Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis.
- Rodríguez AH Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV/CIBERes, Tarragona, Spain. Electronic address: ahr1161@yahoo.es.
- Avilés-Jurado FX Otorhinolaryngology Head-Neck Surgery Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV, Tarragona, Catalonia, Spain. Electronic address: fxavilesj@gmail.com.
- Díaz E Critical Care Department, ParcTaulí Hospital/CIBERes, Sabadell, Spain. Electronic address: emilio.diaz.santos@gmail.com.
- Schuetz P Internal Medicine Department, Kantonsspital Aarau, Switzerland. Electronic address: schuetzph@gmail.com.
- Trefler SI Critical Care Department, Hospital Universitari de Tarragona Joan XXIII, IISPV/URV/CIBERes, Tarragona, Spain. Electronic address: sitrefler@yahoo.es.
- Solé-Violán J Critical Care Department, Hospital Dr. Negrín, Las Palmas de Gran Canaria, Spain. Electronic address: jsolvio@gobiernodecanarias.org.
- Cordero L Critical Care Department, CHUAC, A Coruña, Spain. Electronic address: lcorlor@gmail.com.
- Vidaur L Critical Care Department, Hospital de Donostia, San Sebastian, Spain. Electronic address: loreto.vidaurtello@osakidetza.net.
- Estella Á Critical Care Department, Hospital SAS, Jerez de la Frontera, Spain. Electronic address: litoestella@hotmail.com.
- Pozo Laderas JC Critical Care Department, Hospital Reina Sofía, Córdoba, Spain. Electronic address: juanc.pozo.sspa@juntadeandalucia.es.
- Socias L Critical Care Department, Hospital Son Llatzer, Palma de Mallorca, Spain. Electronic address: lsocias3@gmail.com.
- Vergara JC Critical Care Department, Hospital de Cruces, Vizcaya, Spain. Electronic address: juancarlos.vergaraserrano@osakidetza.net.
- Zaragoza R Critical Care Department, Hospital Dr. Peset, Valencia, Spain. Electronic address: zaragozar@ono.com.
- Bonastre J Critical Care Department, Hospital La Fe, Valencia, Spain. Electronic address: bonastre_jua@gva.es.
- Guerrero JE Critical Care Department, Hospital Gregorio Marañón, Madrid, Spain. Electronic address: jeguerrerosanz@gmail.com.
- Suberviola B Critical Care Department, Hospital Universitario de Santander, Spain. Electronic address: borja.suberviola@gmail.com.
- Cilloniz C Critical Care Department, Hospital Clinic / CIBERES, Barcelona, Spain. Electronic address: catiacilloniz@yahoo.com.
- Restrepo MI Division of Pulmonary Diseases and Critical Care Medicine, University of Texas Health Science Center at San Antonio San Antonio, TX, USA. Electronic address: restrepom@uthscsa.edu.
- Martín-Loeches I Multidisciplinary Intensive Care Research Organization (MICRO), Department of Anaesthesia and Critical Care, St James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland. Electronic address: drmartinloeches@gmail.com.
- 2015-12-26
Published in:
- The Journal of infection. - 2016
CHAID analysis
Community-acquired pneumonia
Influenza A(H1N1)pmd
Procalcitonin
Prognosis
Respiratory coinfection
Septic shock
Adult
Bacterial Infections
Biomarkers
Calcitonin
Calcitonin Gene-Related Peptide
Coinfection
Decision Trees
Female
Humans
Influenza, Human
Intensive Care Units
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Protein Precursors
Sensitivity and Specificity
English
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.
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.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.jinf.2015.11.007
- PMID 26702737
- Persistent URL
- https://folia.unifr.ch/global/documents/126479
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