Procalcitonin prognostic value in predicting mortality among adult patients with sepsis due to Gram-negative bacteria
DOI:
https://doi.org/10.13181/mji.oa.225864Keywords:
bacteremia, mortality, procalcitonin, sepsisAbstract
BACKGROUND Sepsis is a leading cause of mortality and morbidity globally. Gram-negative bacteremia was reported to have a high risk of septic shock and poor prognosis. This study aimed to evaluate the role of procalcitonin in predicting mortality in patients with sepsis due to Gram-negative bacteria.
METHODS This was a retrospective cohort study performed based on medical records and sepsis registry of Tropical and Infectious Disease Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital. The inclusion criteria were patients aged ≥18 years diagnosed with sepsis due to Gram-negative bacteria based on blood culture on admission and hospitalized between March 2017 and October 2020. Data taken from medical records included subjects’ characteristics, laboratory parameters, and 28-day mortality outcomes during hospitalization. Receiver operating characteristic was used to determine the area under the curve (AUC) of procalcitonin and its accuracy.
RESULTS A total of 128 patients were eligible. The cumulative survival of patients with Gram-negative bacteremia was 48.4% (standard error 0.96%). The AUC of procalcitonin to predict mortality was 0.45 (95% confidence interval 0.36–0.54). Escherichia coli was the predominant microorganism in blood culture (n = 38, 29.7%).
CONCLUSIONS Procalcitonin has a poor performance in predicting mortality of patients with sepsis due to Gram-negative bacteria.
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021;49(11):e1063-143. https://doi.org/10.1007/s00134-021-06506-y
Epstein L, Dantes R, Magill S, Fiore A. Varying estimates of sepsis mortality using death certificates and administrative codes-United States, 1999-2014. MMWR Morb Mortal Wkly Rep. 2016;65(13):342-5. https://doi.org/10.15585/mmwr.mm6513a2
Decree of the Minister of Health of the Republic of Indonesia No HK.01.07/MENKES/342/2017 - National regulation of sepsis management. 2017;1-82. Indonesian.
Suwarto S. Procalcitonin levels in elderly compare with non elderly patients with Gram negative bacteremia. eJKI. 2018;6(2):76-80. https://doi.org/10.23886/ejki.6.9722.
Fujishima S. Organ dysfunction as a new standard for defining sepsis. Inflamm Regen. 2016;36(24). https://doi.org/10.1186/s41232-016-0029-y
Abe R, Oda S, Sadahiro T, Nakamura M, Hirayama Y, Tateishi Y, et al. Gram-negative bacteremia induces greater magnitude of inflammatory response than Gram-positive bacteremia. Crit Care. 2010;14(2):R27. https://doi.org/10.1186/cc8898
Fan SL, Miller NS, Lee J, Remick DG. Diagnosing sepsis - The role of laboratory medicine. Clin Chim Acta. 2016;460:203-10. https://doi.org/10.1016/j.cca.2016.07.002
Mellhammar L, Kahn F, Whitlow C, Kander T, Christensson B, Linder A. Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching. Sci Rep. 2021;11(6972). https://doi.org/10.1038/s41598-021-86346-4
Morgan MP, Szakmany T, Power SG, Olaniyi P, Hall JE, Rowan K, et al. Sepsis patients with first and second-hit infections show different outcomes depending on the causative organism. Front Microbiol. 2016;7:207. https://doi.org/10.3389/fmicb.2016.00207
Yap CYF, Aw TC. The use of procalcitonin in clinical practice. Proc Singapore Healthc. 2014;23(1):33-7. https://doi.org/10.1177/201010581402300106
Guo SY, Zhou Y, Hu QF, Yao J, Wang H. Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis. Am J Med Sci. 2015;349(6):499-504. https://doi.org/10.1097/MAJ.0000000000000477
Vijayan AL, Vanimaya, Ravindran S, Saikant R, Lakshmi S, Kartik R, et al. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care. 2017;5:51. https://doi.org/10.1186/s40560-017-0246-8
Gregoriano C, Heilmann E, Molitor A, Schuetz P. Role of procalcitonin use in the management of sepsis. J Thorac Dis. 2020;12(Suppl 1): S5-S15. https://doi.org/10.21037/jtd.2019.11.63
Jain S, Sinha S, Sharma SK, Samantaray JC, Aggrawal P, Vikram NK, et al. Procalcitonin as a prognostic marker for sepsis: a prospective observational study. BMC Res Notes. 2014;7:458. https://doi.org/10.1186/1756-0500-7-458
Singer AJ, Ng J, Thode HC Jr, Spiegel R, Weingart S. Quick SOFA scores predict mortality in adult emergency department patients with and without suspected infection. Ann Emerg Med. 2017;69(4):475-9. https://doi.org/10.1016/j.annemergmed.2016.10.007
Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, et al. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clin Infect Dis. 2005;41(3):281-8. https://doi.org/10.1086/431587
Yunus I, Fasih A, Wang Y. The use of procalcitonin in the determination of severity of sepsis, patient outcomes and infection characteristics. PLoS One. 2018;13(11):e0206527. https://doi.org/10.1371/journal.pone.0206527
