Skip to main content
Erschienen in: Wiener klinische Wochenschrift 15-16/2021

06.10.2020 | original article

Utility of procalcitonin in a medical intensive care unit in Croatia

verfasst von: Ana Vujaklija Brajković, M.D., PhD, Iva Košuta, Dora Tomek, Mia Rora, Jakša Babel, Dunja Rogić, Ana Lončar Vrančić, Radovan Radonić

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 15-16/2021

Einloggen, um Zugang zu erhalten

Summary

Aims

To investigate the clinical benefit of routine procalcitonin (PCT) measurement in the medical intensive care unit (ICU) of a tertiary referral hospital.

Methods

Adult patients with suspected infections were included. White blood cells, C‑reactive protein (CRP), and PCT were measured.

Results

In this study 129 patients of median age 64 years (interquartile range 39–89 years) were prospectively included. The Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 21 ± 14 and 7 ± 6, respectively. Intensive care unit (ICU) mortality was 22.5%. Immunocompromised patients constituted 39.5%. A significant correlation was observed between PCT and APACHE II (Spearman’s rho 0.461, p < 0.01), PCT and SOFA (Spearman’s rho 0.494, p < 0.01) and PCT and CRP (Spearman’s rho 0.403, p < 0.01). Most patients (n = 83, 64.3%) received antibiotics before admission. No difference in PCT (1.56 ± 8 µg/L vs. 1.44 ± 13 µg/L, p = 0.6) was observed with respect to previous antibiotic therapy. Levels of PCT and CRP were significantly increased in patients with positive blood cultures, the infection caused by Gram-negative microorganism regardless of disease severity and pneumonia with complications. PCT did not differ among patients with positive vs negative urine culture (4.6 ± 16 µg/L vs. 1.76 ± 11.9 µg/L) or positive vs. negative endotracheal aspirate (1.93 ± 11.4 µg/L vs. 1.76 ± 1.11 µg/L). PCT-guided stewardship was applied in 36 patients (28%).

Conclusion

Increased initial PCT levels might point to the development of more severe disease caused by Gram-negative bacteria, regardless of previous antibiotic treatment. The results pertain to immunocompetent and immunocompromised patients. Implementation of PCT-guided stewardship in those patients is possible and relies on experience as well as knowledge of reference change value for a marker within the specific setting.
Literatur
1.
Zurück zum Zitat Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.CrossRef Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006;34(6):1589–96.CrossRef
2.
Zurück zum Zitat Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, et al. Vital signs: improving antibiotic use among hospitalized patients. Mmwr Morb Mortal Wkly Rep. 2014;63(9):194–200.PubMedPubMedCentral Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, et al. Vital signs: improving antibiotic use among hospitalized patients. Mmwr Morb Mortal Wkly Rep. 2014;63(9):194–200.PubMedPubMedCentral
3.
Zurück zum Zitat Bouadma L, Luyt C‑E, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375(9713):463–74.CrossRef Bouadma L, Luyt C‑E, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375(9713):463–74.CrossRef
4.
Zurück zum Zitat Jensen JU, Hein L, Lundgren B, Bestle MH, Mohr TT, Andersen MH, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med. 2011;39(9):2048–58.CrossRef Jensen JU, Hein L, Lundgren B, Bestle MH, Mohr TT, Andersen MH, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med. 2011;39(9):2048–58.CrossRef
5.
Zurück zum Zitat Assink-de Jong E, de Lange DW, van Oers JA, Nijsten MW, Twisk JW, Beishuizen A. Stop antibiotics on guidance of procalcitonin study (SAPS): a randomised prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus a standard-of-care approach can safely shorten antibiotic duration in intensive care unit patients—calculated sample size: 1816 patients. BMC Infect Dis. 2013;13:178.CrossRef Assink-de Jong E, de Lange DW, van Oers JA, Nijsten MW, Twisk JW, Beishuizen A. Stop antibiotics on guidance of procalcitonin study (SAPS): a randomised prospective multicenter investigator-initiated trial to analyse whether daily measurements of procalcitonin versus a standard-of-care approach can safely shorten antibiotic duration in intensive care unit patients—calculated sample size: 1816 patients. BMC Infect Dis. 2013;13:178.CrossRef
6.
Zurück zum Zitat Schroeder S, Hochreiter M, Koehler T, Schweiger A‑M, Bein B, Keck FS, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbecks Arch Surg. 2009;394(2):221–6.CrossRef Schroeder S, Hochreiter M, Koehler T, Schweiger A‑M, Bein B, Keck FS, et al. Procalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study. Langenbecks Arch Surg. 2009;394(2):221–6.CrossRef
7.
Zurück zum Zitat Hohn A, Schroeder S, Gehrt A, Bernhardt K, Bein B, Wegscheider K, et al. Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock. BMC Infect Dis. 2013;13:158.CrossRef Hohn A, Schroeder S, Gehrt A, Bernhardt K, Bein B, Wegscheider K, et al. Procalcitonin-guided algorithm to reduce length of antibiotic therapy in patients with severe sepsis and septic shock. BMC Infect Dis. 2013;13:158.CrossRef
8.
Zurück zum Zitat Nobre V, Harbarth S, Graf J‑D, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177(5):498–505.CrossRef Nobre V, Harbarth S, Graf J‑D, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008;177(5):498–505.CrossRef
9.
Zurück zum Zitat Stolz D, Smyrnios N, Eggimann P, Pargger H, Thakkar N, Siegemund M, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J. 2009;34(6):1364–75.CrossRef Stolz D, Smyrnios N, Eggimann P, Pargger H, Thakkar N, Siegemund M, et al. Procalcitonin for reduced antibiotic exposure in ventilator-associated pneumonia: a randomised study. Eur Respir J. 2009;34(6):1364–75.CrossRef
10.
Zurück zum Zitat Layios N, Lambermont B, Canivet J‑L, Morimont P, Preiser J‑C, Garweg C, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med. 2012;40(8):2304–9.CrossRef Layios N, Lambermont B, Canivet J‑L, Morimont P, Preiser J‑C, Garweg C, et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med. 2012;40(8):2304–9.CrossRef
11.
Zurück zum Zitat Oliveira CF, Botoni FA, Oliveira CRA, Silva CB, Pereira HA, Serufo JC, et al. Procalcitonin versus C‑reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med. 2013;41(10):2336–43.CrossRef Oliveira CF, Botoni FA, Oliveira CRA, Silva CB, Pereira HA, Serufo JC, et al. Procalcitonin versus C‑reactive protein for guiding antibiotic therapy in sepsis: a randomized trial. Crit Care Med. 2013;41(10):2336–43.CrossRef
12.
Zurück zum Zitat Deliberato RO, Marra AR, Sanches PR, Martino MDV, dos Santos Ferreira CE, Pasternak J, et al. Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting. Diagn Microbiol Infect Dis. 2013;76(3):266–71.CrossRef Deliberato RO, Marra AR, Sanches PR, Martino MDV, dos Santos Ferreira CE, Pasternak J, et al. Clinical and economic impact of procalcitonin to shorten antimicrobial therapy in septic patients with proven bacterial infection in an intensive care setting. Diagn Microbiol Infect Dis. 2013;76(3):266–71.CrossRef
13.
Zurück zum Zitat Shehabi Y, Sterba M, Garrett PM, Rachakonda KS, Stephens D, Harrigan P, et al. Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis. A randomized controlled trial. Am J Respir Crit Care Med. 2014;190(10):1102–10.CrossRef Shehabi Y, Sterba M, Garrett PM, Rachakonda KS, Stephens D, Harrigan P, et al. Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis. A randomized controlled trial. Am J Respir Crit Care Med. 2014;190(10):1102–10.CrossRef
14.
Zurück zum Zitat Bloos F, Trips E, Nierhaus A, Briegel J, Heyland DK, Jaschinski U, et al. Effect of sodium selenite administration and procalcitonin-guided therapy on mortality in patients with severe sepsis or septic shock: a randomized clinical trial. JAMA Intern Med. 2016;176(9):1266–76.CrossRef Bloos F, Trips E, Nierhaus A, Briegel J, Heyland DK, Jaschinski U, et al. Effect of sodium selenite administration and procalcitonin-guided therapy on mortality in patients with severe sepsis or septic shock: a randomized clinical trial. JAMA Intern Med. 2016;176(9):1266–76.CrossRef
16.
Zurück zum Zitat Huang H‑B, Peng J‑M, Weng L, Wang C‑Y, Jiang W, Du B. Procalcitonin-guided antibiotic therapy in intensive care unit patients: a systematic review and meta-analysis. Ann Intensive Care. 2017;7(1):114.CrossRef Huang H‑B, Peng J‑M, Weng L, Wang C‑Y, Jiang W, Du B. Procalcitonin-guided antibiotic therapy in intensive care unit patients: a systematic review and meta-analysis. Ann Intensive Care. 2017;7(1):114.CrossRef
17.
Zurück zum Zitat Wirz Y, Meier MA, Bouadma L, Luyt CE, Wolff M, Chastre J, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care. 2018;22(1):191.CrossRef Wirz Y, Meier MA, Bouadma L, Luyt CE, Wolff M, Chastre J, et al. Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials. Crit Care. 2018;22(1):191.CrossRef
18.
Zurück zum Zitat Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med. 2019;57(9):1308–18.CrossRef Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med. 2019;57(9):1308–18.CrossRef
19.
Zurück zum Zitat Aguilar-Guisado M, Espigado I, Martín-Peña A, Gudiol C, Royo-Cebrecos C, Falantes J, et al. Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (how long study): an open-label, randomised, controlled phase 4 trial. Lancet Haematol. 2017;4(12):e573–83.CrossRef Aguilar-Guisado M, Espigado I, Martín-Peña A, Gudiol C, Royo-Cebrecos C, Falantes J, et al. Optimisation of empirical antimicrobial therapy in patients with haematological malignancies and febrile neutropenia (how long study): an open-label, randomised, controlled phase 4 trial. Lancet Haematol. 2017;4(12):e573–83.CrossRef
20.
Zurück zum Zitat Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10.CrossRef Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA. 2016;315(8):801–10.CrossRef
21.
Zurück zum Zitat KDIGO. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.CrossRef KDIGO. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.CrossRef
22.
Zurück zum Zitat Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRef Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818–29.CrossRef
23.
Zurück zum Zitat Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European society of intensive care medicine. Crit Care Med. 1998;26(11):1793–800.CrossRef Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European society of intensive care medicine. Crit Care Med. 1998;26(11):1793–800.CrossRef
24.
Zurück zum Zitat Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9:107.CrossRef Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med. 2011;9:107.CrossRef
25.
Zurück zum Zitat Lapić I, Rogić D, Fuček M, Galović R. Effectiveness of minimum retesting intervals in managing repetitive laboratory testing: experience from a Croatian university hospital. Biochem Med. 2019;29(3):30705.CrossRef Lapić I, Rogić D, Fuček M, Galović R. Effectiveness of minimum retesting intervals in managing repetitive laboratory testing: experience from a Croatian university hospital. Biochem Med. 2019;29(3):30705.CrossRef
26.
Zurück zum Zitat Rebers S, Aaronson NK, van Leeuwen FE, Schmidt MK. Exceptions to the rule of informed consent for research with an intervention. BMC Med Ethics. 2016;17:9.CrossRef Rebers S, Aaronson NK, van Leeuwen FE, Schmidt MK. Exceptions to the rule of informed consent for research with an intervention. BMC Med Ethics. 2016;17:9.CrossRef
27.
Zurück zum Zitat Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014;34(4):263–73.CrossRef Meisner M. Update on procalcitonin measurements. Ann Lab Med. 2014;34(4):263–73.CrossRef
28.
Zurück zum Zitat Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med. 2000;26(9):1193–200.CrossRef Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med. 2000;26(9):1193–200.CrossRef
29.
