title: Procalcitonin, C-reactive protein and serum lactate dehydrogenase in the diagnosis of bacterial sepsis, SIRS and systemic candidiasis.
abstract: The aim of this study was to evaluate procalcitonin (PCT), C-reactive protein (CRP), platelet count (PLT) and serum lactate dehydrogenase (LDH) as early markers for diagnosis of SIRS, bacterial sepsis and systemic candidiasis in intensive care unit (ICU) patients. Based on blood culture results, the patients were divided into a sepsis group (70 patients), a SIRS group (42 patients) and a systemic candidiasis group (33 patients). PCT, CRP, LDH and PLT levels were measured on day 0 and on day 2 from the sepsis symptom onset. PCT levels were higher in Gram negative sepsis than those in Gram positive sepsis, although the P value between the two subgroups is not significant (P=0.095). Bacterial sepsis group had higher PCT and CRP levels compared with the systemic candidiasis group, whereas PLT and LDH levels showed similar levels in these two subgroups. The AUC for PCT (AUC: 0.892, P <0.001) was larger than for CRP (AUC: 0.738, P <0.001). The best cut-off values for PCT and CRP were 0.99 ng/mL and 76.2 mg/L, respectively. Diagnostic sensitivity and specificity for PCT were 84.3% and 81.8% whereas CRP showed a sensitivity of 77.2% and a specificity of 63.6%. However, PCT was unable to discriminate between SIRS and systemic candidiasis groups (P=0.093 N.S.). In conclusion, PCT can be used as a preliminary marker in the event of clinical suspicion of systemic candidiasis; however, low PCT levels (<0.99 ng/mL) necessarily require the use of other specific markers of candidaemia to confirm the diagnosis, due to great uniformity of PCT levels in systemic candidiasis and SIRS groups.
authors.affiliation: Laboratory of Microbiology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Miglietta
authors.affiliation: Laboratory of Microbiology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Maria Letizia
authors.initials: ML
authors.lastname: Faneschi
authors.affiliation: Laboratory of Clinical Pathology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Giambattista
authors.initials: G
authors.lastname: Lobreglio
authors.affiliation: Laboratory of Microbiology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Palumbo
authors.affiliation: Laboratory of Microbiology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Rizzo
authors.affiliation: Anesthesiology Unit, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cucurachi
authors.affiliation: Infectious Diseases Unit , Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Gerolamo
authors.initials: G
authors.lastname: Portaccio
authors.affiliation: Laboratory of Clinical Pathology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guerra
authors.affiliation: Laboratory of Clinical Pathology, Vito Fazzi Regional Hospital, Lecce, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Pizzolante
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000097:blood*; D002177:Candidiasis / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D002116:Calcitonin; D002097:C-Reactive Protein; D007770:L-Lactate Dehydrogenase