The level of procalcitonin in the blood can increase significantly in systemic bacterial infections and sepsis. Request pdf procalcitonin as a diagnostic marker for sepsis. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. After applying exclusion criteria, a sample of 514 patients was considered for study. The objective of our study is to investigate current evidence related to the diagnostic accuracy of presepsin in neonatal sepsis. We systematically searched pubmed, scopus, and the cochrane library for studies evaluating pct in neonatal sepsis. In a large meta analysis with 3244 patients, pct alone had a sensitivity of 77% and a specificity of 79% in the diagnosis of sepsis. As a novel biomarker of inflammation, procalcitonin pct has proven useful to guide antibiotic therapy in intensive care unit icu. Although the overall number of covid19 patients with increased procalcitonin values seems limited, as highlighted in a recent article, the results of this concise metaanalysis of the literature would suggest that serial procalcitonin measurement may play a role for predicting evolution towards a more severe form of disease.
The aim of this study was to assess the value of serum procalcitonin pct levels as a diagnostic marker for septic arthritis sa via metaanalysis. Aug 16, 2019 there have been continuous attempts to diagnosis of sirs, sepsis, and severe sepsis using biomarkers, especially procalcitonin pct, c. A number of biomarkers have been studied for the diagnosis of sepsis in paediatrics, but no gold standard has been identified. Procalcitonin for diagnosis of infection and guide to antibiotic decisions. Procalcitonin pct guidance nebraska medicine omaha, ne. Hypothesis infections and sepsis are major complications in secondary peritonitis and still represent a diagnostic challenge. To accomplish this, we searched the medline 19662017, scopus 20042017, clinicaltrials. The aim of the current metaanalysis was to analyze the utility of pct on. Metaanalysis of procalcitonin for sepsis detection the. Comparison of diagnostic accuracy in sepsis between presepsin, procalcitonin, and creactive protein.
Jul 24, 2017 as a novel biomarker of inflammation, procalcitonin pct has proven useful to guide antibiotic therapy in intensive care unit icu. To assess the value of serum procalcitonin pct for the differentiation between patients with and without neonatal sepsis. Headtohead comparison of procalcitonin and presepsin for. Sepsis is a major cause of morbidity and mortality among hospitalized patients, and its reported incidence is increasing. Is procalcitonin evaluation effective in reducing mortality and time receiving antimicrobial therapy in adults with sepsis background. Prognostic value of procalcitonin in adult patients with sepsis. This meta analysis showed that overall pooled area under the curve auc is 0. This work is a metaanalysis on pct performance as a biomarker for sepsis. Diagnosis value of the serum amyloid a test in neonatal. The diagnostic use of procalcitonin for bacterial infections remains a matter of debate. Given the acknowledged problems in sepsis diagnosis, we use a novel way with the application of the latent class analysis lca to determine the operative characteristics of creactive protein crp, ddimer dd and procalcitonin pct as diagnostic tests for sepsis in patients admitted to hospital care with a presumptive infection. Procalcitoninguided antibiotic therapy in critically ill.
From a general assessment and metaanalysis perspective, procalcitonin performed better than creactive protein. Several meta analysis data suggest of heterogeneity for the pct testing. The assessment involved comparing the laboratory characteristics with the clinical characteristics of the groups. The diagnostic accuracy of procalcitonin for bacteraemia. Both decision aids lose sensitivity and gain specificity when. Serum procalcitonin and creactive protein levels as markers. Mar 04, 2020 although the overall number of covid19 patients with increased procalcitonin values seems limited, as highlighted in a recent article, the results of this concise meta analysis of the literature would suggest that serial procalcitonin measurement may play a role for predicting evolution towards a more severe form of disease.
The diagnostic accuracy of presepsin in neonatal sepsis. Serum procalcitonin levels can be used to differentiate betw. Serum procalcitonin as a diagnostic biomarker for sepsis in. We electronically searched the terms chronic obstructive pulmonary disease. Despite this, a metaanalysis of 18 studies found that procalcitonin did not readily distinguish sepsis from nonseptic systemic inflammation sensitivity of 71 percent and evaluation and management of suspected sepsis and septic shock in adults view in chinese. Jun 25, 2019 in this metaanalysis of 12 studies in 2408 patients with cap that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0. Objective its difficult to differentiate sepsis from nonsepsis, especially noninfectious sirs, because no good standard exists for proof of infection. Until recently, sepsis was defined as the presence of two or more positive systemic inflammatory response syndrome sirs criteria and confirmed infection. It arises once preprocalcitonin is cleaved by endopeptidase. Procalcitonin pct, as a sepsis biomarker, may play a role in guiding antibiotics.
