title: Diagnostic accuracy and clinical relevance of an inflammatory biomarker panel for sepsis in adult critically ill patients.
abstract: The objective of this study was to assess the diagnostic accuracy of C-reactive protein (CRP), procalcitonin (PCT), and cellular immune markers levels in sepsis. This was a prospective observational study in adult intensive care unit (ICU) patients, between 2012 and 2014. The 8-color flow cytometric biomarker panel included CD64, CD163, and HLA-DR. Index test results were compared with sepsis, using receiver operating characteristic curve analyses. Multivariate logistic regression assessed the relationship of sets of markers with the probability of sepsis. Of 219 enrolled patients, 120 had sepsis. C-statistic was the highest for CRP (0.86) followed by neutrophil CD64 expression (0.83), procalcitonin (0.82), and Acute Physiology and Chronic Health Evaluation (APACHE) IV (0.72). After adjustment for APACHE IV, the combination of CRP, PCT, and neutrophil CD64 measure remained a significant predictor of sepsis with an excellent AUC (0.90). In a targeted ICU population at increased risk of sepsis, CRP, PCT, and neutrophil CD64 combined improve the diagnostic accuracy of sepsis.
authors.affiliation: Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: bauer.philippe@mayo.edu.
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Bauer
authors.affiliation: Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Kashyap.Rahul@mayo.edu.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kashyap
authors.affiliation: Cellular and Molecular Immunology Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: League.Stacy@mayo.edu.
authors.forename: Stacy C
authors.initials: SC
authors.lastname: League
authors.affiliation: Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Park.John@mayo.edu.
authors.forename: John G
authors.initials: JG
authors.lastname: Park
authors.affiliation: Cellular and Molecular Immunology Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: Block.Darci@mayo.edu.
authors.forename: Darci R
authors.initials: DR
authors.lastname: Block
authors.affiliation: Cellular and Molecular Immunology Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: Baumann.Nikola@mayo.edu.
authors.forename: Nikola A
authors.initials: NA
authors.lastname: Baumann
authors.affiliation: Cellular and Molecular Immunology Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: AlgecirasSchimnich.Alicia@mayo.edu.
authors.forename: Alicia
authors.initials: A
authors.lastname: Algeciras-Schimnich
authors.affiliation: Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Electronic address: Jenkins.Sarah@mayo.edu.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Jenkins
authors.affiliation: Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. Electronic address: Smith.Carin@mayo.edu.
authors.forename: Carin Y
authors.initials: CY
authors.lastname: Smith
authors.affiliation: Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN. Electronic address: Gajic.Ognjen@mayo.edu.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Cellular and Molecular Immunology Laboratory, Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN. Electronic address: Abraham.Roshini@mayo.edu.
authors.forename: Roshini S
authors.initials: RS
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D001774:Blood Chemical Analysis; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D016638:Critical Illness; D004311:Double-Blind Method; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007962:Leukocytes / Q000737:chemistry; D008297:Male; D008565:Membrane Proteins / Q000032:analysis; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood; D012372:ROC Curve; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D008565:Membrane Proteins; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: C-reactive protein; CD64; Procalcitonin; Sensitivity and specificity; Sepsis; Study of diagnostic accuracy