. In addition, PCT levels can be evaluated to predict survival in patients with sepsis.

    Papers of special note have been highlighted as: • of interest; •• of considerable interest

    References

    • 1. Singer M, Deutschman CS, Seymour CW et al. The third international consensus definitions for sepsis and septic shock (SEPSIS-3). JAMA 315(8), 801–810 (2016).
    • 2. Nasa P, Juneja D, Singh O, Dang R, Arora V. Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit. J. Intensive Care Med. 27(3), 179–183 (2012).
    • 3. Chen CM, Cheng KC, Chan KS, Yu WL. Age may not influence the outcome of patients with severe sepsis in intensive care units. Int. J. Gerontol. 8, 22–26 (2014).
    • 4. Vincent J-L, Marshall JC, Ñamendys-Silva SA et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir. Med. 2, 380–386 (2014).
    • 5. Jarczak D, Kluge S, Nierhaus A. Sepsis-pathophysiology and therapeutic concepts. Front. Med. (Lausanne) 8, 628302 (2021).
    • 6. Li S, Rong H, Guo Q, Chen Y, Zhang G, Yang J. Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis. J. Res. Med. Sci. 21, 39 (2016).
    • 7. Gullo A, Bianco N, Berlot G. Management of severe sepsis and septic shock: challenges and recommendations. Crit. Care Clin. 22(3), 489–501 (2006).
    • 8. Marshall JC, Reinhart K. Biomarkers of sepsis. Crit. Care Med. 37(7), 2290–2298 (2009).
    • 9. Langley RJ, Tsalik EL, van Velkinburgh JC et al. An integrated clinico-metabolomic model improves prediction of death in sepsis. Sci. Transl. Med. 5(195), 195ra95 (2013).
    • 10. Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A. Procalcitonin levels in Gram-positive, Gram-negative, and fungal bloodstream infections. Dis. Markers 2015, 701480 (2015). •• Procalcitonin (PCT) level may be a useful tool for distinguishing between Gram-negative and Gram-positive bacteraemia.
    • 11. Brodska H, Malickova K, Adamkova V, Benakova H, Stastna MM, Zima T. Significantly higher procalcitonin levels could differentiate Gram-negative sepsis from Gram-positive and fungal sepsis. Clin. Exp. Med. 13, 165–170 (2013). •• Although the reason for the difference in PCT levels in Gram-positive and Gram-negative sepsis cases cannot be fully explained, this can probably be explained by the different interaction of lipoteichoic acids in Gram-positive bacteria or lipopolysaccharides in Gram-negative bacteria with host cells.
    • 12. Guo SY, Zhou Y, Hu QF, Yao J, Wang H. Procalcitonin is a marker of Gram-negative bacteremia in patients with sepsis. Am. J. Med. Sci. 349, 499–504 (2015).
    • 13. Baykara N, Akalın H, Arslantaş MK et al. Epidemiology of sepsis in intensive care units in turkey: a multicenter, point-prevalence study. Crit. Care 22(1), 93 (2018).
    • 14. Markus B, Peter AW. The inflammatory response in sepsis. Trends Immunol. 34, 129–136 (2013).
    • 15. Bassetti M, Righi E, Carnelutti A. Bloodstream infections in the intensive care unit. Virulence 7, 267–279 (2016).
    • 16. Bilgili B, Haliloğlu M, Aslan MS, Sayan İ, Kasapoğlu US, Cinel İ. Diagnostic accuracy of procalcitonin for differentiating bacteraemic Gram-Negative sepsis from Gram-Positive sepsis. Turk. J. Anaesthesiol. Reanim. 46(1), 38–43 (2018).
    • 17. Cabral L, Afreixo V, Meireles R et al. Evaluation of procalcitonin accuracy for the distinction between Gram-negative and Gram-positive bacterial sepsis in burn patients. J. Burn Care Res. 40(1), 112–119 (2019).
    • 18. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 5(1), 4–11 (2014).
