Lab Med Online.  2021 Jan;11(1):32-39. 10.47429/lmo.2021.11.1.32.

Clinical Use of Procalcitonin in the Diagnosis of Sepsis: Evaluation of PCT–qSOFA

• Kim B
• Lim H
• Kim YA

• KMID: 2525778
• DOI: http://doi.org/10.47429/lmo.2021.11.1.32

Abstract

Background
Sepsis is a life-threatening medical condition, and the diagnosis of sepsis should be conducted rapidly and accurately. The purpose of this study was to evaluate the diagnostic performance of a combination of procalcitonin (PCT) levels and quick sequential organ failure assessment (qSOFA), namely PCT–qSOFA, for the diagnosis of sepsis.
Methods
A total of 204 patients were grouped according to the results of blood culture and systemic inflammatory response syndrome criteria ( ≥ 2/4) into the bacterial sepsis group (N = 67), the blood culture-negative sepsis group (N = 37), the blood culture-positive group without corresponding clinical symptoms or signs of sepsis (N = 35), and the control group without evidence of sepsis (N = 65). The diagnostic performance of PCT–qSOFA was assessed using the post-test probability analysis.
Results
Compared with qSOFA, PCT–qSOFA demonstrated improved post-test probability (from 0.772 to 0.884) and a positive likelihood ratio (from 1.59 to 3.55) when it was applied to all subjects, including those in the intensive care unit (ICU). However, this improvement in diagnostic performance was not observed when PCT–qSOFA was applied to patients outside the ICU.
Conclusions
The combined use of PCT and qSOFA can help clinicians identify patients with sepsis, including those in an ICU setting.

Keyword

Sepsis; Procalcitonin; Quick sequential organ failure assessment (qSOFA); Systemic inflammatory response syndrome (SIRS)

Figure

• 

  Fig. 1 Difference of procalcitoin and qSOFA score median values and the Mann–Whitney comparison of the four groups: (A) Procalcitonin, (B) qSOFA, (C) qSOFA in subjects outside the ICU. *Group 1, bacterial sepsis (BSI+SIRS+); †Group 2, blood culture-negative sepsis (BSI-SIRS+); ‡Group 3, blood culture-positive without clinical symptoms (BSI+SIRS-); §Group 4, control (BSI-SIRs-). Abbreviations: PCT, procalcitonin; qSOFA, quick sequential organ failure assessment; BSI, bloodstream infection; SIRS, systemic inflammatory response syndrome; ICU, intensive care unit; SD, standard deviation; IQR, interquartile range (25th percentile to 75th percentile).

• 

  Fig. 2 Receiver operating characteristic curve comparison of PCT and qSOFA in sepsis. AUROC values are shown in parentheses. Abbreviations: PCT, procalcitonin; qSOFA, quick sequential organ failure assessment; ex. ICU, excluding subjects in the ICU; AUROC, area under the receiver operating characteristics curve.

Reference

1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. 2016; The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 315:801–10. DOI: 10.1001/jama.2016.0287. PMID: 26903338. PMCID: PMC4968574.

2. Cortés-Puch I, Hartog CS. 2016; Opening the debate on the new sepsis definition change is not necessarily progress: revision of the sepsis definition should be based on new scientific insights. Am J Respir Crit Care Med. 194:16–8. DOI: 10.1164/rccm.201604-0734ED. PMID: 27166972. PMCID: PMC4960634.

3. Simpson SQ. 2018; SIRS in the time of Sepsis-3. Chest. 153:34–8. DOI: 10.1016/j.chest.2017.10.006. PMID: 29037526.

4. Meisner M. 2014; Update on procalcitonin measurements. Ann Lab Med. 34:263–73. DOI: 10.3343/alm.2014.34.4.263. PMID: 24982830. PMCID: PMC4071182.

5. Horan TC, Andrus M, Dudeck MA. 2008; CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 36:309–32. DOI: 10.1016/j.ajic.2008.03.002. PMID: 18538699.

6. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. 1992; Crit Care Med. 20:864–74. DOI: 10.1097/00003246-199206000-00025.

7. Spoto S, Cella E, de Cesaris M, Locorriere L, Mazzaroppi S, Nobile E, et al. 2018; Procalcitonin and MR-proadrenomedullin combination with SOFA and qSOFA scores for sepsis diagnosis and prognosis: a diagnostic algorithm. Shock. 50:44–52. DOI: 10.1097/SHK.0000000000001023. PMID: 29023361.

8. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. 2015; Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 372:1629–38. DOI: 10.1056/NEJMoa1415236. PMID: 25776936.

9. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. 2013; Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 41:580–637. DOI: 10.1097/CCM.0b013e31827e83af. PMID: 23353941.

10. Salomão R, Ferreira BL, Salomão MC, Santos SS, Azevedo LCP, Brunialti MKC, et al. 2019; Sepsis: evolving concepts and challenges. Braz J Med Biol Res. 52:e8595. DOI: 10.1590/1414-431x20198595. PMID: 30994733. PMCID: PMC6472937.

11. Vincent JL, Martin GS, Levy MM. 2016; qSOFA does not replace SIRS in the definition of sepsis. Crit Care. 20:210. DOI: 10.1186/s13054-016-1389-z. PMID: 27423462. PMCID: PMC4947518.

12. Faix JD. 2013; Biomarkers of sepsis. Crit Rev Clin Lab Sci. 50:23–36. DOI: 10.3109/10408363.2013.764490. PMID: 23480440. PMCID: PMC3613962.

13. Singh M, Anand L. 2014; Bedside procalcitonin and acute care. Int J Crit Illn Inj Sci. 4:233–7. DOI: 10.4103/2229-5151.141437. PMID: 25337486. PMCID: PMC4200550.

14. Cortés-Puch I, Hartog CS. 2016; Opening the debate on the new sepsis definition change is not necessarily progress: revision of the sepsis definition should be based on new scientific insights. Am J Respir Crit Care Med. 194:16–8. DOI: 10.1164/rccm.201604-0734ED. PMID: 27166972. PMCID: PMC4960634.