[Predictive value of white blood cell, procalcitonin and high-sensitivity C-reactive protein for the bloodstream infection in the super-elderly critically-ill patients].
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Objective: To investigate the ability of white blood cell (WBC), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the super-elderly patients with bloodstream infection. Methods: It was a retrospective study. A total of 77 patients (≥85 years) admitted to the ICU of Peking Union Medical College Hospital from June, 2016 to December, 2017 were enrolled. The patients included 67 males and 10 females, with an age of 85-105 years and the average age was (92±5) years. According to the results of blood culture, patients were divided into positive blood culture group (n=50) and negative blood culture group (n=27). The data which obeyed normal distribution were compared with single sample t test between the two groups. Results: There was no significant difference in WBC level between the positive blood culture group and the negative blood culture group[12.4(7.8, 36.6)×10(9)/L vs 10.7(8.5, 18.7)×10(9)/L, U=0.109, P=0.124]. Compared to the positive blood culture group, the PCT level [2.6(0.8, 7.4)μg/L vs 1.5(0.6, 5.3)μg/L, U=3.015, P=0.004] and hs-CRP level [119(62, 220) mg/vs 54 (24, 80) mg/L, U=7.791, P<0.001] were significantly higher in the negative blood culture group. The ROC analysis showed that the area under the curves (AUC) of WBC, PCT and hs-CRP was 0.704(95%CI: 0.586-0.822, P<0.01), 0.896(95%CI: 0.829-0.964, P<0.01) and 0.864(95%CI: 0.778-0.949, P<0.01), respectively. The best cutoff value of PCT for discrimination of positive blood culture was 0.44 μg/L, which resulted in a sensitivity of 70.0% and a specificity of 92.6%. The best cutoff value of hs-CRP was 50.35 mg/L, which resulted in a sensitivity of 62.0% and a specificity of 88.9%. Conclusion: Compared to WBC, both PCT and hs-CRP have a better ability to predict bloodstream infection in the Super-elderly patients.目的： 比较白细胞（WBC）、降钙素原（PCT）及超敏C反应蛋白（hs-CRP）在超高龄重症患者中对血流感染的诊断预测价值。 方法： 回顾分析2016年6月至2017年12月北京协和医院重症医学科收治的77例超高龄重症感染患者（≥85岁），男性患者67例，女性患者10例，年龄85~105岁，平均年龄（92±5）岁，以血培养结果进行分组，其中血培养阳性组50例，血培养阴性组27例，分析WBC、PCT、hs-CRP对血流感染的预测价值。两组间正态分布参数比较应用独立样本t检验。 结果： 血培养阳性组与阴性组WBC无显著差异[12.4（7.8，36.6）×10(9)/L比10.7（8.5，18.7）×10(9)/L，U=0.109，P=0.124]，血培养阳性组PCT[2.6（0.8，7.4）μg/L比1.5（0.6，5.3）μg/L，U=3.015，P=0.004]和hs-CR[119（62，220）mg/L比54（24，80）mg/L，U=7.791，P<0.001]显著高于血培养阴性组。WBC、PCT和hs-CRP预测血培养阳性的受试者工作特征（ROC）曲线下面积分别为0.704（95%CI：0.586~0.822，P<0.01）、0.896（95%CI：0.829~0.964，P<0.001）和0.864（95%CI：0.778~0.949，P<0.001）。其中PCT预测血培养阳性临界值为0.44 μg/L，敏感度为70.0%，特异度为92.6%；hs-CRP预测的临界值为50 mg/L，敏感度为62.0%，特异度为88.9%。 结论： PCT和hs-CRP能较WBC更好地早期预测超高龄重症患者的血流感染，PCT和hs-CRP的诊断阈值值得重视。.Keywords:
Procalcitonin
White blood cell
Blood Culture
Objective: To investigate the ability of white blood cell (WBC), procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) in the super-elderly patients with bloodstream infection. Methods: It was a retrospective study. A total of 77 patients (≥85 years) admitted to the ICU of Peking Union Medical College Hospital from June, 2016 to December, 2017 were enrolled. The patients included 67 males and 10 females, with an age of 85-105 years and the average age was (92±5) years. According to the results of blood culture, patients were divided into positive blood culture group (n=50) and negative blood culture group (n=27). The data which obeyed normal distribution were compared with single sample t test between the two groups. Results: There was no significant difference in WBC level between the positive blood culture group and the negative blood culture group[12.4(7.8, 36.6)×10(9)/L vs 10.7(8.5, 18.7)×10(9)/L, U=0.109, P=0.124]. Compared to the positive blood culture group, the PCT level [2.6(0.8, 7.4)μg/L vs 1.5(0.6, 5.3)μg/L, U=3.015, P=0.004] and hs-CRP level [119(62, 220) mg/vs 54 (24, 80) mg/L, U=7.791, P<0.001] were significantly higher in the negative blood culture group. The ROC analysis showed that the area under the curves (AUC) of WBC, PCT and hs-CRP was 0.704(95%CI: 0.586-0.822, P<0.01), 0.896(95%CI: 0.829-0.964, P<0.01) and 0.864(95%CI: 0.778-0.949, P<0.01), respectively. The best cutoff value of PCT for discrimination of positive blood culture was 0.44 μg/L, which resulted in a sensitivity of 70.0% and a specificity of 92.6%. The best cutoff value of hs-CRP was 50.35 mg/L, which resulted in a sensitivity of 62.0% and a specificity of 88.9%. Conclusion: Compared to WBC, both PCT and hs-CRP have a better ability to predict bloodstream infection in the Super-elderly patients.目的： 比较白细胞（WBC）、降钙素原（PCT）及超敏C反应蛋白（hs-CRP）在超高龄重症患者中对血流感染的诊断预测价值。 方法： 回顾分析2016年6月至2017年12月北京协和医院重症医学科收治的77例超高龄重症感染患者（≥85岁），男性患者67例，女性患者10例，年龄85~105岁，平均年龄（92±5）岁，以血培养结果进行分组，其中血培养阳性组50例，血培养阴性组27例，分析WBC、PCT、hs-CRP对血流感染的预测价值。两组间正态分布参数比较应用独立样本t检验。 结果： 血培养阳性组与阴性组WBC无显著差异[12.4（7.8，36.6）×10(9)/L比10.7（8.5，18.7）×10(9)/L，U=0.109，P=0.124]，血培养阳性组PCT[2.6（0.8，7.4）μg/L比1.5（0.6，5.3）μg/L，U=3.015，P=0.004]和hs-CR[119（62，220）mg/L比54（24，80）mg/L，U=7.791，P<0.001]显著高于血培养阴性组。WBC、PCT和hs-CRP预测血培养阳性的受试者工作特征（ROC）曲线下面积分别为0.704（95%CI：0.586~0.822，P<0.01）、0.896（95%CI：0.829~0.964，P<0.001）和0.864（95%CI：0.778~0.949，P<0.001）。其中PCT预测血培养阳性临界值为0.44 μg/L，敏感度为70.0%，特异度为92.6%；hs-CRP预测的临界值为50 mg/L，敏感度为62.0%，特异度为88.9%。 结论： PCT和hs-CRP能较WBC更好地早期预测超高龄重症患者的血流感染，PCT和hs-CRP的诊断阈值值得重视。.
Procalcitonin
White blood cell
Blood Culture
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Objective To investigate the differential diagnosis significance of serum procalcitonin(PCT) in children with bacterial and viral infected community-acquired pneumonia(CAP),and compare the accuracies and application of C reactive protein(CRP),erythrocyte sedimentation rate(ESR) and white blood cell(WBC) count.Methods A total of 79 patients with CAP(20 cases with lobar pneumonia and 59 cases with bronchopneumonia) and 21 healthy controls were enrolled.PCT,CRP,ESR and WBC count were determined.Receiver operating characteristic(ROC) curve analysis was performed.The 79 patients with CAP were classified into 2 years old group(31 patients),2-5 years old group(18 patients) and 5 years old group(30 patients) according to their ages,and their PCT,CRP,ESR and WBC counts were compared.Results Serum PCT,CRP,ESR and WBC count were significantly higher in CAP group than in control group(P=0.000,P0.01).Serum PCT,CRP,ESR and WBC count in lobar pneumonia group were higher than those in bronchopneumonia group(P0.01).The level of PCT in 5 years old group were higher than that in 2 years old group(P=0.000),and the levels of CRP,ESR and WBC count had no statistical significance among the different age groups(P0.05).The area under receiver operating characteristic(ROC) curve of PCT was 0.97 [95% confidence interval(CI): 0.93-1.00],which was higher than those of CRP [0.91(95%CI: 0.78-0.99)] and ESR [0.87(95% CI:0.78-0.96)](P0.01).The area of WBC count [0.95(0.95%CI: 0.91-0.98)] had no statistical significance(P=0.14).The best cut-off value of PCT was 1 ng/mL,and the sensitivity and specificity were 94.1% and 82.3%.Conclusions Serum PCT level is a better marker than CRP and ESR for the diagnosis of CAP in children,and can be used as a reliable indicator of the early diagnosis for clinicians and rational use of antibiotics.