Zurück zum Zitat Rhee C. Using procalcitonin to guide antibiotic therapy. Open Forum Infect Dis. 2017;4(1):ofw249.CrossRef Rhee C. Using procalcitonin to guide antibiotic therapy. Open Forum Infect Dis. 2017;4(1):ofw249.CrossRef
30.
Zurück zum Zitat 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.CrossRef 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.CrossRef
31.
Zurück zum Zitat Luo X, Chen S, Zhang J, Ren J, Chen M, Lin K, et al. Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia. Leuk Lymphoma. 2019;60(10):2441–8.CrossRef Luo X, Chen S, Zhang J, Ren J, Chen M, Lin K, et al. Procalcitonin as a marker of Gram-negative bloodstream infections in hematological patients with febrile neutropenia. Leuk Lymphoma. 2019;60(10):2441–8.CrossRef
32.
Zurück zum Zitat Andriolo BN, Andriolo RB, Salomão R, Atallah ÁN. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database Syst Rev. 2017;1:CD10959.PubMed Andriolo BN, Andriolo RB, Salomão R, Atallah ÁN. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database Syst Rev. 2017;1:CD10959.PubMed
33.
Zurück zum Zitat Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Analytic review: interleukin‑6 in surgery, trauma, and critical care: part I: basic science. J Intensive Care Med. 2011;26(1):3–12.CrossRef Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Analytic review: interleukin‑6 in surgery, trauma, and critical care: part I: basic science. J Intensive Care Med. 2011;26(1):3–12.CrossRef
34.
Zurück zum Zitat Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Interleukin‑6 in surgery, trauma, and critical care part II: clinical implications. J Intensive Care Med. 2011;26(2):73–87.CrossRef Jawa RS, Anillo S, Huntoon K, Baumann H, Kulaylat M. Interleukin‑6 in surgery, trauma, and critical care part II: clinical implications. J Intensive Care Med. 2011;26(2):73–87.CrossRef
35.
Zurück zum Zitat Jekarl DW, Kim JY, Lee S, Kim M, Kim Y, Han K, et al. Diagnosis and evaluation of severity of sepsis via the use of biomarkers and profiles of 13 cytokines: a multiplex analysis. Clin Chem Lab Med. 2015;53(4):575–81.CrossRef Jekarl DW, Kim JY, Lee S, Kim M, Kim Y, Han K, et al. Diagnosis and evaluation of severity of sepsis via the use of biomarkers and profiles of 13 cytokines: a multiplex analysis. Clin Chem Lab Med. 2015;53(4):575–81.CrossRef
36.
Zurück zum Zitat Oda S, Hirasawa H, Shiga H, Nakanishi K, Matsuda K, Nakamua M. Sequential measurement of IL‑6 blood levels in patients with systemic inflammatory response syndrome (SIRS)/sepsis. Cytokine. 2005;29(4):169–75.CrossRef Oda S, Hirasawa H, Shiga H, Nakanishi K, Matsuda K, Nakamua M. Sequential measurement of IL‑6 blood levels in patients with systemic inflammatory response syndrome (SIRS)/sepsis. Cytokine. 2005;29(4):169–75.CrossRef
37.
Zurück zum Zitat Weidhase L, Wellhöfer D, Schulze G, Kaiser T, Drogies T, Wurst U, et al. Is interleukin‑6 a better predictor of successful antibiotic therapy than procalcitonin and C‑reactive protein? A single center study in critically ill adults. BMC Infect Dis. 2019;19(1):150.CrossRef Weidhase L, Wellhöfer D, Schulze G, Kaiser T, Drogies T, Wurst U, et al. Is interleukin‑6 a better predictor of successful antibiotic therapy than procalcitonin and C‑reactive protein? A single center study in critically ill adults. BMC Infect Dis. 2019;19(1):150.CrossRef
38.
Zurück zum Zitat Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin‑6, and interleukin‑8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001;164(3):396–402.CrossRef Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin‑6, and interleukin‑8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med. 2001;164(3):396–402.CrossRef
39.
Zurück zum Zitat Pierrakos C, Velissaris D, Bisdorff M, Marshall JC, Vincent J‑L. Biomarkers of sepsis: time for a reappraisal. Crit Care. 2020;24(1):287.CrossRef Pierrakos C, Velissaris D, Bisdorff M, Marshall JC, Vincent J‑L. Biomarkers of sepsis: time for a reappraisal. Crit Care. 2020;24(1):287.CrossRef
40.
Zurück zum Zitat Fischer SK, Williams K, Wang L, Capio E, Briman M. Development of an IL-6 point-of-care assay: utility for real-time monitoring and management of cytokine release syndrome and sepsis. Bioanalysis. 2019;11(19):1777–85.CrossRef Fischer SK, Williams K, Wang L, Capio E, Briman M. Development of an IL-6 point-of-care assay: utility for real-time monitoring and management of cytokine release syndrome and sepsis. Bioanalysis. 2019;11(19):1777–85.CrossRef
Metadaten
Titel
Utility of procalcitonin in a medical intensive care unit in Croatia
verfasst von
Ana Vujaklija Brajković, M.D., PhD
Iva Košuta
Dora Tomek
Mia Rora
Jakša Babel
Dunja Rogić
Ana Lončar Vrančić
Radovan Radonić
Publikationsdatum
06.10.2020
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 15-16/2021
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-020-01747-1

Weitere Artikel der Ausgabe 15-16/2021

Wiener klinische Wochenschrift 15-16/2021 Zur Ausgabe