Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

BMC Infectious Diseases

Élie Azoulay¹  Benoît Schlemmer¹  Nadir Adaoui³  Stéphane Legriel¹  Jean-Paul Feugeas³  Isaline Coquet¹  Michael Darmon²  Nicolas Bele¹ 

[1]AP-HP, Hôpital Saint-Louis, Medical ICU Department, 75010 Paris, France

[2] University Paris-7 Paris-Diderot, UFR de Médecine, 75010 Paris, France

[3]Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Avenue Albert Raymond, Saint-Etienne, 42270, France

[4]AP-HP, Hôpital Saint-Louis, Biochemistry Department, 75010 Paris, France

[5] University Paris-7 Paris-Diderot, UFR de Médecine, 75010 Paris, France

关键词: Sensitivity and Specificity.;    bone marrow transplantation;    immune deficiency;    HIV infection;    neutropenia;    bacterial infection;   

Others  :  1175625
DOI  :  10.1186/1471-2334-11-224

 received in 2010-10-12, accepted in 2011-08-24,  发布年份 2011

【 摘 要 】

Background

Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients.

Methods

This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis.

Results

We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P < 0.0001). PCT concentrations on day 1 that were > 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006). PCT concentrations were not significantly correlated with hospital mortality.

Conclusion

Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

【 授权许可】

   
2011 Bele et al; licensee BioMed Central Ltd.

【 图 表 】

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