Title
Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis
Date Issued
01 February 2016
Access level
open access
Resource Type
journal article
Author(s)
Rodríguez A.H.
Avilés-Jurado F.X.
Díaz E.
Schuetz P.
Trefler S.I.
Solé-Violán J.
Cordero L.
Vidaur L.
Estella Á.
Pozo Laderas J.C.
Socias L.
Vergara J.C.
Zaragoza R.
Bonastre J.
Guerrero J.E.
Suberviola B.
Restrepo M.I.
Martín-Loeches I.
Hospital Clinic / CIBERES
Publisher(s)
W.B. Saunders Ltd
Abstract
Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009-2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (-) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
Start page
143
End page
151
Volume
72
Issue
2
Language
English
OCDE Knowledge area
Epidemiología
Subjects
Scopus EID
2-s2.0-84960421328
PubMed ID
Source
Journal of Infection
Resource of which it is part
Journal of Infection
ISSN of the container
01634453
Source funding
Thermo Fisher Scientific
Sponsor(s)
Dr P. Schuetz has received financial support from Thermo Fisher Scientific Biomarkers and bioMérieux to attend meetings and fulfil speaking engagements, and has received research grants from both companies.
This study was endorsed by the SEMICYUC (Spanish Society of Intensive Care Medicine). We thank the GETGAG (Influenza A/H1N1 Working Group from SEMICYUC) investigators for their contributions to the research. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the SEMICYUC.
Sources of information:
Directorio de Producción Científica
Scopus