title: Discriminative value of inflammatory biomarkers for suspected sepsis.
abstract: BACKGROUND
  Circulating biomarkers can facilitate sepsis diagnosis, enabling early management and improved outcomes. Procalcitonin (PCT) has been suggested to have superior diagnostic utility compared to other biomarkers.
  
  
  OBJECTIVE
  To define the discriminative value of PCT, interleukin-6 (IL-6), and C-reactive protein (CRP) for suspected sepsis.
  
  
  METHODS
  PCT, CRP, and IL-6 were correlated with infection likelihood, sepsis severity, and septicemia. Multivariable models were constructed for length-of-stay and discharge to a higher level of care.
  
  
  RESULTS
  Of 336 enrolled subjects, 60% had definite infection, 13% possible infection, and 27% no infection. Of those with infection, 202 presented with sepsis, 28 with severe sepsis, and 17 with septic shock. Overall, 21% of subjects were septicemic. PCT, IL6, and CRP levels were higher in septicemia (median PCT 2.3 vs. 0.2 ng/mL; IL-6 178 vs. 72 pg/mL; CRP 106 vs. 62 mg/dL; p < 0.001). Biomarker concentrations increased with likelihood of infection and sepsis severity. Using receiver operating characteristic analysis, PCT best predicted septicemia (0.78 vs. IL-6 0.70 and CRP 0.67), but CRP better identified clinical infection (0.75 vs. PCT 0.71 and IL-6 0.69). A PCT cutoff of 0.5 ng/mL had 72.6% sensitivity and 69.5% specificity for bacteremia, as well as 40.7% sensitivity and 87.2% specificity for diagnosing infection. A combined clinical-biomarker model revealed that CRP was marginally associated with length of stay (p = 0.015), but no biomarker independently predicted discharge to a higher level of care.
  
  
  CONCLUSIONS
  In adult emergency department patients with suspected sepsis, PCT, IL-6, and CRP highly correlate with several infection parameters, but are inadequately discriminating to be used independently as diagnostic tools.
authors: Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
authors: Ephraim L
authors: EL
authors: Tsalik
authors: L Brett
authors: LB
authors: Jaggers
authors: Seth W
authors: SW
authors: Glickman
authors: Raymond J
authors: RJ
authors: Langley
authors: Jennifer C
authors: JC
authors: van Velkinburgh
authors: Lawrence P
authors: LP
authors: Park
authors: Vance G
authors: VG
authors: Fowler
authors: Charles B
authors: CB
authors: Cairns
authors: Stephen F
authors: SF
authors: Kingsmore
authors: Christopher W
authors: CW
authors: Woods
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood / Q000175:diagnosis; D015850:Interleukin-6 / Q000097:blood*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010351:Patient Discharge; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D015850:Interleukin-6; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide