Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients. A prospective observational study

The EProK study group

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Purpose: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. Materials and methods: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. Results: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P<.05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P<.05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P<.001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P<.001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). Conclusions: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.

Original languageEnglish
Pages (from-to)50-55
Number of pages6
JournalJournal of Critical Care
Volume34
DOIs
Publication statusPublished - Aug 1 2016

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Calcitonin
Critical Illness
Observational Studies
Prospective Studies
Area Under Curve
Therapeutics
Hospital Mortality
Infection
ROC Curve
Confidence Intervals

Keywords

  • Appropriate antimicrobial therapy
  • Biomarkers
  • Empirical antimicrobial therapy
  • Infection
  • Procalcitonin
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients. A prospective observational study. / The EProK study group.

In: Journal of Critical Care, Vol. 34, 01.08.2016, p. 50-55.

Research output: Contribution to journalArticle

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abstract = "Purpose: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. Materials and methods: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. Results: Of 209 patients, infection was confirmed in 67{\%}. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P<.05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P<.05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69{\%} from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95{\%} confidence interval, 0.63-0.83), P<.001; from t0 to t24, a greater than or equal to 74{\%} increase had an area under the curve of 0.86 (0.77-0.94), P<.001. Hospital mortality was 37{\%} in the A group and 61{\%} in the IA group (P= .017). Conclusions: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.",
keywords = "Appropriate antimicrobial therapy, Biomarkers, Empirical antimicrobial therapy, Infection, Procalcitonin, Sepsis",
author = "{The EProK study group} and Domonkos Tr{\'a}sy and Kriszti{\'a}n T{\'a}nczos and M{\'a}rton N{\'e}meth and P{\'e}ter Hankovszky and Andr{\'a}s Lovas and Andr{\'a}s Mikor and Ildik{\'o} L{\'a}szl{\'o} and Edit Hajd{\'u} and Angelika Osztroluczki and J{\'a}nos Fazakas and Z. Moln{\'a}r",
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T1 - Early procalcitonin kinetics and appropriateness of empirical antimicrobial therapy in critically ill patients. A prospective observational study

AU - The EProK study group

AU - Trásy, Domonkos

AU - Tánczos, Krisztián

AU - Németh, Márton

AU - Hankovszky, Péter

AU - Lovas, András

AU - Mikor, András

AU - László, Ildikó

AU - Hajdú, Edit

AU - Osztroluczki, Angelika

AU - Fazakas, János

AU - Molnár, Z.

PY - 2016/8/1

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N2 - Purpose: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. Materials and methods: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. Results: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P<.05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P<.05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P<.001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P<.001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). Conclusions: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.

AB - Purpose: The purpose was to investigate the value of procalcitonin (PCT) kinetics in predicting the appropriateness of empirical antimicrobial treatment in critically ill patients. Materials and methods: This prospective observational study recruited patients in whom empirical antimicrobial therapy was started for suspected infection. Biochemical and physiological parameters were measured before initiating antimicrobials (t0), 8 hourly (t8, t16, t24), and then daily (day2-6). Patients were grouped post hoc into appropriate (A) and inappropriate (IA) groups. Results: Of 209 patients, infection was confirmed in 67%. Procalcitonin kinetics were different between the IA (n = 33) and A groups (n = 108). In the IA group, PCT levels (median [interquartile range]) increased: t0= 2.8 (1.2-7.4), t16= 8.6 (4.8-22.1), t24= 14.5 (4.9-36.1), P<.05. In the A group, PCT peaked at t16 and started to decrease by t24: t0= 4.2 (1.9-12.8), t16= 6.99 (3.4-29.1), t24= 5.2 (2.0-16.7), P<.05. Receiver operating characteristic analysis revealed that a PCT elevation greater than or equal to 69% from t0 to t16 had an area under the curve for predicting inappropriate antimicrobial treatment of 0.73 (95% confidence interval, 0.63-0.83), P<.001; from t0 to t24, a greater than or equal to 74% increase had an area under the curve of 0.86 (0.77-0.94), P<.001. Hospital mortality was 37% in the A group and 61% in the IA group (P= .017). Conclusions: Early response of PCT in the first 24 hours of commencing empirical antimicrobials in critically ill patients may help the clinician to evaluate the appropriateness of therapy.

KW - Appropriate antimicrobial therapy

KW - Biomarkers

KW - Empirical antimicrobial therapy

KW - Infection

KW - Procalcitonin

KW - Sepsis

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