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Tytuł:
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Performance enhancement of procalcitonin by high-sensitivity C-reactive protein at the optimal cutoff in predicting bacteremia in emergency department adult patients.
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Autorzy:
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Kok VC; a Department of Internal Medicine , Kuang Tien General Hospital , Taichung , Taiwan.; b Department of Bioinformatics and Medical Engineering , Asia University , Taichung , Taiwan.
Lin CT; c Department of Laboratory Medicine , China Medical University Hospital, China Medical University , Taichung , Taiwan.
Yeh CB; d Department of Emergency Medicine, School of Medicine , Chung Shan Medical University , Taichung , Taiwan.; e Department of Emergency Medicine , Chung Shan Medical University Hospital , Taichung , Taiwan.
Yang CC; f Division of Infectious Diseases, Department of Internal Medicine , Kuang Tien General Hospital , Taichung , Taiwan.
Horng JT; g Department of Computer Science and Information Engineering , National Central University , Taoyuan , Taiwan.
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Źródło:
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Scandinavian journal of clinical and laboratory investigation [Scand J Clin Lab Invest] 2019 Feb - Apr; Vol. 79 (1-2), pp. 25-31. Date of Electronic Publication: 2019 Jan 10.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: London : Informa Healthcare
Original Publication: Oslo, Medisinsk Fysiologisk Forenings Forlag.
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MeSH Terms:
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Bacteremia/*diagnosis
C-Reactive Protein/*metabolism
Gram-Negative Bacterial Infections/*diagnosis
Gram-Positive Bacterial Infections/*diagnosis
Lactic Acid/*blood
Procalcitonin/*blood
Adult ; Aged ; Bacteremia/blood ; Bacteremia/microbiology ; Bacteremia/pathology ; Biomarkers/blood ; Emergency Service, Hospital ; Female ; Gram-Negative Bacterial Infections/blood ; Gram-Negative Bacterial Infections/microbiology ; Gram-Negative Bacterial Infections/pathology ; Gram-Positive Bacterial Infections/blood ; Gram-Positive Bacterial Infections/microbiology ; Gram-Positive Bacterial Infections/pathology ; Humans ; Male ; Middle Aged ; Odds Ratio ; ROC Curve ; Retrospective Studies
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Contributed Indexing:
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Keywords: Procalcitonin; bacteremia; diagnostic performance; emergency department; high-sensitivity C-reactive protein; lactate
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Substance Nomenclature:
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0 (Biomarkers)
0 (Procalcitonin)
33X04XA5AT (Lactic Acid)
9007-41-4 (C-Reactive Protein)
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Entry Date(s):
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Date Created: 20190111 Date Completed: 20190826 Latest Revision: 20190826
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Update Code:
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20240104
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DOI:
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10.1080/00365513.2018.1550808
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PMID:
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30628465
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Pathogenic bacteremia portends a high mortality risk in adult patients admitted to an Emergency Department (ED). This study aims to investigate the effect of adding high-sensitivity C-reactive protein (hs-CRP) to procalcitonin (PCT) and lactate in predicting bacteremia, Gram-negative (GNB) and Gram-positive bacteremia (GPB), using the optimal cutoff derived from the receiver operating characteristics analysis. We evaluated the diagnostic measures, including the positive-test likelihood (LR+), the negative-test likelihood (LR-), and the diagnostic odds ratio (DOR) using a single-center retrospective analysis design. This Standards for Reporting Diagnostic-compliant study comprised 886 consecutive adults who were admitted to the ED in 2010; to this cohort, a 22.2% prevalence of true bacteremia was subsequently confirmed. At the cutoff of 3.9 μg/L, PCT had a DOR of 5.3 (95% confidence interval [CI]: 3.76-7.61) and LR + of 2.8 (95% CI: 2.3-3.4) in predicting overall bacteremia. Elevated PCT and lactate (cutoff at 2 mmol/L), increased the DOR and LR + to 6.3 (95% CI: 4.27-9.29) and 4.0 (95% CI: 3.1-5.2). The DOR and LR + were further improved to 7.1 (95% CI: 4.2-11.95) and 5.6 (95% CI: 3.7-8.6), respectively, when hs-CRP at the cutoff of 1238 nmol/L was added to PCT plus lactate. High-sensitivity CRP at the cutoff of 1,255 nmol/L can enhance the discriminative power raising DOR and LR + values for GPB. The elevation of hs-CRP at the optimal cutoff might improve the diagnostic performance to predict unspecified bacteremia and GPB, but not GNB.
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