title: Quantitative data from the SeptiFast real-time PCR is associated with disease severity in patients with sepsis.
abstract: BACKGROUND
  The commercial test, SeptiFast, is designed to detect DNA from bacterial and fungal pathogens in whole blood. The method has been found to be specific with a high rule-in value for the early detection of septic patients. The software automatically provides information about the identified pathogen, without quantification of the pathogen. However, it is possible to manually derive Crossing point (Cp) values, i.e. the PCR cycle at which DNA is significantly amplified. The aim of this study was to find out whether Cp values correlate to disease severity.
  
  
  METHODS
  We used a study cohort of patients with positive results from SeptiFast tests for bacteria from a recent study which included patients with suspected sepsis in the Emergency department. Cp values were compared with disease severity, classified as severe sepsis/septic shock or non-severe sepsis, according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine.
  
  
  RESULTS
  Ninety-four patients were included. The prevalence of severe sepsis/septic shock in the study was 29%. SeptiFast positive tests from patients with severe sepsis/septic shock had significantly lower Cp values compared with those from patients with non-severe sepsis, median 16.9 (range: 7.3-24.3) versus 20.9 (range: 8.5-25.0), p < 0.001. Positive predictive values from the SeptiFast test for identifying severe sepsis/septic shock were 34% at Cp cut-off <25.0, 35% at Cp cut-off <22.5, 50% at Cp cut-off <20.0, and 73% at Cp cut-off <17.5. Patients with a positive Septifast test with a Cp value <17.5 had significantly more severe sepsis/septic shock (73% versus 15%, p < 0.001), were more often admitted to the Intensive Care Unit (23% versus 4%, p = 0.016), had positive blood culture (BC) more frequently (100% versus 32%, p < 0.001) and had longer hospital stays (median 19.5 [range: 4-78] days versus 5 [range: 0-75] days, p < 0.001) compared with those with a Cp value >17.5.
  
  
  CONCLUSIONS
  Our results suggest that introducing quantitative data to the SeptiFast test could be of value in assessing sepsis severity. Moreover, such data might also be useful in predicting a positive BC result.
authors.affiliation: Department of Infectious Diseases, Örebro University Hospital, S-701 85 Örebro, Sweden. ingrid.ziegler@orebroll.se.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ziegler
authors.forename: Per
authors.initials: P
authors.lastname: Josefson
authors.forename: Per
authors.initials: P
authors.lastname: Olcén
authors.forename: Paula
authors.initials: P
authors.lastname: Mölling
authors.forename: Kristoffer
authors.initials: K
authors.lastname: Strålin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000235:genetics; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing / Q000379:methods*; D060888:Real-Time Polymerase Chain Reaction / Q000379:methods*; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology* / Q000503:physiopathology; D055815:Young Adult