Tung-Lin Tsui1,2,3, Ya-Ting Huang4,5, Wei-Chih Kan6,7, Mao-Sheng Huang8, Min-Yu Lai4, Kwo-Chang Ueng9,10, Chih-Chung Shiao5,11. 1. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. 2. Intensive Care Unit, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, Luodong, Yilan, Taiwan. 3. Division of Cardiology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, Luodong, Yilan, Taiwan. 4. Department of Nursing, Camillian Saint Mary's Hospital Luodong, Luodong, Yilan, Taiwan. 5. Saint Mary's Junior College of Medicine, Nursing and Management, Yilan, Taiwan. 6. Department of Nephrology, Department of Internal medicine, Chi-Mei Medical Center, Tainan, Taiwan. 7. Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan. 8. Department of laboratory medicine, Camillian Saint Mary's Hospital Luodong, Luodong, Yilan, Taiwan. 9. School of Medicine, Chung Shan Medical University, Taichung, Taichung, Taiwan. 10. Division of Cardiology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan. 11. Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary's Hospital Luodong, Luodong, Yilan, Taiwan.
Abstract
BACKGROUND: Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically ill patients. METHODS: We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. RESULTS: A total of 258 critically ill patients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, "serum PCT level," "albumin level" and "neutrophil-lymphocyte ratio" at ICU admission, along with "diabetes mellitus," and "with vasopressor." We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74-0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69-0.90; sensitivity 0.64; specificity 0.87). CONCLUSIONS: We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.
BACKGROUND: Procalcitonin (PCT) has been widely investigated as an infection biomarker. The study aimed to prove that serum PCT, combining with other relevant variables, has an even better sepsis-detecting ability in critically illpatients. METHODS: We conducted a retrospective cohort study in a regional teaching hospital enrolling eligible patients admitted to intensive care units (ICU) between July 1, 2016, and December 31, 2016, and followed them until March 31, 2017. The primary outcome measurement was the occurrence of sepsis. We used multivariate logistic regression analysis to determine the independent factors for sepsis and constructed a novel PCT-based score containing these factors. The area under the receiver operating characteristics curve (AUROC) was applied to evaluate sepsis-detecting abilities. Finally, we validated the score using a validation cohort. RESULTS: A total of 258 critically illpatients (70.9±16.3 years; 55.4% man) were enrolled in the derivation cohort and further subgrouped into the sepsis group (n = 115) and the non-sepsis group (n = 143). By using the multivariate logistic regression analysis, we disclosed five independent factors for detecting sepsis, namely, "serum PCT level," "albumin level" and "neutrophil-lymphocyte ratio" at ICU admission, along with "diabetes mellitus," and "with vasopressor." We subsequently constructed a PCT-based score containing the five weighted factors. The PCT-based score performed well in detecting sepsis with the cut-points of 8 points (AUROC 0.80; 95% confidence interval (CI) 0.74-0.85; sensitivity 0.70; specificity 0.76), which was better than PCT alone, C-reactive protein and infection probability score. The findings were confirmed using an independent validation cohort (n = 72, 69.2±16.7 years, 62.5% men) (cut-point: 8 points; AUROC, 0.79; 95% CI 0.69-0.90; sensitivity 0.64; specificity 0.87). CONCLUSIONS: We proposed a novel PCT-based score that performs better in detecting sepsis than serum PCT levels alone, C-reactive protein, and infection probability score.
Authors: Philipp Schuetz; Albertus Beishuizen; Michael Broyles; Ricard Ferrer; Gaetan Gavazzi; Eric Howard Gluck; Juan González Del Castillo; Jens-Ulrik Jensen; Peter Laszlo Kanizsai; Andrea Lay Hoon Kwa; Stefan Krueger; Charles-Edouard Luyt; Michael Oppert; Mario Plebani; Sergey A Shlyapnikov; Giulio Toccafondi; Jennifer Townsend; Tobias Welte; Kordo Saeed Journal: Clin Chem Lab Med Date: 2019-08-27 Impact factor: 3.694