Serum Procalcitonin Levels Distinguish Gram-negative Bacterial Sepsis from Gram-positive Bacterial and Fungal Sepsis

Overview

Journal J Res Med Sci

Specialty General Medicine

Date 2016 Dec 2

PMID 27904585

Citations 32

Authors

Shuhua Li

Hengmo Rong

Qinliang Guo

Yifei Chen

Guqing Zhang

Jiong Yang

Affiliations

Soon will be listed here.

Abstract

Background: Serum procalcitonin (PCT) levels differ in patients with bacterial or fungal infections and are significantly elevated in patients with Gram-negative bacteremia. We evaluated the diagnostic accuracy of different inflammatory markers to discriminate sepsis caused by different pathogens.

Materials And Methods: We included 328 episodes of bacteremia from 292 patients with sepsis and 31 patients with suspected sepsis in this study. Medical records of patients who had bacteremia caused by Gram-negative bacteria (Gram-negative), Gram-positive bacteria (Gram-positive) or fungi were reviewed, and information about PCT and other inflammatory markers was recorded. The diagnostic performance of inflammatory markers was calculated via receiver operating characteristic (ROC) curves.

Results: Serum PCT levels in Gram-negative, Gram-positive, and fungal sepsis were 7.47 (interquartile range [IQR]: 1.09-41.26) ng/mL, 0.48 (IQR: 0.15-2.16) ng/mL, and 0.60 (IQR: 0.14-2.06) ng/mL, respectively ( < 0.001). ROC analysis revealed an optimal cut-off value of 2.44 ng/mL for PCT in discriminating Gram-negative sepsis from Gram-positive sepsis, which yielded a sensitivity of 68.4% and a specificity of 77.1%. An optimal cut-off value of 3.11 ng/mL for PCT in discriminating Gram-negative sepsis from fungal sepsis, led to a sensitivity of 63.9% and specificity of 93.3%. Neither PCT nor other inflammatory markers could be used to distinguish between Gram-positive and fungal sepsis.

Conclusion: Serum PCT levels were significantly higher in patients with Gram-negative sepsis than in those with Gram-positive or fungal sepsis. PCT is a potential sensitive biomarker for distinguishing Gram-negative sepsis from Gram-positive and fungal sepsis.

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