J Dent Anesth Pain Med.  2015 Sep;15(3):135-140.

Diagnostic value of procalcitonin and CRP in critically ill patients admitted with suspected sepsis

• Joen JS
• Ji SM

Abstract

BACKGROUND
Identifying early markers of septic complications can aid in the diagnosis and therapeutic management of hospitalized patients. In this study, the utility of procalcitonin (PCT) vs. C-reactive protein (CRP) as early markers of sepsis was compared.
METHODS
A series of 2,697 consecutive blood samples was collected from hospitalized patients and serum PCT and CRP levels were measured. Patients were categorized by PCT level as follows: < 0.05 ng/ml, 0.05-0.49 ng/ml, 0.5-1.99 ng/ml, 2-9.99 ng/ml, and > 10 ng/ml. Diagnostic utility was analyzed by receiver operating characteristic (ROC) curves.
RESULTS
Mean CRP levels varied among the five PCT categories at 0.31 ± 2.87, 5.65 ± 6.26, 13.78 ± 8.01, 12.15 ± 10.16, and 17.77 ± 10.59, respectively (P < 0.05). PCT and CRP differed between positive and negative blood culture groups (PCT: 15.9 vs. 4.78 mg/dl; CRP: 11.5 ng/ml vs. 9.57 ng/ml; P < 0.05). The areas under the ROC curves (PCT, 95% confidence interval [CI]: 0.743, range: 0.698-0.789 at a threshold of 0.5 ng/ml; CRP, 95% CI: 0.540, range: 0.478-0.602 at a threshold of 8 mg/l) differed for PCT and CRP (P < 0.05).
CONCLUSIONS
Therefore, PCT is a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture. These findings can be useful for the treatment of critically ill sepsis patients.

Keyword

C-reactive protein; Infection; Procalcitonin; Sepsis

MeSH Terms

C-Reactive Protein
Critical Illness*
Diagnosis
Humans
ROC Curve
Sepsis*
C-Reactive Protein

Figure

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  Fig. 1 Comparison of C-reactive protein levels in accordance with the five categorized groups of patients based on procalcitonin levels as follows: Group 1: 10 ng/mL. The box plot shows the lower quartile, mean, and upper quartile value.

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  Fig. 2 Procalcitonin levels in the blood culture-positive group and blood culture negative-group. The boxes show the lower quartile, median, and upper quartile values.

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  Fig. 3 C-reactive protein levels between the blood culture-positive group and blood culturenegative group. The boxes show the lower quartile, median, and upper quartile values.

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  Fig. 4 Receiver operating characteristic curve for procalcitonin (PCT) and C-reactive protein (CRP) values for sepsis prediction. The area under the curve respectively, indicating a statistically significant difference (P < 0.0001).

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