Diagnostic and prognostic utilities of multimarkers approach using procalcitonin, B-type natriuretic peptide, and neutrophil gelatinase-associated lipocalin in critically ill patients with suspected sepsis.
BACKGROUND
We investigated the diagnostic and prognostic utilities of procalcitonin (PCT), B-type natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically or based on PCT concentrations.


METHODS
PCT, BNP, and NGAL concentrations were measured in 340 patients and were followed up in 109 patients. All studied biomarkers were analyzed according to the diagnosis, severity, and clinical outcomes of sepsis.


RESULTS
Clinical sepsis and PCT-based sepsis showed poor agreement (kappa = 0.2475). BNP and NGAL showed significant differences between the two groups of PCT-based sepsis (P = 0.0001 and P < 0.0001), although there was no difference between the two groups of clinical sepsis. BNP and NGAL were significantly different according to the PCT staging and sepsis-related organ failure assessment subscores (P < 0.0001, all). BNP and PCT concentrations were significantly higher in the non-survivors than in the survivors (P = 0.0002) and showed an equal ability to predict in-hospital mortality (P = 0.0001). In the survivors, the follow-up NGAL and PCT concentrations were significantly lower than the initial values (148.7 ng/mL vs. 214.5 ng/mL, P < 0.0001; 0.61 ng/mL vs. 5.56 ng/mL, P = 0.0012).


CONCLUSIONS
PCT-based sepsis diagnosis seems to be more reliable and discriminating than clinical sepsis diagnosis. Multimarker approach using PCT, BNP, and NGAL would be useful for the diagnosis, staging, and prognosis prediction in the critically ill patients with suspected sepsis.
Mina
M
Hur
Hanah
H
Kim
Seungho
S
Lee
Flavia
F
Cristofano
Laura
L
Magrini
Rossella
R
Marino
Chiara Serena
CS
Gori
Cristina
C
Bongiovanni
Benedetta
B
Zancla
Patrizia
P
Cardelli
Department of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology 'Sapienza' University of Rome, Emergency Medicine, Sant' Andrea Hospital, Rome, Italy. salvatore.disomma@uniroma1.it.
Salvatore
S
Di Somma
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D054834:Lipocalins / Q000097:blood; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D018805:Sepsis / Q000097:blood / Q000175:diagnosis*
D015415:Biomarkers; C000606589:CALCA protein, human; D054834:Lipocalins; D011498:Protein Precursors; D020097:Natriuretic Peptide, Brain; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide