Biomarkers of sepsis: Clinically useful?

Current Opinion in Critical Care

Volumn 11, Issue 5, 2005, Pages 473-480

  Meisner, Michael ^a  

^a Stadtisches Krankenhaus Dresden Neustadt   (Germany)

Author keywords

Biological markers; Multiple organ failure; Sepsis; Syndrome

Indexed keywords

ATRIAL NATRIURETIC FACTOR; BIOLOGICAL MARKER; ENDOTOXIN; INTERLEUKIN 6; LIPOPROTEIN RECEPTOR; PROCALCITONIN;

BLOOD CLOTTING; DISEASE SEVERITY; HUMAN; INFECTION; INFLAMMATION; REVIEW; SEPSIS;

BIOLOGICAL MARKERS; CALCITONIN; HUMANS; INTENSIVE CARE UNITS; INTERLEUKIN-6; PROTEIN PRECURSORS; SEPSIS;

EID: 26944477775     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/01.ccx.0000176694.92883.ce     Document Type: Review

References (63)

1. Dellinger RP, Carlet JM, Masur M, et al. Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock. Crit Care Med 2004; 32:858-872.
2. Marshall JC, Walker PM, Foster DM, et al. Measurement of endotoxin activity in critically ill patients using whole blood neutrophil dependent chemilummescence. Crit Care 2002; 6:342-348.
3. Marshall JC, Foster D, Vincent JL, et al. Diagnostic and prognostic implications of endotoxinemia in criticall illness: Results of the MEDIC study. J Infect Dis 2004; 190:527-534. A new and highly sensitive bioassay for the measurement of endotoxin is evaluated in this study. The assay has a high negative predictive value for diagnosis of sepsis and infection and is approved by the FDA. The positive predictive value is low and severity of the host response is only weak reflected by the assay. Further data are needed to confirm the observed indications and results in various patient populations.
4. Morgenthaler NG, Struck J, et al. Detection of procalcitonin (PCT) in healthy controls and patients with local infection by a sensitive ILMA. Clin Lab 2002; 48:263-270.
5. Harbarth S, Holeckova K, Froidevaux C, et al. Diagnostic value of procalcitonin, interleukin-6 and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001; 164:396-402.
6. Müller B, Becker KL, Schächinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000; 28: 977-983.
7. Castelli GP, Pognani C, Meisner M, et al. Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care 2004; 8:R234-R240. In this study procalcitonin and CRP concentrations in ICU patients were measured. The innovative element of this study is the comparison of both biomarkers at the various levels of organ dysfunction (measured by the SOFA score) in patients with and without infection. This study confirms the results of previous studies about the different properties of procalcitonin and CPR and the dichotomy of both parameters with regard to diagnosis of infection and reflection of the host response.
8. Selberg O, Hecker H, Martin M, et al. Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein complement 3a, and interleukin-6. Crit Care Med 2000; 28:2793-2798.
9. Brunkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R. Procatcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shook. Intensive Care Med 2000; 26(suppl.):S148-S152.
10. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 1999; 3: 45-55.
11. Clech C, Ferriere F, Karoubi P, et al. Diagnostic and prognostic value of procalcitonin in patients with septic shock. Crit Care Med 2004; 32: 1166-1169.
12. Lee YJ, Park CH, Yun JW, Lee YS. Predictive comparisons of procalctionin (PCT) level, arterial ketone body ratio (AKBR), APACHE III score and multiple organ dysfunction score (MODS) in systemic inflammatory response syndrome (SIRS). Yonsei Med J 2004; 45:29-37.
13. Wunder C, Eichelbrönner O, Röwer N. Are IL-6, IL-10 and PCT plasma concentrations reliable for outcome prediction in severe sepsis? A comparison with APACHE III and SAPS II. Inflamm Res 2004; 53:158-163.
14. Simon L, Gauvin F, Amre DK, et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004; 39:206-217. This meta-analysis combines the results of a number of previous studies comparing the diagnostic sensitivity and specificity of procalcitonin and CRP for the differential diagnosis of bacterial and nonbacterial infection.
15. Wiedermann FJ, Kaneider N, Egger P, et al. Migration of human monocytes in response to procalcitonin. Crit Care Med 2002; 30:1112-1117.
16. Linscheid P, Seboek D, Schaer JD, et al. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and macrophage-activated adipocytes. Crit Care Med 2004; 32:1715-1721. A sophisticated analysis of cell-cell interactions indicating for the first time that induction of procalcitonin requires a cross-talk of adherent monocytes and tissue cells. It also indicates, among other studies, that there is a time-dependent reaction of the various participants and a sequential response of and to procalcitonin during the local or systemic immune response.
