Daily monitoring of biomarkers of sepsis in complicated long-term ICU-patients: can it support treatment decisions?

Iapichino G, Marzorati S, Umbrello M, Baccalini R, Barassi A, Cainarca M, Colombo Pavini F, Mantovani E, Mauri A, Moroni B, Noto A, Melzi D'Eril GV, Langer M.


Minerva Anestesiologica 2010;76:814-23


Background: Diagnosis/granding of infection and the systemic response to infection may be difficult on admission to the intensive care unit, but it is even more complicated for severely ill patients with long intensive care stays. The ACCP-SCCM criteria are difficult to apply for such patients, and objective, validated biomarkers would be of great use in this setting.

Methods: Long-term (> 6 days) critically ill patients in the general ICU of University Hospital were prospectively enrolled in the study. All patients were assessed daily by the attending physician using the ACCP-SCCM classification. C-reactive protein (CRP, mg/dL), and interleukin-6 (IL-6, pg/mL) of daily stored sera were measured after each patient's discharge. After discharge, an independent, overall clinical evaluation and an aposteriori ACCP-SCCM classification were chosen as the reference standard for all comparison. The assessor was aware of the patient's clinical course but was blinded to levels of biomarkers.

Results: We studied clinical vafiables and biomarkers  of 26 patients over a total of 592 patient days. The day-by-day ACCP-SCCM classification of the attending physician overstimated the severity of the inflammatory response to infection. The diagnostic discriminative ability of severe-sepsis/septic-shock for PCT was high (ROC area 0.952 [0.931-0.973]) and had best treshold value of 1.58 (83.7% sensitivity, 94.6% specificity). IL-6 had better discriminative ability than CRP, but both were worse than PCT.

Conclusion: PCT>0.43 ng/mL could add to the clinical propensity for sepsis vs. SIRS not related to infection. Values higher than 1.58 ng/mL may support the bedside clinical diagnosis of severe-sepsis. PCT between 0.5 and 1.0 suggest tight daily monitoring of clinical condition and re-evaluation of PCT.




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