A Retrospective Case Control Study Examining Procalcitonin as a Biomarker for Necrotizing Enterocolitis
Heather LiebeSamara E. LewisChristopher LoerkeAlena GolubkovaTyler LeivaKenneth StewartZoona SarwarAmy GinMary E. PorterHala ChaabanCatherine J. Hunter
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Abstract:
Background: Procalcitonin (PCT) is a biomarker for sepsis, but its utility has not been investigated in necrotizing enterocolitis (NEC). Necrotizing enterocolitis is a devastating multisystem disease of infants that in severe cases requires surgical intervention. We hypothesize that an elevated PCT will be associated with surgical NEC. Patients and Methods: After obtaining Institutional Review Board (IRB) approval (#12655), we performed a single institution retrospective case control study between 2010 and 2021 of infants up to three months of age. Inclusion criteria was PCT drawn within 72 hours of NEC or sepsis diagnosis. Control infants had a PCT drawn in the absence of infectious symptoms. Recursive partitioning (RP) identified PCT cutoffs. Categorical variable associations were tested using Fisher exact or χ2 tests. Continuous variables were tested using Wilcoxon rank sum test, Student t-test, and Kruskal-Wallis test. Adjusted associations of PCT and other covariables with NEC or sepsis versus controls were obtained via multinomial logistic regression analysis. Results: We identified 49 patients with NEC, 71 with sepsis, and 523 control patients. Based on RP, we selected two PCT cutoffs: 1.4 ng/mL and 3.19 ng/ml. A PCT of ≥1.4 ng/mL was associated with surgical (n = 16) compared with medical (n = 33) NEC (87.5% vs. 39.4%; p = 0.0015). A PCT of ≥1.4 ng/mL was associated with NEC versus control (p < 0.0001) even when adjusting for prematurity and excluding stage IA/IB NEC (odds ratio [OR], 28.46; 95% confidence interval [CI], 11.27-71.88). A PCT of 1.4-3.19 ng/mL was associated with both NEC (adjusted odds ratio [aOR], 11.43; 95% CI, 2.57-50.78) and sepsis (aOR, 6.63; 95% CI, 2.66-16.55) compared with controls. Conclusions: A PCT of ≥1.4 ng/mL is associated with surgical NEC and may be a potential indicator for risk of disease progression.Keywords:
Procalcitonin
Necrotizing Enterocolitis
Objective To analyze the procalcitonin(PCT) and C reactive protein(CRP)in the combined detection of diseases in clinical infection,proves that the combined detection of PCT and CRP has important clinical value in diagnosis of infectious diseases.Methods 40 cases of the virus in our hospital from 2012 January to 2013 January were infectious disease,80 cases of bacterial infection disease patients and 40 healthy subjects were used in immunofluorescence analysis and immunenephelometry procalcitonin and C reactive protein,and then the test results were analyzed.Results Severe bacterial infection group(Zu),the general bacterial infection group(Group II) procalcitonin levels were significantly higher than that ofviral infection group(Group III) and control group(Zu),the difference was statistically significant(P0.05);the positive correlation between bacterial infection group PCTand CRP,and group PCT with no relationship between CRP virus infection.Conclusion The procalcitonin and C reactive protein can be used for clinical diagnosis of infectious diseases,and procalcitonin compared with C reactive protein more in bacterial infection in clinical infection,combined detection of PCT and CRP diseasebetter effect,has great diagnostic value.
Procalcitonin
Clinical Diagnosis
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Procalcitonin (PCT) is a precursor peptide for the hormone calcitonin and is frequently increased in overt sepsis. The aim of this study was to test diagnostic accuracy of procalcitonin among patients with positive systemic inflammatory response syndrome (SIRS) in identifying sepsis. In this cross sectional study, from 563 patients with positive SIRS admitted through the emergency department of a university hospital, we included 120 patients. Procalcitonin was measured semi-quantitatively. Two groups of patients (with and without infection) were defined based on clinical, laboratory and bacteriologic findings throughout the admission course; the serum PCT levels were compared between the two groups. Seventy two (60%) patients were male and 48 (40%) were female, and the mean age was 49.1 ± 20.2 years. Final diagnosis was infection in 71 patients (59.2%) and 49 (40.8%) had non-infectious SIRS. When considering PCT > 0.5 μg/L as the cut-off point, PCT had a sensitivity of 88.7%, a specificity of 77.6%, a positive predictive value of 85.1% and a negative predictive value of 82.6%. S erum level of procalcitonin in infectious group was significantly higher than in non-infectious group ( P < 0.0001) . PCT level was a predictor of mortality in patients with infectious SIRS. ( P = 0.01) In summary, PCT is a useful marker for differentiating sepsis from other cause of SIRS. With change in the cut-off value of PCT in any situation its application can be maximized. Procalcitonin can also be a good marker for predicting outcome in patients with infection.
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Objective To evaluate the value of procalcitonin and CRP as prognostic markers in surgery infections.Methods 72 patients who were treated in our hospital's surgery from 2007 to 2008.Those patents were divided into 3 groups:non-infection,intensive infection and partially infection respectively.Serum procalcitonin and CRP levels were measured in the first 3 days or before using antibiotics.Results procalcitonin and CRP levels were significantly higher than the other two groups(P 0.05),especially the procalcitonin level.Taking procalcitonin≥2 μg/L as the diagnostic standards for intensive infection,its sensitivity and specifity are higher than CRP.Conclusion Compared to CRP,Procalcitonin is a marker for the diagnosis of bacterial infections in surgery,especially for the early diagnosis.
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Objective To explore the change of serum procalcitonin and C reactive protein and assessing their prognostic value in patients with intracranial infection.Methods Fifty-one patients with intracranial infection from January 2009 to December 2012 in our hospital were selected as the study subjects(the study group),and 34 healthy individuals at the same time were selected as the control group.Procalcitonin and C reactive protein in serum were determined.The 51 patients were divided randomly into the cure group,the improved group and the worse/death group.The relationship between procalcitonin,C reactive protein and prognosis were analyzed.Results Compared with the control group,procalcitonin and C reactive protein in serum were significantly increased in the study group(P0.05).Compared with the worse/death group,procalcitonin and C reactive protein in serum significantly reduced in the cure group and the improved group(P0.05).Procalcitonin and C reactive protein in the cure group significantly reduced than that in the improved group(P0.05).Conclusion Serum procalcitonin and C reactive protein level can be used as auxiliary indexes for clinical diagnosis and prognosis of intracranial infection.
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Objective: To investigate the serum procalcitonin(PCT) and C-reactive protein(CRP) in the diagnosis of infectious diseases.Method: A retrospective analysis was designed to explore the relationship of procalcitonin and C-reactive protein levels and Infectious disease.All the cases were confirmed by clinical trials of pathogenic examination in our hospital clinical laboratory.Result: The level of procalcitonin and C-reactive protein in serum is related to the severity of the infection disease.The concentration of procalcitonin between bacterial infection group and normal control group was different statistically significant(P 0.05);the concentration of procalcitonin in the bacterial infection group compared to the original with the viral infection group,the difference was statistically significant(P 0.05);the concentration of procalcitonin in the infection group and normal control group was no significant difference(P 0.05).C-reactive protein compared among the three groups,were statistically significant(P 0.05).Conclusion: Using the serum procalcitonin and C-reactive protein in the detection of clinical infection diagnosis can improve the accuracy of the diagnosis in the infectious diseases.
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Background Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP. Methods This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (≥65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI). Results The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ρ=0.408 with p<0.001; procalcitonin and PSI, ρ=0.293 with p=0.003; procalcitonin and mortality, ρ=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly. Conclusion The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly. Keywords: Community-Acquired Infections; Aged; Pneumonia; Procalcitonin
Procalcitonin
White blood cell
Pneumonia severity index
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In recent years, procalcitonin and C-reactive protein have been used as important indexes in the detection of inflammation. In order to analyze the combined detection of procalcitonin and C-reactive protein in infected patients, 57 subjects in the Clinical Laboratory of Zhengzhou Maternal and Child Health Hospital with a bacterial infection were selected as the observation group. Correspondingly, 57 non-infected subjects were selected for the control group. The procalcitonin and C-reactive protein levels in the included cases were analyzed and compared by extracting peripheral blood. The results showed that the two indexes of C-reactive protein (46.13±8.24 mg/L) and procalcitonin (6.61±3.45 ug/L) of the observation group were significantly higher than those of the control group (P less than 0.05). The positive rates of C-reactive protein (71.93%) and procalcitonin (91.23%) of the observation group were significantly higher than those of the control group (P less than0.05). Within the observation group, the C-reactive protein and procalcitonin levels in the infected patients after 2 and 3 days of treatment, decreased significantly (P less than 0.05). This study indicates that the combined detection of procalcitonin and C-reactive protein in patients with bacterial infections is effective and can be used in clinical settings.
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Objective
To analyze the clinical value of serum procalcitonin in judging the severity of infection.
Methods
83 patients with infection admitted to ICU of our hospital from May 2015 to May 2016 were enrolled in the study. According to the symptoms of septic shock, they were divided into group A (n=40, with septic shock) and group B (n=43, without septic shock). Another 40 patients without infection were selected as the control group at the same time. All groups received the detection of serum procalcitonin. C-reactive protein and white blood cell count were determined.
Results
The levels of serum procalcitonin, C reactive protein, and white blood cell count in group A and group B were higher than those in control group, and those were higher in group A than group B (P<0.05).
Conclusions
The detection of serum procalcitonin is helpful in judging the severity of infection. It can improve the accuracy of the judgment, which is important for the scientific adjustment of treatment to improve the prognosis of patients.
Key words:
Serum procalcitonin; Infection; Condition; Clinical judgment
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White blood cell
Group B
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Objective: Procalcitonin, white blood cell count, neutrophil count, C-reactive protein and mean plate volume are biomarkers that are frequently used in clinics and whose levels increase in infective and inflammatory processes. We aimed to investigate the relationship between procalcitonin and other biomarkers based on normal and abnormal procalcitonin values in critically ill patients admitted to the intensive care units. Material and Methods: A total of 9.867 records of 1.357 patients admitted to different intensive care units were included in the study. Firstly, the correlation between procalcitonin values and other biomarkers was evaluated. Then, a cut-off value for , white blood cell count, neutrophil count, C-reactive protein and mean platelet volume was determined based on normal and abnormal procalcitonin values using ROC analysis. Results: The correlation between procalcitonin and the other inflammatory markers was statistically significant (p˂0.001) for the relationship between all biomarker values and procalcitonin level. A weak positive correlation was found only between the procalcitonin and C-reactive protein level (r=0.272). There was either no correlation between other biomarker values and the procalcitonin level. The results of ROC analysis showed that sensitivity was very low (1-1.3%), although AUC > 0.5, p<0.001, specificity 99.9% and LR + values were high in all tests. Conclusion: Abnormal and normal procalcitonin levels were primarily correlated with C-reactive protein levels in critically ill patients admitted to intensive care units and that identifying a suitable cutoff value for white blood cell count, C-reactive protein, neutrophil count, and mean platelet volume based on abnormal and normal procalcitonin levels would not be useful due to low sensitivity values.
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White blood cell
Absolute neutrophil count
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Objective To evaluate the value of procalcitonin and CRP as prognostic markers in surgery infections.Methods 72 patients who were treated surgically in our hospital from 2007 to 2008.All the patents were divided into 3 groups:non-infection,intensive infection and partially infection respectively.Serum procalcitonin and CRP levels were measured in the first 3 days or before the using of antibiotics.Results Procalcitonin and CRP levels were significantly higher than that of the other two groups(P0.05),especially the procalcitonin level.Taking procalcitonin≥2μg/L as the diagnostic standards for intensive infection,its sensitivity and specifity are higher than CRP.Conclusion Compared to CRP,Procalcitonin is a marker for the diagnosis of bacterial infections in surgery,especially for the early diagnosis.
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