title: Prognostic and diagnostic value of eosinopenia, C-reactive protein, procalcitonin, and circulating cell-free DNA in critically ill patients admitted with suspicion of sepsis.
abstract: BACKGROUND
  The aims of this study were to assess the reliability of circulating cell-free DNA (cf-DNA) concentrations, compared with C-reactive protein (CRP), procalcitonin (PCT) and eosinophil count, in the diagnosis of infections in patients with systemic inflammatory response syndrome (SIRS) and their prognostic values in a cohort of critically ill patients.
  
  
  METHODS
  We conducted a prospective cohort study in a medical-surgical intensive care unit of a university hospital. Eosinophil count and concentrations of cf-DNA, CRP, and PCT were measured in patients who fulfilled SIRS criteria at admission to the intensive care unit (ICU) and a second determination 24 hours later. DNA levels were determined by a PCR method using primers for the human beta-haemoglobin gene.
  
  
  RESULTS
  One hundred and sixty consecutive patients were included: 43 SIRS without sepsis and 117 with sepsis. Levels of CRP and PCT, but not cf-DNA or eosinophil count, were significantly higher in patients with sepsis than in SIRS-no sepsis group on days 1 and 2. PCT on day 1 achieves the best area under the curve (AUC) for sepsis diagnosis (0.87; 95% confidence interval = 0.81-0.94). Levels of cf-DNA do not predict outcome and the accuracy of these biomarkers for mortality prediction was lower than that shown by APACHE II score. PCT decreases significantly from day 1 to day 2 in survivors in the entire cohort and in patients with sepsis without significant changes in the other biomarkers.
  
  
  CONCLUSIONS
  Our data do not support the clinical utility of cf-DNA measurement in critical care patients with SIRS. PCT is of value especially for infection identification in patients with SIRS at admission to the ICU.
authors.forename: Jose
authors.initials: J
authors.lastname: Garnacho-Montero
authors.forename: María J
authors.initials: MJ
authors.lastname: Huici-Moreno
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez-Pizarraya
authors.forename: Isabel
authors.initials: I
authors.lastname: López
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Márquez-Vácaro
authors.forename: Hada
authors.initials: H
authors.lastname: Macher
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Guerrero
authors.forename: Antonio
authors.initials: A
authors.lastname: Puppo-Moreno
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004247:DNA / Q000097:blood; D003937:Diagnosis, Differential; D004804:Eosinophils; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications* / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D004247:DNA; D015740:Calcitonin Gene-Related Peptide