Domonkos Trásy1, Krisztián Tánczos2, Márton Németh3, Péter Hankovszky4, András Lovas5, András Mikor6, Ildikó László7, Edit Hajdú8, Angelika Osztroluczki9, János Fazakas10, Zsolt Molnár11. 1. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: trasydom@gmail.com. 2. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: tkrisztian78@gmail.com. 3. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: nemethmarton85@gmail.com. 4. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: hankovszky@gmail.com. 5. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: anlovas@gmail.com. 6. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: andrasmikor@gmail.com. 7. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: ildiko.laszlo88@gmail.com. 8. University of Szeged, Faculty of Medicine, Division of Infectious Diseases, First Department of Internal Medicine, Szeged, Hungary. Electronic address: horvathne.hajdu.edit@med.u-szeged.hu. 9. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: oszang78@gmail.com. 10. Semmelweis University, Faculty of Medicine, Department of Transplantation and Surgery, Budapest, Hungary. Electronic address: jancsidora@gmail.com. 11. University of Szeged, Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, Szeged, Hungary. Electronic address: zsoltmolna@gmail.com.
Abstract
PURPOSE: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. MATERIALS AND METHODS: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. RESULTS: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P< .05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P< .05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P< .001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P< .001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). CONCLUSIONS: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.
PURPOSE: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically illpatients. MATERIALS AND METHODS: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. RESULTS: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P< .05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P< .05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P< .001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P< .001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). CONCLUSIONS: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically illpatients may help the clinician to evaluate the appropriateness of therapy.
Authors: Attila Rutai; Bettina Zsikai; Szabolcs Péter Tallósy; Dániel Érces; Lajos Bizánc; László Juhász; Marietta Zita Poles; József Sóki; Zain Baaity; Roland Fejes; Gabriella Varga; Imre Földesi; Katalin Burián; Andrea Szabó; Mihály Boros; József Kaszaki Journal: Front Med (Lausanne) Date: 2022-05-09
Authors: Zoltán Ruszkai; Erika Kiss; Ildikó László; Fanni Gyura; Erika Surány; Péter Töhötöm Bartha; Gergely Péter Bokrétás; Edit Rácz; István Buzogány; Zoltán Bajory; Erzsébet Hajdú; Zsolt Molnár Journal: Trials Date: 2017-08-11 Impact factor: 2.279
Authors: Domonkos Trásy; Krisztián Tánczos; Márton Németh; Péter Hankovszky; András Lovas; András Mikor; Edit Hajdú; Angelika Osztroluczki; János Fazakas; Zsolt Molnár Journal: J Immunol Res Date: 2016-08-15 Impact factor: 4.818