17. Hoffmann G, Totzke G, Seibel M, et al. In vitro modulation of inducible nitric oxide synthase gene expression and nitric oxide synthesis by procalcitonin. Crit Care Med 2001; 29:112-116.
18. Hoffmann G, Czechowski M, Schloesser M, Schobersberger W. Procalcitonin amplifies inducible nitric oxide synthase gene expression and nitric oxide production in vascular smooth muscle cells. Crit Care Med 2002; 30: 2091-2095.
19. Meisner M, Tschaikowsky K, Hutzler A, et al. Postoperative plasma concentrations of procalcitonin after different types of surgery. Intensive Care Med 1998; 24:680-684.
20. Neely AN, Fowler LA, Kagan RJ, Warden GD. Procalcitonin in pediatric burn patients: an early indicator of sepsis? J Burn Care Rehabil 2004; 25:76-80.
21. O'Connor E, Venkatesh B, Mashongonyika C, et al. Serum procalcitonin and C-reactive protein as markers of sepsis and outcome in patients with neurotrauma and subarachnoidal haemorrhage. Anaesth Intensive Care 2004; 32: 465-470.
22. Korczowski B, Szybist W. Serum procalcitonin and C-reactive protein in children with diarrhoea of various aetiologies. Acta Paediatr 2004; 93:169-173.
23. Scire CA, Caporali R, Perotti C, Montecucco C. Il dosaggio della procalcitonina plasmatica in reumatologia (Plasma concentration in rheumatic diseases). Reumatismo 2003; 55:113-118.
24. Resch B, Gusenleitner W, Müller W. Procalcitonin, interleukin-6, C-reactive protein and leukocyte counts in infants with bronchiolitis. Pediatr Infect Dis J 2003; 22:476.
25. Schwarz S, Bertram M, Schwab S, et al. Serum procalcitonin levels in bacterial and abacterial meningitis. Crit Care Med 2000; 28:1828-1832.
26. Chua AP, Lee KH. Procalcitonin in severe acute respiratory syndrome (SARS). J Infect 2004; 48:303-306.
27. Bugden SA, Coles C, Mills GD. The potential role of procalcitonin in the emergency department management of febrile young adults during a sustained meningococcal epidemic. Emerg Med Australas 2004; 16: 114-119.
28. Carrol ED, Newland P, Thomson APJ, Hart A. Prognostic value of procalcitonin in children with meningococcal sepsis. Crit Care Med 2005; 33: 224-225.
29. Chiwakata BC, Manegold C, Bönicke L, et al. Procalcitonin as a parameter of disease severity and risk of mortality in patients with plasmodium falciparum malaria. J Infect Dis 2001; 183:1161-1164.
30. Boutoille D, Struillou L, El Kouri D, et al. Meningites a examen bacteriologique direct negatif. Presse Med 2004; 33:235-240.
31. Matesanz JL, Fernandez E, Fernandez JM, Viejo G. Plasma procalcitonin and C-reactive protein concentrations in pediatric patient with Epstein-Barr virus infection. Clin Chem 2003; 49:2103-2104.
32. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster randomised, single-blinded intervention trial. The Lancet 2004. This is the first prospective and randomized study demonstrating that the use of antibiotics can be guided by biomarkers of sepsis. Using procalcitonin as a biomarker, both costs and unneccessary treatment with antibiotics can be reduced without negative effects. This is most important; the use of antibiotics (also in out-patients) contributes to the persistance or maintenance of resistant bacterial strains and has various side effects on the normal bacterial colonization of the organism.
33. Steinbach G, Rau B, Debard AL, et al. Multicenter evaluation of a new immunoassay for procalcitonin measurement of the Kryptor System. Clin Chem Lab Med 2004; 42:440-449.
34. Leroy S, Adamsbaum C, Marc E, et al. Procalcitonin as a predictor of vesicoureteral reflux in children with a first febrile urinary tract infection. Pediatrics 2005; 115: (in press)
35. Pecile P, Miorin E, Romanello C, et al. Procalcitonin: a marker of severity of acute pyelonephritis among children. Pediatrics 2004; 114:249-254.
36. Prat C, Dominguez J. Rodrigo C, et al. Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection. Pediatr Infect Dis J 2003; 22:438-442
37. Smolkin V, Koren A, Raz R, et al. Procalcitonin as a marker of acute pyelonephritis in infants and children. Pediatr Nephrol 2002; 17:409-412.
38. Hryniewiecki T, Sitkiewicz D, Rawczynska-Englert I. Role of procalcitonin in diagnosis of uncomplicated infective endocarditis (article in polish). Przeglad Lakarnski 2002; 59:793-795.
39. Kocazeybek B, Kücükoglu S, Öner YA. Procalcitonin and C-reactive protein in infective endocarditis: correlation with etiology and prognosis. Chemotherapy 2003; 49:76-84.
40. Mueller C, Huber P, Laifer G, et al. Procalcitonin and the early diagnosis of infective endocarditis. Circulation 2004; 109:1707-1710.
41. Mueller C, Christ-Crain M, Müller B. What Cardiologist do need to know about procalcitonin. Clin Lab 2005; 51:1-4.
