Diagnostic Value of Procalcitonin, Interleukin-6, and Interleukin-8 in Critically Ill Patients Admitted with Suspected Sepsis

• Published in: American journal of respiratory and critical care medicine 2001-08, Vol.164 (3), p.396-402
• Main Authors: HARBARTH, STEPHAN, HOLECKOVA, KATARINA, FROIDEVAUX, CELINE, PITTET, DIDIER, RICOU, BARA, GRAU, GEORGES E, VADAS, LASZLO, PUGIN, JEROME, Geneva Sepsis Network
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Area Under Curve; Biological and medical sciences; Biomarkers - analysis; Calcitonin - analysis; Calcitonin Gene-Related Peptide; Critical Care; Diagnosis, Differential; Emergency and intensive care: infection, septic shock; Female; Humans; Intensive care medicine; Interleukin-6 - analysis; Interleukin-8 - analysis; Male; Medical sciences; Predictive Value of Tests; Prospective Studies; Protein Precursors - analysis; Regression Analysis; Sensitivity and Specificity; Sepsis - diagnosis; Sepsis - physiopathology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/ajrccm.164.3.2009052

To assess the diagnostic value of procalcitonin (PCT), interleukin (IL)-6, IL-8, and standard measurements in identifying critically ill patients with sepsis, we performed prospective measurements in 78 consecutive patients admitted with acute systemic inflammatory response syndrome (SIRS) and suspected infection. We estimated the relevance of the different parameters by using multivariable regression modeling, likelihood-ratio tests, and area under the receiver operating characteristic curves (AUC). The final diagnosis was SIRS in 18 patients, sepsis in 14, severe sepsis in 21, and septic shock in 25. PCT yielded the highest discriminative value, with an AUC of 0.92 (CI, 0.85 to 1.0), followed by IL-6 (0.75; CI, 0.63 to 0.87), and IL-8 (0.71; CI, 0.59 to 0.83; p < 0.001). At a cutoff of 1.1 ng/ml, PCT yielded a sensitivity of 97% and a specificity of 78% to differentiate patients with SIRS from those with sepsis-related conditions. Median PCT concentrations on admission (ng/ ml, range) were 0.6 (0 to 5.3) for SIRS; 3.5 (0.4 to 6.7) for sepsis; 6.2 (2.2 to 85) for severe sepsis; and 21.3 (1.2 to 654) for septic shock (p < 0.001). The addition of PCT to a model based solely on standard indicators improved the predictive power of detecting sepsis (likelihood ratio test; p = 0.001) and increased the AUC value for the routine value-based model from 0.77 (CI, 0.64 to 0.89) to 0.94 (CI, 0.89 to 0.99; p = 0.002). In contrast, no additive effect was seen for IL-6 (p = 0.56) or IL-8 (p = 0.14). Elevated PCT concentrations appear to be a promising indicator of sepsis in newly admitted, critically ill patients capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection.