Usefulness of Procalcitonin Levels for Predicting the Microbiological Orientation in Patients with Sepsis

Author:

Gómez Natalia Fernanda Pascual12ORCID,del Pilar Sanz Martín María1,Chong María Auxiliadora Semiglia3,Cruz Nelly Daniela Zurita3,Hernández Rosa Méndez4ORCID,Molina Iñigo Guerra5,Sanz Iñigo García6,Tejerina Angels Figuerola7,Rueda Fernando Ramasco4ORCID

Affiliation:

1. Department of Clinical Analysis, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain

2. Physiology and Pathophysiology Teaching Unit, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain

3. Department of Microbiology, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain

4. Department of Anesthesiology and Surgical Intensive Care, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain

5. Department of Emergency, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain

6. Department of Digestive and General Surgical, La Princesa University Hospital, Autónoma University of Madrid, Diego de León 62, 28006 Madrid, Spain

7. Department of Preventive Medicine and Public Health, La Princesa University Hospital, Diego de León 62, 28006 Madrid, Spain

Abstract

The main objective of the study was to verify whether levels of procalcitonin (PCT) could guide us toward determining the type of bacteria causing the sepsis and to identify the discriminatory cut-off point in the first urgent laboratory test. This study is a single center retrospective analysis that includes 371 patients with a mean age of 71.7 ± 15.6 years who were diagnosed with sepsis or septic shock. The yield of blood cultures in demonstrating the causative microbiological agent was 24.3% (90), and it was 57, 1% (212) when evaluating all types of cultures. Statistically significant positive differences were observed in the mean value of the PCT between the group that obtained positive cultures and the group that did not (p < 0.0001). The AUC-ROC of PCT values as a guide to the causal bacteria type was 0.68 (95%CI: 0.57–0.78, p < 0.0021). The PCT value that showed the best diagnostic characteristics for identifying Gram-negative rods (GNR) as the causative agent in blood cultures was 2.1 ng/mL. The positive predictive value (PPV) was 78, 9% (66.3–88.1%). The AUC-ROC of the PCT values for sepsis diagnosis, with any positive culture that could be assessed, was 0.67 (95%CI: 0.63–0.73, p < 0.0001). The PCT value that showed the best diagnostic characteristic for predicting sepsis was 3.6 ng/mL.

Publisher

MDPI AG

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