42. Fernandez Lopez F, Cubells CL, Garcia JJ, et al. Emergencies atSSoP. Procalcitonin in pediatric emergency departments for the early diagnosis of invasive bacterial infections in febrile infants: results of a multicenter study and utility of a rapid qualitative test for this marker. Pediatr Infect Dis J 2003; 22:895-903.
43. Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral center. Pediatrics 2003; 112:1054-1060.
44. Oda S, Hirasawa H, Shiga H, et al. Sequential measurement of IL-6 blood levels in patients with systemic inflammatory response syndrome (SIRS/sepsis). Cytokine 2005; 29:169-175.
45. Chiesa C, Pellegrini G, Pandero A, et al. C-reactive protein, interleukin-6, and procalcitonin in the immediate postnatal period: influence of illness severity, risk status, antenatal and perinatal complications, and infection. Clin Chem 2003; 49:60-68.
46. Resch B, Gusenleitner W, Müller WD. Procalcitonin and Interleukin-6 in the diagnosis of early-onset sepsis of the neonate. Acta Paediatr 2003; 92: 243-245.
47. Distefano G, Curreri R, Betta P, et al. Procalcitonin serum levels in perinatal bacterial and fungal infection of preterm infants. Acta Paediatr 2004; 93:216-219.
48. Guibourdenche J, Bedu A, Petzold L, et al. Biochemical markers of neonatal sepsis: value of procalcitonin in the emergency setting. Ann Clin Biochem 2002; 39:130-135.
49. Pavcnik-Arnol M, Hojker S, Derganc M. Lipoprotein-binding protein in critically ill neonates and children with suspected infection: comparison with procalcitonin, interleukin-6 and C-reactive protein. Intensive Care Med 2004; 30:1454-1460.
50. Lorrot M, Moulin F, Coste J, et al. Procalcitonin aux urgences pediatriques. Presse Med 2000; 29:128-134.
51. Han YY, Doughty LA, Kofos D, et al. Procalcitonin is persistency increased among children with poor outcome from bacterial sepsis. Pediatr Crit Care Med 2003; 4:21-25.
52. Casado-Flores J, Blanco-Quiros A, Asensio J, et al. Serum procalcitonin in children with suspected sepsis: a comparison with C-reactive protein and neutrophile count. Pediatr Crit Care Med 2003; 4:190-195.
53. van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM. Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis 2004; 4: 620-630.
54. Bernard GR, Vincent JL, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001; 344: 759-762.
55. Vincent JL, Light B, Wright T, et al. Global ENHANCE results indicate organ function improvement with drotrecogin alfa (activated) in severe sepsis patients. Chest 2003; 124:1035.
56. Dhainaut JF, Shorr AF, Marcias WL, et al. Dynamic evolution of coagulopathy in the first day of severe sepsis: relationship with mortality and organ failure. Crit Care Med 2005; 33:341-348. Markers of the coagulation system are probably early indicators of severe sepsis or septic shock. This is the result of a retrospective analysis on selected markers of the coagulation system from the PROWESS study and an evaluation of their relation to the outcome.
57. Bouchon A, Dietrich J, Colonna M. Inflammatory responses can be triggered by TREM-1, a novel receptor expressed on neutrophils and monocytes. J Immunol 2000; 164:4991-4995.
58. Gibot S, Kolopp-Sarda MN, Bene MC, et al. Plasma level of a triggering receptor expressed on myeloid cells-1: Its diagnostic accuracy in patients with suspected sepsis. Ann Intern Med 2004; 141:9-15. In this study a new marker of infection (sTREM-1) is evaluated in patients with sepsis. sTREM-1 indicated infection with high sensitivity and specificity. The clinical usefulness of this marker, however, must be evaluated in further studies.
59. Gibot S, Pe LR, Bollaert PE, et al. Surface triggering receptor expressed on myeloid cells 1 expression patterns in septic shock. Intensive Care Med 2005; 31:594-597.
60. Nijhuis CSMO, Vellenga E, Daenen SMGJ, et al. Lipopolysaccharide-binding protein a possible diagnostic marker for Gram-negative bacteremia in neutropenic cancer patients. Intensive Care Med 2003; 29:2157-2161.
61. Hartemink KJ, Groeneveld AB, de Groot MC, et al. Alpha-atrial natriuretic peptide, cyclic guanosine monophosphate, and endothelinin plasma as markers of myocardial depression in human septic shock. Crit Care Med 2001; 29:80-87.
62. Morgenthaler NG, Struck J, Christ-Crain M, et al. Pro-atrial natriuretic peptide is a prognostic marker in sepsis, similar to the APACHE II score: an observational study. Crit Care 2005; 9:R37-R45. This is the first report about possible indications for the new marker of mid-pro ANP. In this study, the marker had a high correlation with the outcome in septic patients. The clinical characteristics of this new marker, however, should be analyzed in further studies.
63. Kordek A, Giedrys-Kalemba S, Pawlus B, et al. Umbilical cord blood serum procalcitonin concentration in the diagnosis of early neonatal infection. J Perinatol 2003; 23:148-153.