Procalcitonin
Erythrocyte sedimentation rate
White blood cell
Lobar pneumonia
Absolute neutrophil count
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To investigate the clinical application values of procalcitonin (PCT), high-sensitivity C-reactive protein (hs-CRP) and serum amyloid A (SAA) in the early diagnosis of sepsis.In this retrospective analysis, 36 patients admitted to Liaocheng People's Hospital were selected from May 2018 to July 2019. According to infectious disease diagnostic criteria, 17 patients were confirmed to have sepsis (observation group), and 19 patients were determined to be nonseptic (control group). The levels of PCT, CRP and SAA of patients were detected on admission, and the clinical application values of PCT, CRP and SAA for sepsis were compared.Seventeen patients were included in the observation group, including 9 males and 8 females, with an average age of 52.18 ± 9.49 years; 19 patients were included in the control group, including 12 males and 7 females, with an average age of 51.53 ± 8.50 years. On admission, there were significant differences in white blood cell (WBC) count (t = 5.134), neutrophil count (t = 3.143), lymphocyte count (t = 2.510), PCT (t = 9.250), hs-CRP (t = 2.947) and SAA (t = 11.360) between the observation group and the control group, and the differences were statistically significant. For the comparison of clinical application values: the sensitivity of PCT, hs-CRP and SAA was 78.95%, 52.17% and 50.00%, respectively; the specificity of PCT, hs-CRP and SAA was 88.24%, 61.54% and 37.50%, respectively; the area under the ROC curve (AUC) of PCT, hs-CRP and SAA was 0.920, 0.684 and 0.870, respectively; the logistic regression coefficient of PCT, hs-CRP and SAA was -0.577, -0.028 and -0.009, respectively; and the 95% confidence interval (CI) of PCT, hs-CRP and SAA was 0.779-0.985, 0.508-0.828 and 0.716-0.958, respectively.Compared with hs-CRP and SAA, PCT had a higher clinical application value for sepsis, and PCT could be used as a reliable index for the early diagnosis of sepsis.
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Procalcitonin (PCT) levels can be used to predict bacteremia and DNAemia in patients with sepsis. In this study, the diagnostic accuracy of PCT in predicting blood culture (BC) results and DNAemia, as detected by real-time PCR (RT-PCR), was compared with that of other markers of inflammation commonly evaluated in patients with suspected sepsis, such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and white blood cell (WBC) count.A total of 571 patients for whom BC, blood RT-PCR, PCT, CRP, ESR, and WBC count were requested for laboratory diagnosis of sepsis were included in the study. Receiver operating characteristic curve analysis was performed to compare the ability of the above biomarkers to predict BC and blood RT-PCR results.A total of 108 pathogens were identified by BC (79 pathogens, 14.5% positive rate) and/or RT-PCR (90 pathogens, 16.5% positive rate), after exclusion of 26 contaminated samples. The PCT areas under the curve (AUCs) in predicting BC (0.843; 95% CI 0.796-0.890; p < 0.0001) and RT-PCR (0.916; 95% CI 0.888-0.945; p < 0.0001) results were significantly greater than AUCs found for CRP, ESR, and WBC count.PCT showed a better diagnostic accuracy than CRP, ESR, and WBC count in predicting DNAemia and bacteremia in patients with suspected sepsis.
Procalcitonin
White blood cell
Erythrocyte sedimentation rate
Bacteremia
Blood Culture
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Background. Serious infections in children are difficult to determine from symptoms and signs alone. Fever is both a marker of insignificant viral infection, as well as more serious bacterial sepsis. Therefore, seeking markers of invasive disease, as well as culture positivity for organisms, has been a goal of paediatricians for many years. In addition, the avoidance of unnecessary antibiotics is important in this time of emerging multiresistant micro-organisms. Objective. To ascertain whether acute-phase reactant tests predict positive culture results. Methods. A prospective, cross-sectional study over a 1-year period included all documented febrilechildrenunder the age of 5 years (with an axillary temperature ≥38°C) who presented to Steve Biko Academic Hospital, Pretoria, with signs and symptoms of pneumonia, meningitis and/or generalised sepsis. Every child had clinical signs, chest radiograph findings, urine culture, blood testing (full blood count, C-reactive protein, procalcitonin) and blood culture results recorded. Results. A total of 63 patients were enrolled, all of whom had an axillary temperature ≥38°C. C-reactive protein, procalcitonin and white cell count did not predict the presence of positive blood culture or cerebrospinal fluid culture results, nor infiltrates on chest radiographs. No statistically significant correlations were found between the duration of hospital stay and the degree of fever ( p =0.123), white cell count ( p =0.611), C-reactive protein ( p =0.863) or procalcitonin ( p =0.392). Conclusion. Biomarkers do not seem to predict severity of infection, source of infection, or duration of hospitalisation in children presenting to hospital with fever. The sample size is however too small to definitively confirm this viewpoint. This study suggests that clinical suspicion of serious infection and appropriate action are as valuable as extensive testing.
