A latent class approach for sepsis diagnosis supports use of procalcitonin in the emergency room for diagnosis of severe sepsis

BMC Anesthesiology

Research Article

Gisela D De La Rosa¹  Sigifredo Ospina²  Carlos I Gomez³  Adriana I Henao⁴  Susana C Osorno⁴  Marta L Valencia⁴  Clara M Arango⁵  Fabián A Jaimes⁶  Alex Garcia⁷ 

[1] Department of Critical Care, Hospital Pablo Tobón Uribe, Medellín, Colombia;Department of Epidemiology, Hospital Universitario San Vicente de Paul, Medellín, Colombia;Department of Internal Medicine, Hospital Pablo Tobón Uribe, Medellin, Colombia;Department of Internal Medicine, School of Medicine, Universidad de Antioquia, 1226, Medellín, AA, Colombia;Department of Internal Medicine, School of Medicine, Universidad de Antioquia, 1226, Medellín, AA, Colombia;Department of Internal Medicine, Hospital Pablo Tobón Uribe, Medellin, Colombia;Department of Internal Medicine, School of Medicine, Universidad de Antioquia, 1226, Medellín, AA, Colombia;Research Unit, Hospital Pablo Tobón Uribe, Medellín, Colombia;Grupo Académico de Epidemiología Clínica (GRAEPIC), Universidad de Antioquia, Medellín, Colombia;Intensive Care Unit, Clínica Universitaria Bolivariana, Medellín, Colombia;

关键词: Sensitivity;    Specificity;    Sepsis;    Latent class;    C-reactive protein;    Procalcitonin;    D-dimer;   

DOI  :  10.1186/1471-2253-13-23

 received in 2013-03-12, accepted in 2013-09-12,  发布年份 2013

来源: Springer

【 摘 要 】

BackgroundGiven the acknowledged problems in sepsis diagnosis, we use a novel way with the application of the latent class analysis (LCA) to determine the operative characteristics of C-reactive protein (CRP), D-dimer (DD) and Procalcitonin (PCT) as diagnostic tests for sepsis in patients admitted to hospital care with a presumptive infection.MethodsCross-sectional study to determine the diagnostic accuracy of three biological markers against the gold standard of clinical definition of sepsis provided by an expert committee, and also against the likelihood of sepsis according to LCA. Patients were recruited in the emergency room within 24 hours of hospitalization and were follow-up daily until discharge.ResultsAmong 765 patients, the expert committee classified 505 patients (66%) with sepsis, 112 (15%) with infection but without sepsis and 148 (19%) without infection. The best cut-offs points for CRP, DD, and PCT were 7.8 mg/dl, 1616 ng/ml and 0.3 ng/ml, respectively; but, neither sensitivity nor specificity reach 70% for any biomarker. The LCA analysis with the same three tests identified a “cluster” of 187 patients with several characteristics suggesting a more severe condition as well as better microbiological confirmation. Assuming this subset of patients as the new prevalence of sepsis, the ROC curve analysis identified new cut-off points for the tests and suggesting a better discriminatory ability for PCT with a value of 2 ng/ml.ConclusionsUnder a “classical” definition of sepsis three typical biomarkers (CRP, PCT and DD) are not capable enough to differentiate septic from non-septic patients in the ER. However, a higher level of PCT discriminates a selected group of patients with severe sepsis.

【 授权许可】

CC BY   
© Jaimes et al.; licensee BioMed Central Ltd. 2013