title: A prediction model for real-time PCR results in blood samples from febrile patients with suspected sepsis.
abstract: Sepsis, a systemic, deleterious host response to infection that leads to organ dysfunction, is a potentially deadly condition needing prompt identification of the causative organisms and early appropriate antimicrobial therapy. Among non-culture-based diagnostic methods, SeptiFast (SF) can be employed to speed bacterial and fungal DNA detection, but it suffers from poor sensitivity and high cost. The aim of the present study, performed in 285 febrile patients, was to develop a prediction model to restrict the SF assay to clinical cases with a high probability of positive SF results. The prevalence of SF results positive for a pathogen was 17.2 %. Independent predictors of positive results were: blood sampling within 12 h after the onset of fever [odds ratio (OR) 20.03; 95 % confidence interval (CI) 6.87-58.38; P<0.0001]; ≥0.5 ng serum procalcitonin (PCT) ml(-1) (OR 18.52; 95 % CI 5.12-67.02; P<0.0001); body temperature ≥38 °C (OR 3.78; 95 % CI 1.39-10.25; P = 0.009); ≤3 g serum albumin dl(-1) (OR 3.40; 95 % CI 1.27-9.08; P = 0.014); and ≥13 000 white blood cells mm(-3) (OR 2.75; 95 % CI 1.09-7.69; P = 0.05). The model showed good calibration (Hosmer-Lemeshow chi-squared 1.61; P = 0.978). Area under the receiving operating characteristic curve was 0.944 (95 % CI 0.914-0.973; P<0.0001). These results suggest that a prediction model based on PCT and a few other routinely available laboratory and clinical variables could be of help in selecting patients with a high probability of SF-positive results.
authors: Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors: Christian
authors: C
authors: Leli
authors: Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors: Angela
authors: A
authors: Cardaccia
authors: Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors: Francesco
authors: F
authors: D'Alò
authors: Department of Clinical Chemistry and Haematology, Santa Maria della Misericordia Hospital, Perugia, Italy.
authors: Carla
authors: C
authors: Ferri
authors: Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors: Francesco
authors: F
authors: Bistoni
authors: Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, University of Perugia, Perugia, Italy.
authors: Antonella
authors: A
authors: Mencacci
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods*; D012372:ROC Curve; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D013048:Specimen Handling / Q000379:methods