1Department of Anesthesiology, Intensive Care, and Pain Management, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
Prediction of pathogen's species among sepsis and septic shock patients within hours would be helpful in accelerating proper treatment. A biomarker like PCT could beapotential method to decrease the time of identification & prevent antibiotic resistency.
To assess the usefulness of procalcitonin (PCT) to predict blood culture (BC) results.
The authors retrospectively analyzed data of sepsis and septic shock patients in ICU Dr. Wahidin Sudirohusodo Hospital from January 2015 to June 2016 with BC and PCT draw simultaneously in ≤ 24 hours. Kruskal-Wallis analysis was used for multi group comparisons. The diagnostic performance of PCT to predict gram-negative bacteremia was tested using a ROC curve.
A total of 90 diagnostic episodes met the inclusion criteria. A significantly higher value of PCT was found in gram-negative BC (77.3 ng/mL, 0.43–200.01) than that in negative BC (50.15 ng/ml, 0.45–200.01) gram-positive BC (28.9 ng/mL, 0.75–200.01) or fungal BC (31.5 ng/mL, 30.33–32.62).
For gram-negative bacteremia identification in sepsiscut-off value ≥ 6.8ng/mL for PCT yielded sensitivity 77.3%, specificity58.6%, PPV 58.6%, NPV 77.2% and AUC 0.655. In septic shock cut off value ≥50, 82 ng/ml, Sensitivity 82, 4%, Specificity 63, 6%, PPV 63, 6%, NPV 82, 3%, AUC 0, 713.
The diagnostic accuracy of PCT to predict gramnegative bacteremia is sufficient to good, it may be useful for differentiating gram-negative from gram-positive and fungal bloodstream infection with a significantly higher PCT level indicating gram-negative bacteremia. The high NPV may represent a useful tool to exclude the presence of gramnegative bacteremia to guide the empirical antimicrobial therapy
Procalcitonin; Sepsis; Septic shock; Blood Culture; Gram-negative bacteremia