    • 19. Cernada M, Pinilla-González A, Kuligowski J et al. Transcriptome profiles discriminate between Gram-positive and Gram-negative sepsis in preterm neonates. Pediatr. Res. 91(3), 637–645 (2022).
    • 20. Niederman MS, Baron RM, Bouadma L et al. Initial antimicrobial management of sepsis. Crit. Care. 25(1), 307 (2021).
    • 21. Gao Y, Lin H, Xu Y et al. Prognostic risk factors of carbapenem-resistant Gram-negative bacteria bloodstream infection in immunosuppressed patients: a 7-year retrospective cohort study. Infect. Drug Resist. 15, 6451–6462 (2022). • PCT level higher than 0.5 μg/l was found to be associated with 60-day mortality in sepsis cases caused by GN bacteria that developed antibiotic resistance.
    • 22. Schuetz P, Affolter B, Hunziker S et al. Serum procalcitonin, C-reactive protein and white blood cell levels following hypothermia after cardiac arrest: a retrospective cohort study. Eur. J. Clin. Invest. 40, 376–381 (2010).
    • 23. Ryoo SM, Han KS, Ahn S et al. The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: a multicenter prospective registry-based observational study. Sci. Rep. 9(1), 6579 (2019).
    • 24. Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol. 72(1–2), 69–80 (2006).
    • 25. Pradhan S, Ghimire A, Bhattarai B et al. The role of C-reactive protein as a diagnostic predictor of sepsis in a multidisciplinary intensive care unit of a tertiary care center in Nepal. Indian J. Crit. Care Med. 20(7), 417–420 (2016).
    • 26. Vijayan AL, Vanimaya, Ravindran S et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J. Intensive Care 5, 51 (2017).
    • 27. Arora S, Singh P, Singh PM, Trikha A. Procalcitonin levels in survivors and nonsurvivors of sepsis: systematic review and meta-analysis. Shock 43, 212–221 (2015).
    • 28. Schuetz P, Birkhahn R, Sherwin R et al. Serial procalcitonin predicts mortality in severe sepsis patients: results from the multicenter procalcitonin MOnitoring SEpsis (MOSES) study. Crit. Care Med. 45(5), 781 (2017).
    • 29. Varis E, Pettilä V, Poukkanen M et al. Evolution of blood lactate and 90-day mortality in septic shock. a post hoc analysis of the FINNAKI study. Shock 47(5), 574–581 (2017).
    • 30. Safari S, Shojaee M, Rahmati F et al. Accuracy of SOFA score in prediction of 30-day outcome of critically ill patients. Turk. J. Emerg. Med. 16, 146–150 (2016).
    • 31. Chen YX, Wang JY, Guo SB. Use of CRB-65 and quick sepsis-related organ failure assessment to predict site of care and mortality in pneumonia patients in the emergency department: a retrospective study. Crit. Care 20, 167 (2016).
    • 32. Djordjevic D, Rondovic G, Surbatovic M et al. Neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injure patients: which ratio to choose to predict outcome and nature of bacteremia? Mediators Inflamm. 2018, 3758068 (2018).
    • 33. Riche F, Gayat E, Barthelemy R, Le Dorze M, Mateo J, Payen D. Reversal of neutrophil-to-lymphocyte count ratio in early versus late death from septic shock. Crit. Care 19, 439 (2015).
    • 34. Salciccioli JD, Marshall DC, Pimentel MA et al. The association between the neutrophil-to-lymphocyte ratio and mortality in critical illness: an observational cohort study. Crit. Care 19(1), 1–8 (2015).
    • 35. Lai L, Lai Y, Wang H et al. Diagnostic accuracy of procalcitonin compared to C-reactive protein and interleukin 6 in recognizing gram-negative bloodstream infection: a meta-analytic study. Dis. Markers 2020, 4873074 (2020). • The factors isolated as bacteremia agents in studies differ according to countries and even clinics, and the patient population included in the study and the severity of the disease may cause these differences.