Matzaraki V, Alexandraki KI, Venetsanou K, Piperi C, Myrianthefs P, Malamos N, et al. Evaluation of serum procalcitonin and interleukin-6 levels as markers of liver metastasis. Clin Biochem. 2007;40(5-6):336-42. https://doi.org/10.1016/j.clinbiochem.2006.10.027
Giovanella L, Suriano S, Ricci R, Ravani P, Ceriani L. Circulating procalcitonin in aseptic carcinoma patients: a specificity study with (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography as benchmark. Clin Chem Lab Med. 2010;48(8):1163-5. https://doi.org/10.1515/CCLM.2010.214
Durna? B, W?tek M, Wollny T, Niemirowicz K, Marzec M, Bucki R, et al. Utility of blood procalcitonin concentration in the management of cancer patients with infections. Onco Targets Ther. 2016;9:469-75. https://doi.org/10.2147/OTT.S95600
Aziz SA, Nelwan EJ, Sukrisman L, Suhendro S. Higher cut-off serum procalcitonin level for sepsis diagnosis in metastatic solid tumor patients. BMC Res Notes. 2018;11:84. https://doi.org/10.1186/s13104-018-3204-1
Sun Y, Jiang L, Shao X. Predictive value of procalcitonin for diagnosis of infections in patients with chronic kidney disease: a comparison with traditional inflammatory markers C-reactive protein, white blood cell count, and neutrophil percentage. Int Urol Nephrol. 2017;49(12):2205-16. https://doi.org/10.1007/s11255-017-1710-z
Dharmawan A, Istia MJ, Tan HT, Suparto, Anastasia MC, Layanto N. The outcome of patients with sepsis at Tarakan Hospital Central Jakarta in 2018. Muhammadiyah Medical Journal. 2021;2(2):49-54. https://doi.org/10.24853/mmj.2.2.49-54
Handayani N, Lardo S, Nugrohowati N. Difference of procalcitonin levels in Gram-positive and Gram-negative bacterial sepsis patients of Indonesia Army Central Hospital Gatot Soebroto in 2016. JUXTA: Jurnal Ilmiah Mahasiswa Kedokteran Univeristas Airlangga. 2022;13(1):38-41. https://doi.org/10.20473/juxta.V13I12022.38-41
Katu S, Suwarto S, Pohan H, Abdullah M. [Factors influencing the success of empiric antibiotic therapy in patients with severe sepsis and septic shock in the inpatient ward in Cipto Mangunkusumo Hospital]. J Penyakit Dalam Indones. 2015;2(2):96-106. Indonesian. https://doi.org/10.7454/jpdi.v2i2.72
Li S, Rong H, Guo Q, Chen Y, Zhang G, Yang J. Serum procalcitonin levels distinguish Gram-negative bacterial sepsis from Gram-positive bacterial and fungal sepsis. J Res Med Sci. 2016;21:39. https://doi.org/10.4103/1735-1995.183996
Mahendra AD, Tirtodiharjo K, Kusuma ITD. The pattern of bacteria and its resistance on adult sepsis patient at Dr. Moewardi General Hospital, Indonesia. Arch Clin Microbiol. 2016;7(5):28. https://doi.org/10.1101/044032
Octora M, Mertaniasih NM, Semedi BP, Koendhori EB. Predictive score model of clinical outcomes sepsis in intensive care unit tertier referral hospital of eastern Indonesia. Open Access Maced J Med Sci. 2021;9(B):1710-6. https://doi.org/10.3889/oamjms.2021.7780
Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence. 2014;5(1):4-11. https://doi.org/10.4161/viru.27372
Liu D, Su L, Han G, Yan P, Xie L. Prognostic value of procalcitonin in adult patients with sepsis: a systematic review and meta-analysis. PLoS ONE. 2015;10(6):e0129450. https://doi.org/10.1371/journal.pone.0129450
Poddar B, Gurjar M, Singh S, Aggarwal A, Singh R, Azim A, et al. Procalcitonin kinetics as a prognostic marker in severe sepsis/septic shock. Indian J Crit Care Med. 2015;19(3):140-6. https://doi.org/10.4103/0972-5229.152755
Viallon A, Guyomarc'h S, Marjollet O, Berger C, Carricajo A, Robert F, et al. Can emergency physicians identify a high mortality subgroup of patients with sepsis: role of procalcitonin. Eur J Emerg Med. 2008;15(1):26-33. https://doi.org/10.1097/MEJ.0b013e3280ec539b
Jones E, Benowitz J, Swensen A, Schmidt M, Feinstein D. Procalcitonin and lactic acid: a review of predictive value in septic patients. EC Emerg Med Crit Care. 2019;6:362-73.
Durrance RJ, Ullah T, Patel H, Martinez G, Cervellione K, Zafonte VB, et al. Marked elevation in serum procalcitonin levels do not correlate with severity of disease or mortality in hospitalized patients: a retrospective study. Biomark Insights. 2020;15:1177271920917941. https://doi.org/10.1177/1177271920917941
Perman SM, Mikkelsen ME, Goyal M, Ginde A, Bhardwaj A, Drumheller B, et al. The sensitivity of qSOFA calculated at triage and during emergency department treatment to rapidly identify sepsis patients. Sci Rep. 2020;10(1):20395. https://doi.org/10.1038/s41598-020-77438-8
Lo RSL, Leung LY, Brabrand M, Yeung CY, Chan SY, Lam CCY, et al. qSOFA is a poor predictor of short-term mortality in all patients: a systematic review of 410,000 patients. J Clin Med. 2019;8(1):61. https://doi.org/10.3390/jcm8010061
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