title: Procalcitonin as a biomarker for early sepsis in the emergency department.
abstract: OBJECTIVE
  In the critical care setting, increasing levels of midregional proadrenomedullin (MRproADM), midregional proatrial natriuretic peptide (MRproANP), procalcitonin (PCT), copeptin, and proendothelin-1 (proET-1) have been shown to be correlated with increasing severity of sepsis. The objective of this study was to investigate the utility of sepsis biomarkers in an Emergency Department (ED) population.
  
  
  METHODS
  Through a prospective, observational pilot study, we investigated the utility of MRproADM, MRproANP, PCT, copeptin, and proET-1 in predicting a diagnosis of early sepsis in patients presenting to the ED for suspected infection. Data were analyzed using nonparametric Mann-Whitney U-tests, χ²-tests, and receiver operating characteristic curves.
  
  
  RESULTS
  Of the 66 patients enrolled in this study, 37 (56.1%) were men, with a median age of 58 years [interquartile range (IQR) 39-69 years], and 19 (28.8%) had a final diagnosis of early sepsis. A higher percentage of sepsis patients compared with no-sepsis patients met systemic inflammatory response syndrome (SIRS) criteria at initial presentation (85.7 vs. 41.3%; P<0.0001) and were admitted to the hospital (84.2 vs. 55.6%; P=0.02). PCT was higher in sepsis patients [median 0.32 ng/ml (IQR 0.19-1.17) vs. 0.18 ng/ml (IQR 0.07-0.54); P=0.04]. There were no differences between groups for MRproADM, MRproANP, copeptin, or proET-1 (P≥0.53). The C-statistic was maximized with the combination of SIRS criteria and PCT levels (0.92±0.05), which was better than PCT alone (0.67±0.08; P=0.005) or SIRS alone (0.75±0.07; P=0.04).
  
  
  CONCLUSIONS
  In this pilot study, we found that the combination of SIRS criteria and PCT levels is useful for the early detection of sepsis in ED patients with suspected infection. Larger studies investigating use of PCT are necessary.
authors.affiliation: aEmergency Services Institute bDepartment of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland cDepartment of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio dDepartment of General Surgery, The Johns Hopkins Hospital eDepartment of Pathology, Clinical Chemistry Laboratories, University of Maryland Medical Center, Baltimore, Maryland fSection of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Caitlin W
authors.initials: CW
authors.lastname: Hicks
authors.forename: Rakesh S
authors.initials: RS
authors.lastname: Engineer
authors.forename: Justin L
authors.initials: JL
authors.lastname: Benoit
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Dasarathy
authors.forename: Robert H
authors.initials: RH
authors.lastname: Christenson
authors.forename: William F
authors.initials: WF
authors.lastname: Peacock
mesh_terms: D053607:Adrenomedullin / Q000097:blood; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004636:Emergency Service, Hospital; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D006020:Glycopeptides / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D019332:Endothelin-1; D006020:Glycopeptides; D011498:Protein Precursors; C048197:copeptins; C552580:midregional pro-atrial natriuretic peptide, human; C088633:proadrenomedullin; C093240:proendothelin 1; D053607:Adrenomedullin; D009320:Atrial Natriuretic Factor; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide