Web site designed and maintained by Chris Cairns  © SICS EBM Group 2004                                  

Up

 

Low procalcitonin makes sepsis unlikely.

 

Procalcitonin better than interleukins at stratifying patients to SIRS or one of the sepsis syndromes.
Pre-test probability of sepsis syndrome 77%, if procalcitonin positive increases probability to 94%. If negative reduces probability to 12%.
Level 2+ evidence.

 

Citation/s:  Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. American Journal of Respiratory and Critical Care Medicine 2001;164:396-402.
 

Lead Author's name and fax: Jerome Pugin, Division of Medical Intensive Care, University of Geneva Hospitals, jerome.pugin@medecine.unige.ch

 

Three-part Clinical Question: In patients with suspected sepsis, are procalcitonin or interleukins, useful at discriminating infective causes from SIRS?
 

Search Terms: 1. exp sepsis/ or severe sep$.tw or sept$.tw or sepsis syn$.tw 2. exp critcial care/ 3.1 and 2 4. diagnosis filter 5. 3 and 4

 

The Study: Independent, blind comparison, of consecutive patients.   Cohort study.
 

The Study Patients: Patients admitted to 2 ICUs at University of Geneva Hospitals. Included: new admission with suspected infection and 2 SIRS criteria. Suspected infection = statement by attending physician, diagnostic work-up and prescription of antibiotics. Excluded: early discharge or death, withholding life support, or absence of antimicrobial therapy.
Independent, blind comparison with a reference (gold) standard. There was an appropriate spectrum of patients. The gold standard was applied regardless of the test result.

 

Target disorder and Gold Standard: 2 blinded investigators reviewed charts and lab results (microbiology, radiology & PM) at ICU discharge. Classified as SIRS, sepsis, severe sepsis, or septic shock.
 

Diagnostic test: Procalcitonin (cut-off ³ 1.1ng.ml-1), interlukin-6 (cut-off ³ 200 ng.ml-1), interleukin-8 (cut-off ³ 30 ng.ml-1).

The Evidence:

 

Target Disorder: Sepsis (any level)

 

Test: Prolcalcitonin

(³ 1.1 ng.ml-1)

Present

Absent

 

Test Result

Num

Prop

Num

Prop

Likelihood RatiosTR>

Positive

58

a

4

b

4.35

1.83 to 10.34

Negative

2

c

14

d

0.04

0.01 to 0.17

Sensitivity: 97%; CI: 92 to 100

Specificity: 78%; CI: 59 to 97

Prevalence: 77%; CI: 68 to 86

Positive Predictive Value: 94%; CI: 87 to 100

Negative Predictive Value: 88%; CI: 71 to 100

 

Comments:


1. Note high pre-test probability of sepsis syndrome.
2. An example of SnNOut - tests of high Sensitivity if Negative rule the diagnosis Out.

Appraised by: Malcolm Daniel, Department of Anaesthesia, Glasgow Royal Infirmary; Monday, October 28, 2002     Email: md23s@udcf.gla.ac.uk

 

Printer-friendly format