Yoon Suk Lee1, Kwang Bum Cho2, Kyung Sik Park3, Ju Yup Lee3, Yoo Jin Lee3. 1. Department of Internal Medicine, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea. 2. Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea. chokb@dsmc.or.kr. 3. Department of Internal Medicine, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, South Korea.
Abstract
BACKGROUND AND AIM: This study aimed to evaluate the association of serum procalcitonin (PCT) at hospital presentation with disease severity and clinical deterioration to septic shock in acute cholangitis. METHODS: This study included consecutive patients with a diagnosis of acute cholangitis who presented to the emergency department and underwent biliary drainage. PCT and blood culture tests were conducted at the time of initial presentation. Patients were categorized into three groups based on disease severity. White blood cell count, levels of C-reactive protein and PCT were compared regarding the following: cholangitis severity, blood culture positivity, and clinical deterioration to septic shock. RESULTS: A total of 204 consecutive patients were enrolled, with grade I severity in 39 (19.1%), grade II in 139 (68.1%), and grade III in 26 (12.7%). The numbers of patients with blood culture positivity and clinical deterioration were 6 (15.4%) and 1 (2.6%) in grade I, 45 (32.4%) and 4 (2.9%) in grade II, and 14 (53.8%) and 1 (5.6%) in grade III cholangitis, respectively. Only PCT was significantly associated with blood culture positivity (3.25 vs 0.62 ng/mL; P = 0.001) and clinical deterioration (9.11 vs 0.89 ng/mL; P = 0.040). The cutoff value of PCT for clinical deterioration to septic shock among patients with grade I and II was 3.77 ng/mL (sensitivity of 80.0% and specificity of 74.0%). CONCLUSION: PCT could be a promising marker of clinical deterioration to septic shock in acute cholangitis. Therefore, PCT might be used as a decision-supporting biomarker for urgent biliary decompression.
BACKGROUND AND AIM: This study aimed to evaluate the association of serum procalcitonin (PCT) at hospital presentation with disease severity and clinical deterioration to septic shock in acute cholangitis. METHODS: This study included consecutive patients with a diagnosis of acute cholangitis who presented to the emergency department and underwent biliary drainage. PCT and blood culture tests were conducted at the time of initial presentation. Patients were categorized into three groups based on disease severity. White blood cell count, levels of C-reactive protein and PCT were compared regarding the following: cholangitis severity, blood culture positivity, and clinical deterioration to septic shock. RESULTS: A total of 204 consecutive patients were enrolled, with grade I severity in 39 (19.1%), grade II in 139 (68.1%), and grade III in 26 (12.7%). The numbers of patients with blood culture positivity and clinical deterioration were 6 (15.4%) and 1 (2.6%) in grade I, 45 (32.4%) and 4 (2.9%) in grade II, and 14 (53.8%) and 1 (5.6%) in grade III cholangitis, respectively. Only PCT was significantly associated with blood culture positivity (3.25 vs 0.62 ng/mL; P = 0.001) and clinical deterioration (9.11 vs 0.89 ng/mL; P = 0.040). The cutoff value of PCT for clinical deterioration to septic shock among patients with grade I and II was 3.77 ng/mL (sensitivity of 80.0% and specificity of 74.0%). CONCLUSION: PCT could be a promising marker of clinical deterioration to septic shock in acute cholangitis. Therefore, PCT might be used as a decision-supporting biomarker for urgent biliary decompression.
Authors: Angela W S Fung; Daniel Beriault; Eleftherios P Diamandis; Carey-Ann D Burnham; Todd Dorman; Mark Downing; Joshua Hayden; Bradley J Langford Journal: Clin Chem Date: 2017-06-20 Impact factor: 8.327
Authors: Evelien de Jong; Jos A van Oers; Albertus Beishuizen; Piet Vos; Wytze J Vermeijden; Lenneke E Haas; Bert G Loef; Tom Dormans; Gertrude C van Melsen; Yvette C Kluiters; Hans Kemperman; Maarten J van den Elsen; Jeroen A Schouten; Jörn O Streefkerk; Hans G Krabbe; Hans Kieft; Georg H Kluge; Veerle C van Dam; Joost van Pelt; Laura Bormans; Martine Bokelman Otten; Auke C Reidinga; Henrik Endeman; Jos W Twisk; Ewoudt M W van de Garde; Anne Marie G A de Smet; Jozef Kesecioglu; Armand R Girbes; Maarten W Nijsten; Dylan W de Lange Journal: Lancet Infect Dis Date: 2016-03-02 Impact factor: 25.071