Should procalcitonin be introduced in the diagnostic criteria for the systemic inflammatory response syndrome and sepsis?
OBJECTIVE
To define whether procalcitonin should be introduced in the diagnostic criteria of sepsis.


METHODS
Procalcitonin was estimated in sera of 105 critically ill patients by an immunochemiluminometric assay. Diagnosis was settled by 3 types of criteria: A, the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) 1992 criteria; B, the ACCP/SCCM criteria and concentrations of procalcitonin above 1.0 ng/mL as indicative of SIRS/sepsis; and C, the ACCP/SCCM criteria and concentrations of procalcitonin 0.5 to 1.1 ng/mL for SIRS and above 1.1 ng/mL for sepsis.


RESULTS
Criteria A identified 50.5% of patients with SIRS, 18.1% with sepsis, 0.9% with severe sepsis and 22.9% with septic shock; respective diagnosis by criteria B were 26.7%, 9.5%, 10.5% and 25.7%; and respective diagnosis by criteria C were 19.0%, 25.7%, 9.5%, and 25.7%. Sensitivity of concentrations between 0.5 ng/mL and 1.1 ng/mL was 25.6% for Systemic Inflammatory Response Syndrome (SIRS); and above 1.1 ng/mL 92.8% for sepsis. Sepsis-related death was associated with elevated procalcitonin upon presentation of a clinical syndrome.


CONCLUSIONS
Despite the limited diagnostic value of procalcitonin for SIRS, concentrations of procalcitonin above 1.1 ng/mL are highly indicative for sepsis without, however, excluding the presence of SIRS.
Fourth Department of Internal Medicine, University of Athens School of Medicine, Athens Korgialenion Benakion Hospital, Greece. giamarel@internet.gr
Evangelos J
EJ
Giamarellos-Bourboulis
Panagiota
P
Giannopoulou
Paraskevi
P
Grecka
Dionyssios
D
Voros
Konstantinos
K
Mandragos
Helen
H
Giamarellou
D000328:Adult; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000145:classification / Q000175:diagnosis*
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide