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A latent class approach for sepsis diagnosis supports use of procalcitonin in the emergency room for diagnosis of severe sepsis / Gisela de la Rosa Echavez ; Clara María Arango Toro ; Carlos Ignacio Gómez Roldán ; Fabián Alberto Jaimes Barragán    

Público ISBD Título : A latent class approach for sepsis diagnosis supports use of procalcitonin in the emergency room for diagnosis of severe sepsis Tipo de documento : documento electrónico Autores : Gisela de la Rosa Echavez, ; Clara María Arango Toro, ; Carlos Ignacio Gómez Roldán, ; Fabián Alberto Jaimes Barragán, Fecha de publicación : 2013 Títulos uniformes : BMC Anesthesiology Idioma : Inglés (eng) Palabras clave : Sensitivity  specificity  sepsis  latent class  C-reactive protein  procalcitonin  D-dimer Resumen : Background: Given the acknowledged problems in sepsis diagnosis, we use a novel way with the application of the latent class analysis (LCA) to determine the operative characteristics of C-reactive protein (CRP), D-dimer (DD) and Procalcitonin (PCT) as diagnostic tests for sepsis in patients admitted to hospital care with a presumptive infection. Methods: Cross-sectional study to determine the diagnostic accuracy of three biological markers against the gold standard of clinical definition of sepsis provided by an expert committee, and also against the likelihood of sepsis according to LCA. Patients were recruited in the emergency room within 24 hours of hospitalization and were follow-up daily until discharge. Results: Among 765 patients, the expert committee classified 505 patients (66%) with sepsis, 112 (15%) with infection but without sepsis and 148 (19%) without infection. The best cut-offs points for CRP, DD, and PCT were 7.8 mg/dl, 1616 ng/ml and 0.3 ng/ml, respectively; but, neither sensitivity nor specificity reach 70% for any biomarker. The LCA analysis with the same three tests identified a “cluster” of 187 patients with several characteristics suggesting a more severe condition as well as better microbiological confirmation. Assuming this subset of patients as the new prevalence of sepsis, the ROC curve analysis identified new cut-off points for the tests and suggesting a better discriminatory ability for PCT with a value of 2 ng/ml. Conclusions: Under a “classical” definition of sepsis three typical biomarkers (CRP, PCT and DD) are not capable enough to differentiate septic from non-septic patients in the ER. However, a higher level of PCT discriminates a selected group of patients with severe sepsis. Mención de responsabilidad : Fabián A Jaimes, Gisela D De La Rosa, Marta L Valencia, Clara M Arango, Carlos I Gomez, Alex Garcia, Sigifredo Ospina, Susana C Osorno, Adriana I Henao Referencia : BMC Anesthesiol. 2013 Sep 19;13(1):23. DOI (Digital Object Identifier) : 10.1186/1471-2253-13-23 PMID : 24050481 Derechos de uso : CC BY En línea : https://bmcanesthesiol.biomedcentral.com/articles/10.1186/1471-2253-13-23#Abs1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3689 A latent class approach for sepsis diagnosis supports use of procalcitonin in the emergency room for diagnosis of severe sepsis [documento electrónico] / Gisela de la Rosa Echavez, ; Clara María Arango Toro, ; Carlos Ignacio Gómez Roldán, ; Fabián Alberto Jaimes Barragán,  . - 2013. Obra : BMC Anesthesiology Idioma : Inglés (eng) Palabras clave : Sensitivity  specificity  sepsis  latent class  C-reactive protein  procalcitonin  D-dimer Resumen : Background: Given the acknowledged problems in sepsis diagnosis, we use a novel way with the application of the latent class analysis (LCA) to determine the operative characteristics of C-reactive protein (CRP), D-dimer (DD) and Procalcitonin (PCT) as diagnostic tests for sepsis in patients admitted to hospital care with a presumptive infection. Methods: Cross-sectional study to determine the diagnostic accuracy of three biological markers against the gold standard of clinical definition of sepsis provided by an expert committee, and also against the likelihood of sepsis according to LCA. Patients were recruited in the emergency room within 24 hours of hospitalization and were follow-up daily until discharge. Results: Among 765 patients, the expert committee classified 505 patients (66%) with sepsis, 112 (15%) with infection but without sepsis and 148 (19%) without infection. The best cut-offs points for CRP, DD, and PCT were 7.8 mg/dl, 1616 ng/ml and 0.3 ng/ml, respectively; but, neither sensitivity nor specificity reach 70% for any biomarker. The LCA analysis with the same three tests identified a “cluster” of 187 patients with several characteristics suggesting a more severe condition as well as better microbiological confirmation. Assuming this subset of patients as the new prevalence of sepsis, the ROC curve analysis identified new cut-off points for the tests and suggesting a better discriminatory ability for PCT with a value of 2 ng/ml. Conclusions: Under a “classical” definition of sepsis three typical biomarkers (CRP, PCT and DD) are not capable enough to differentiate septic from non-septic patients in the ER. However, a higher level of PCT discriminates a selected group of patients with severe sepsis. Mención de responsabilidad : Fabián A Jaimes, Gisela D De La Rosa, Marta L Valencia, Clara M Arango, Carlos I Gomez, Alex Garcia, Sigifredo Ospina, Susana C Osorno, Adriana I Henao Referencia : BMC Anesthesiol. 2013 Sep 19;13(1):23. DOI (Digital Object Identifier) : 10.1186/1471-2253-13-23 PMID : 24050481 Derechos de uso : CC BY En línea : https://bmcanesthesiol.biomedcentral.com/articles/10.1186/1471-2253-13-23#Abs1 Enlace permanente : https://hospitalpablotobon.cloudbiteca.com/pmb/opac_css/index.php?lvl=notice_display&id=3689

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