Procalcitonin as a biomarker for bacterial infections in patients with liver cirrhosis in the emergency department

Chih Huang Li, Ruey Bing Yang, Jong Hwei S Pang, Shy Shin Chang, Chih Chuan Lin, Chien Hsiun Chen, Hsien Yi Chen, Te Fa Chiu

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Objectives: The objective was to determine the diagnostic accuracy of procalcitonin measurement for bacterial infections in patients with all causes of liver cirrhosis. Methods: The authors conducted a cross-sectional study of 98 patients with cirrhosis treated in the emergency department (ED) of Chang-Gung Memorial Hospital, Taiwan. Serum procalcitonin levels and other clinical information were obtained concurrently. Patients were assigned to a sepsis or nonsepsis group after the medical records were reviewed by two emergency physicians blinded to the study. Receiver operating characteristic (ROC) curve analysis was conducted to determine the sensitivity, specificity, likelihood ratio, and suggested cutoff values. The diagnostic accuracy of the C-reactive protein (CRP) level was also determined for comparison. Results: A total of 98 patients were enrolled for analysis in 1 year. Twenty-seven patients (27.6%) were assigned to the sepsis group. Eleven patients (11.2%) had positive blood cultures. The areas under the ROC curves for procalcitonin and CRP in predicting sepsis were 0.89 (95% confidence interval [CI] = 0.77 to 0.92) and 0.81 (95% CI = 0.72 to 0.89), respectively (p = 0.11). The cutoff that maximized Youden's index was 0.49 ng/mL for procalcitonin and 24.7 mg/L for CRP. At these cutoffs, the sensitivity and specificity were 81.5 and 87.3% for procalcitonin and 80.0 and 80.3% for CRP. These results suggest that procalcitonin measurement shows at least an equivalent diagnostic accuracy to CRP measurement. Conclusions: Procalcitonin provided satisfactory diagnostic accuracy in differentiating bacterial infections in patients with all causes of liver cirrhosis in the ED. A cutoff value of 0.5 ng/mL is suggested for clinical use.

Original languageEnglish
Pages (from-to)122-126
Number of pages5
JournalAcademic Emergency Medicine
Volume18
Issue number2
DOIs
Publication statusPublished - Feb 1 2011
Externally publishedYes

Fingerprint

Calcitonin
Bacterial Infections
Liver Cirrhosis
Hospital Emergency Service
Biomarkers
C-Reactive Protein
Sepsis
ROC Curve
Confidence Intervals
Sensitivity and Specificity
Taiwan
Medical Records
Emergencies
Fibrosis
Cross-Sectional Studies
Physicians
Serum

ASJC Scopus subject areas

  • Emergency Medicine
  • Medicine(all)

Cite this

Procalcitonin as a biomarker for bacterial infections in patients with liver cirrhosis in the emergency department. / Li, Chih Huang; Yang, Ruey Bing; Pang, Jong Hwei S; Chang, Shy Shin; Lin, Chih Chuan; Chen, Chien Hsiun; Chen, Hsien Yi; Chiu, Te Fa.

In: Academic Emergency Medicine, Vol. 18, No. 2, 01.02.2011, p. 122-126.

Research output: Contribution to journalArticle

Li, Chih Huang ; Yang, Ruey Bing ; Pang, Jong Hwei S ; Chang, Shy Shin ; Lin, Chih Chuan ; Chen, Chien Hsiun ; Chen, Hsien Yi ; Chiu, Te Fa. / Procalcitonin as a biomarker for bacterial infections in patients with liver cirrhosis in the emergency department. In: Academic Emergency Medicine. 2011 ; Vol. 18, No. 2. pp. 122-126.
@article{7eb5edf8d63e4252bc621aac94da7268,
title = "Procalcitonin as a biomarker for bacterial infections in patients with liver cirrhosis in the emergency department",
abstract = "Objectives: The objective was to determine the diagnostic accuracy of procalcitonin measurement for bacterial infections in patients with all causes of liver cirrhosis. Methods: The authors conducted a cross-sectional study of 98 patients with cirrhosis treated in the emergency department (ED) of Chang-Gung Memorial Hospital, Taiwan. Serum procalcitonin levels and other clinical information were obtained concurrently. Patients were assigned to a sepsis or nonsepsis group after the medical records were reviewed by two emergency physicians blinded to the study. Receiver operating characteristic (ROC) curve analysis was conducted to determine the sensitivity, specificity, likelihood ratio, and suggested cutoff values. The diagnostic accuracy of the C-reactive protein (CRP) level was also determined for comparison. Results: A total of 98 patients were enrolled for analysis in 1 year. Twenty-seven patients (27.6{\%}) were assigned to the sepsis group. Eleven patients (11.2{\%}) had positive blood cultures. The areas under the ROC curves for procalcitonin and CRP in predicting sepsis were 0.89 (95{\%} confidence interval [CI] = 0.77 to 0.92) and 0.81 (95{\%} CI = 0.72 to 0.89), respectively (p = 0.11). The cutoff that maximized Youden's index was 0.49 ng/mL for procalcitonin and 24.7 mg/L for CRP. At these cutoffs, the sensitivity and specificity were 81.5 and 87.3{\%} for procalcitonin and 80.0 and 80.3{\%} for CRP. These results suggest that procalcitonin measurement shows at least an equivalent diagnostic accuracy to CRP measurement. Conclusions: Procalcitonin provided satisfactory diagnostic accuracy in differentiating bacterial infections in patients with all causes of liver cirrhosis in the ED. A cutoff value of 0.5 ng/mL is suggested for clinical use.",
author = "Li, {Chih Huang} and Yang, {Ruey Bing} and Pang, {Jong Hwei S} and Chang, {Shy Shin} and Lin, {Chih Chuan} and Chen, {Chien Hsiun} and Chen, {Hsien Yi} and Chiu, {Te Fa}",
year = "2011",
month = "2",
day = "1",
doi = "10.1111/j.1553-2712.2010.00991.x",
language = "English",
volume = "18",
pages = "122--126",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Procalcitonin as a biomarker for bacterial infections in patients with liver cirrhosis in the emergency department

AU - Li, Chih Huang

AU - Yang, Ruey Bing

AU - Pang, Jong Hwei S

AU - Chang, Shy Shin

AU - Lin, Chih Chuan

AU - Chen, Chien Hsiun

AU - Chen, Hsien Yi

AU - Chiu, Te Fa

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Objectives: The objective was to determine the diagnostic accuracy of procalcitonin measurement for bacterial infections in patients with all causes of liver cirrhosis. Methods: The authors conducted a cross-sectional study of 98 patients with cirrhosis treated in the emergency department (ED) of Chang-Gung Memorial Hospital, Taiwan. Serum procalcitonin levels and other clinical information were obtained concurrently. Patients were assigned to a sepsis or nonsepsis group after the medical records were reviewed by two emergency physicians blinded to the study. Receiver operating characteristic (ROC) curve analysis was conducted to determine the sensitivity, specificity, likelihood ratio, and suggested cutoff values. The diagnostic accuracy of the C-reactive protein (CRP) level was also determined for comparison. Results: A total of 98 patients were enrolled for analysis in 1 year. Twenty-seven patients (27.6%) were assigned to the sepsis group. Eleven patients (11.2%) had positive blood cultures. The areas under the ROC curves for procalcitonin and CRP in predicting sepsis were 0.89 (95% confidence interval [CI] = 0.77 to 0.92) and 0.81 (95% CI = 0.72 to 0.89), respectively (p = 0.11). The cutoff that maximized Youden's index was 0.49 ng/mL for procalcitonin and 24.7 mg/L for CRP. At these cutoffs, the sensitivity and specificity were 81.5 and 87.3% for procalcitonin and 80.0 and 80.3% for CRP. These results suggest that procalcitonin measurement shows at least an equivalent diagnostic accuracy to CRP measurement. Conclusions: Procalcitonin provided satisfactory diagnostic accuracy in differentiating bacterial infections in patients with all causes of liver cirrhosis in the ED. A cutoff value of 0.5 ng/mL is suggested for clinical use.

AB - Objectives: The objective was to determine the diagnostic accuracy of procalcitonin measurement for bacterial infections in patients with all causes of liver cirrhosis. Methods: The authors conducted a cross-sectional study of 98 patients with cirrhosis treated in the emergency department (ED) of Chang-Gung Memorial Hospital, Taiwan. Serum procalcitonin levels and other clinical information were obtained concurrently. Patients were assigned to a sepsis or nonsepsis group after the medical records were reviewed by two emergency physicians blinded to the study. Receiver operating characteristic (ROC) curve analysis was conducted to determine the sensitivity, specificity, likelihood ratio, and suggested cutoff values. The diagnostic accuracy of the C-reactive protein (CRP) level was also determined for comparison. Results: A total of 98 patients were enrolled for analysis in 1 year. Twenty-seven patients (27.6%) were assigned to the sepsis group. Eleven patients (11.2%) had positive blood cultures. The areas under the ROC curves for procalcitonin and CRP in predicting sepsis were 0.89 (95% confidence interval [CI] = 0.77 to 0.92) and 0.81 (95% CI = 0.72 to 0.89), respectively (p = 0.11). The cutoff that maximized Youden's index was 0.49 ng/mL for procalcitonin and 24.7 mg/L for CRP. At these cutoffs, the sensitivity and specificity were 81.5 and 87.3% for procalcitonin and 80.0 and 80.3% for CRP. These results suggest that procalcitonin measurement shows at least an equivalent diagnostic accuracy to CRP measurement. Conclusions: Procalcitonin provided satisfactory diagnostic accuracy in differentiating bacterial infections in patients with all causes of liver cirrhosis in the ED. A cutoff value of 0.5 ng/mL is suggested for clinical use.

UR - http://www.scopus.com/inward/record.url?scp=79951602206&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79951602206&partnerID=8YFLogxK

U2 - 10.1111/j.1553-2712.2010.00991.x

DO - 10.1111/j.1553-2712.2010.00991.x

M3 - Article

VL - 18

SP - 122

EP - 126

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 2

ER -