Procalcitonin in patients with severe coronavirus disease. We will include all studies that compare pct and psep in adult critically ill patients with suspected bacterial infection or sepsis. Diagnostic value of creactive protein in neonatal sepsis. Sepsis, shock, and multiorgan failure do occur but appear to be uncommon when compared with noncovid19. Apr 24, 2017 a number of biomarkers have been studied for the diagnosis of sepsis in paediatrics, but no gold standard has been identified. Procalcitonin is a substance produced by many types of cells in the body, often in response to bacterial infections but also in response to tissue injury. Comparison of the accuracy of neutrophil cd64, procalcitonin.
Herein, we performed a comprehensive metaanalysis to assess the overall diagnostic. Neonatal sepsis is a leading cause of morbidity and mortality. We systematically searched pubmed, embase, isi web of knowledge, and the cochrane library for literature published between database inception and 19 may. Yamamoto t, nishimura t, kaga s, uchida k, tachibana y, esaki m, et al. Several metaanalysis data suggest of heterogeneity for the pct testing. A systematic search in pubmed, embase and cochrane was performed.
Procalcitonin evaluation for reducing mortality in adults. Pct had to be measured in neonatal blood samples, at the initial presentation of patients with suspected sepsis, before the administration of antibiotics. Procalcitoninguided therapy in intensive care unit. Early and accurate diagnosis of sepsis is challenging. Our metaanalysis provided evidence that the diagnostic accuracy of procalcitonin and presepsin in detecting infection was similar and that both are useful for early diagnosis of sepsis and subsequent reduction of mortality in critically ill adult patients. Muller and colleagues conducted a study in consecutive critically ill patients to compare the usefulness of serum concentration of calcitonin precursor, crp, il6 and. In a meta analysis of 17 studies, pct had a sensitivity of 85% and a specificity of 54% in diagnosing sepsis in neonates and children. This condition can evolve to an acute organ dysfunction, known as severe sepsis. Procalcitoninguided algorithms of antibiotic therapy in the. Elevated procalcitonin level was a risk factor for death in communityacquired pneumonia cap.
Crosssectional study to determine the diagnostic accuracy. The analysis included published studies that evaluated these markers for the diagnosis of bacterial infections in hospitalized patients. Procalcitonin guided algorithms of antibiotic therapy in the intensive care unit with sepsis. Sepsis is an important cause of neonatal morbidity and mortality. This metaanalysis suggests that both qsofa and sirs are better than chance in predicting mortality. Accuracy of serum procalcitonin for the diagnosis of sepsis. We hypothesized that the laboratory marker procalcitonin would provide an early and reliable assessment of septic complications.
There is a plausible explanation for this evidence. The authors found a low diagnostic performance of procalcitonin and concluded that procalcitonin cannot reliably differentiate sepsis from other, noninfectious causes of systemic inflammatory response syndrome sirs and that the widespread use of the procalcitonin test for sepsis diagnosis in critical. A metaanalysis to assess usefulness of procalcitoninguided. A systematic search in pubmed, embase and cochrane was. This updated metaanalysis of individual participant data from 12 countries shows that the use of procalcitonin to guide initiation and duration of antibiotic treatment results in lower risks of mortality, lower antibiotic consumption, and lower risk for antibioticrelated side effects. Current laboratory tests cannot accurately discriminate endangered neonates. Procalcitonin pct is a biologically active precursor to the calciummodulating hormone calcitonin. The aim of this study was to evaluate the utility of pctguided antibiotic therapy in critically ill adults and determine whether studies are sufficient. Use of serum procalcitonin to detect bacterial infection. In this metaanalysis of 12 studies in 2408 patients with cap that included etiologic diagnoses and sufficient data to enable analysis, the sensitivity and specificity of serum procalcitonin were 0. Combining procalcitonin with the qsofa and sepsis mortality.
The aim of this study was to assess the value of serum procalcitonin pct levels as a diagnostic marker for septic arthritis sa via meta analysis. Mar 11, 2020 wu cc, lan hm, han st, chaou ch, yeh cf, liu sh, et al. Presepsin and procalcitonin as predictors of sepsis based on. Neonatal sepsis ns, a common disorder for humans, is recognized as a leading global public health challenge. Serum procalcitonin levels can be used to differentiate between inflammatory and noninflammatory diarrhea in acute infectious diarrhea. It is composed of 116 amino acids and is produced by parafollicular cells c cells of the thyroid and by the neuroendocrine cells of. Serum procalcitonin levels as a diagnostic marker for. Finally seven studies comprising a total of 1,075 patients with severe sepsis or septic shock were included in the metaanalysis. Herein, we performed a comprehensive meta analysis to assess the overall diagnostic value of. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Neutrophil cd64 is widely described as an accurate biomarker for the diagnosis of infection in patients with septic syndrome. Accuracy of serum procalcitonin for the diagnosis of. There have been continuous attempts to diagnosis of sirs, sepsis, and severe sepsis using biomarkers, especially procalcitonin pct, c. The diagnostic value of procalcitonin in predicting prognosis was determined using a bivariate metaanalysis model.
Sepsis is defined as confirmed or suspected infection associated with a systemic inflammatory response syndrome sirs. Design prospective, international, multicenter inception cohort study setting five european surgical referral centers. Serum procalcitonin as a diagnostic biomarker for sepsis. The combination of procalcitonin and creactive protein or. Jul 15, 2004 a meta analysis was performed to evaluate the accuracy of determination of procalcitonin pct and creactive protein crp levels for the diagnosis of bacterial infection. This meta analysis was performed to assess the accuracy of the serum amyloid a saa test for diagnosing ns. The aim of this study was to determine the value of creactive protein crp in the diagnosis of patients with neonatal sepsis by a meta analysis. Diagnostic value of procalcitonin and presepsin for sepsis. Metaanalysis suggests that the use of procalcitonin to guide antibiotic therapy in acute respiratory tract infections can reduce duration of antibiotic therapy and hospital admission without. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma. According to our metaanalysis, presepsin is a useful protein that may help clinicians identify neonates at risk.
Although procalcitonin and presepsin have been identified as potential biomarkers to differentiate between sepsis and other noninfectious causes of systemic inflammation, the diagnostic accuracy of these biomarkers remains controversial. Presepsin and procalcitonin as predictors of sepsis based. We used the qtest and i2 index to test heterogeneity. Among numerous indicators of inflammation and sepsis, procalcitonin. The aim of this metaanalysis was to assess the accuracy of ncd64 expression for the diagnosis of sepsis in critically ill adult patients. Serum procalcitonin as a diagnostic marker for neonatal. The accuracy of pct has been shown to be valid for various sites of infection and for different populations such as the elderly, patients with renal impairment, and patients with autoimmune disease. The primary objective is to evaluate the diagnostic accuracy of these 2 biomarkers to a reference standard of sepsisinfection and to compare the diagnostic accuracy with each other. Soluble cd14 subtype scd14st, recently renamed presepsin, was identified as a new marker for the diagnosis of sepsis in several reports. Uzzan b, cohen r, nicolas p, cucherat m, perret gy. Our metaanalysis provided evidence that the diagnostic accuracy of. Procalcitonin to distinguish viral from bacterial pneumonia. This metaanalysis showed that overall pooled area under the curve auc is 0.
Procalcitoninguided antibiotic therapy in critically ill adults. The diagnostic value of procalcitonin in predicting prognosis was determined using a bivariate meta analysis model. The primary objective is to evaluate the diagnostic accuracy of these 2 biomarkers to a reference standard of sepsis infection and to compare the diagnostic accuracy. Neonatal sepsis is a common severe bacterial infection of the bloodstream, presenting in a newborn baby, 1 with a high mortality. Procalcitoninguided algorithms of antibiotic therapy in the intensive care unit with sepsis. Most studies have used ambiguous outcome measures such as sepsis instead of infection. This metaanalysis was performed to assess the accuracy of the serum amyloid a saa test for diagnosing ns. There is growing evidence that presepsin is a promising biomarker in the diagnosis of sepsis in adults. Prognostic value of procalcitonin in sepsis and pneumonia. Procalcitonin pct was demonstrated to be an accurate biomarker for the diagnosis of sepsis in adults and showed to be promising in paediatrics. Diagnostic value of procalcitonin and presepsin for sepsis in.
The use of procalcitonin pct for diagnosis of sepsis in. Procalcitonin algorithms for antibiotic therapy decisions. Use of serum procalcitonin to detect bacterial infection in. Univariate meta regression analysis and subgroup analysis will be. However, sirs criteria are limited in that they exhibit inadequate specificity and sensitivity for dysregulated. However, the findings were based on the results of individual clinical trials, rather than a. Neutrophil cd64 ncd64 expression appears to be a promising marker of bacterial infections. Methods we searched pubmed, embase and the cochrane library, as well as the reference lists of relevant articles, for studies published up to may 21, 2015 and did not impose language restrictions. In a large metaanalysis with 3244 patients, pct alone had a sensitivity of 77% and a specificity of 79% in the diagnosis of sepsis. The metaanalysis by benjamin tang and colleagues1 requires some comment. Compared with traditional indicators of bacterial infection, pct. The purpose of the present metaanalysis is to explore the diagnostic accuracy.
Procalcitonin as a prognostic marker for sepsis based on. Results were similar for different clinical settings and types of aris, thus supporting the use of. Serum procalcitonin levels as a diagnostic marker for septic. The overall sepsis effect in pct levels is significant and strong cohens d is 2. We searched seven databases to identify studies that met. Serum procalcitonin levels can be used to differentiate.
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