Procalcitonin
White blood cell
Blood Culture
Chest radiograph
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Procalcitonin
White blood cell
Blood Culture
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Objective To investigate the diagnostic values of procalcitonin (PCT),white blood cell (WBC) count,70％ marginal values of neutral granular cell (NEU％) and C reactive protein (CRP) to old patients with sepsis.Methods An analysis was conducted including both 116 sepsis patients with positive blood culture and 50 patients with negative blood culture from January to December in 2013.The serum PCT,WBC,NEU％ and CRP were tested.Results The levels of serum PCT,WBC,CRP and 70％ marginal values NEU％ in the positive blood culture group were significantly higher than those in the negative group (P ＜ 0.05).Combination of PCT,WBC and NEU％,the sensitivity,specificity,positive predictive value,and negative predictive value were 82.4％,40％,52.6％ and 74％ respectively.PCT,WBC and NEU％ might be considered respectively as single predictor through univariate and multivariate analysis in old patients with sepsis.Conclusion Serum PCT,WBC and NEU％ may be used as markers in early diagnosis of sepsis.The combined determination of serum PCT,WBC and NEU％ helps to exclude the diagnosis of sepsis.
Key words:
Blood culture; Sepsis; Procalcitonin; White blood cell count; Percentage of neutrophils
Procalcitonin
White blood cell
Blood Culture
Univariate analysis
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Blood infection is one of the causes of morbidity in hospitalized patients. While some scholars have identified procalcitonin (PCT) as a potential biomarker for the diagnosis of blood infection, others have questioned its diagnostic value. Thus, the present study was conducted to compare the diagnostic values of PCT with C-reactive protein (CRP), erythrocytes sedimentation rate (ESR), white blood cell (WBC) count, and blood culture in patients with bacterial blood infections. In a prospective case–control study, 45 septic patients (6 months–5 years old), who were hospitalized in Shahid Motahhari Hospital of Urmia over the year 2016 and 45 patients with noninfectious diseases, whose gender and age range were similar to the members of the septic group, were examined. The participants' blood samples were taken for the sake of blood culture and measurement of PCT level, ESR, and CRP. Finally, the collected data were analyzed through the SPSS-21 software. the results indicated that the average PCT, ESR, CRP, and WBC count was significantly higher in septic patients. Moreover, the blood culture of patients with negative or intermediate serum PCT levels was negative, while 50% of blood culture results in patients with positive PCT were positive and the rest were negative. Finally, a significant relationship was detected between the frequency of blood culture results and results of serum PCT tests (P = 0.003). serum PCT level can be considered a diagnostic marker of bacterial infections. If used in conjunction with tests of CRP, ESR, and WBC count, the PCT test can enhance the diagnosis of bacterial infections.
Procalcitonin
Erythrocyte sedimentation rate
White blood cell
Blood Culture
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Procalcitonin
Transplant surgery
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Objective To investigate the expression of C-reactive protein(CRP)and procalcitonin(PCT)in acute pancreatitis(AP)patients and their role in the diagnosis of AP.Methods Blood samples were collected from 58AP patients(patient group)and 30 healthy people(control group).The levels of CRP and PCT and white blood cell(WBC)count were measured.The relationship between serum amylase(AMY)and WBC count,PCT and CRP and the relationship between WBC count,PCT and CRP were evaluated by correlation test. Diagnostic sensitivity of WBC count,PCT and CRP was investigated by receiver operating characteristic cure(ROC)curve and area under curve of ROC(AUC).Results The positive rates and levels of CRP,WBC count and PCT in the patient group were significantly higher than those in the control group(P0.01 and 0.05).For the three inflammatory response parameters,PCT had the highest positive rate,followed by CRP and WBC count(all P0.01).AUC analysis showed that PCT was the most sensitive parameter for diagnosis of AP,followed by CRP.In patient group,the AMY was not correlated with CRP(r=0.13,P=0.35),WBC count(r=0.028,P= 0.83),and PCT(r=0.15,P=0.26);CRP was positively correlated with WBC count(r=0.337,P=0.01); WBC count was positively correlated with PCT(r=0.303,P=0.021);there was no correlation between CRP and PCT(r=0.236,P=0.074).Conclusion PCT and CRP are sensitive parameters for diagnosis of AP and can provide valuable basis for the diagnosis.The diagnostic performance of PCT is superior to CRP.
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