tetano
Editor, Senior Moderator
J Infect. 2015 Dec 15. pii: S0163-4453(15)00372-2. doi: 10.1016/j.jinf.2015.11.007. [Epub ahead of print]
[h=1]Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis.[/h] Rodr?guez AH[SUP]1[/SUP], Avil?s-Jurado FX[SUP]2[/SUP], D?az E[SUP]3[/SUP], Schuetz P[SUP]4[/SUP], Trefler BCs SI[SUP]5[/SUP], Sol?-Viol?n J[SUP]6[/SUP], Cordero L[SUP]7[/SUP], Vidaur L[SUP]8[/SUP], Estella ?[SUP]9[/SUP], Pozo Laderas JC[SUP]10[/SUP], Socias L[SUP]11[/SUP], Vergara JC[SUP]12[/SUP], Zaragoza R[SUP]13[/SUP], Bonastre J[SUP]14[/SUP], Guerrero JE[SUP]15[/SUP], Suberviola B[SUP]16[/SUP], C C[SUP]17[/SUP], Restrepo MI[SUP]18[/SUP], Mart?n-Loeches I[SUP]19[/SUP]; SEMICYUC/GETGAG working group.
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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<0.29ng/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 <0.29ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%.
[h=4]CONCLUSION:[/h] 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.
Copyright ? 2015. Published by Elsevier Ltd.
[h=4]KEYWORDS:[/h] CHAID analysis; Community-acquired pneumonia; Influenza A(H1N1)pmd; Procalcitonin; Prognosis; Respiratory Coinfection; septic shock
PMID: 26702737 [PubMed - as supplied by publisher]
[h=1]Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis.[/h] Rodr?guez AH[SUP]1[/SUP], Avil?s-Jurado FX[SUP]2[/SUP], D?az E[SUP]3[/SUP], Schuetz P[SUP]4[/SUP], Trefler BCs SI[SUP]5[/SUP], Sol?-Viol?n J[SUP]6[/SUP], Cordero L[SUP]7[/SUP], Vidaur L[SUP]8[/SUP], Estella ?[SUP]9[/SUP], Pozo Laderas JC[SUP]10[/SUP], Socias L[SUP]11[/SUP], Vergara JC[SUP]12[/SUP], Zaragoza R[SUP]13[/SUP], Bonastre J[SUP]14[/SUP], Guerrero JE[SUP]15[/SUP], Suberviola B[SUP]16[/SUP], C C[SUP]17[/SUP], Restrepo MI[SUP]18[/SUP], Mart?n-Loeches I[SUP]19[/SUP]; SEMICYUC/GETGAG working group.
[h=3]Author information[/h]
[h=3]Abstract[/h] [h=4]OBJECTIVES:[/h] To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis.
[h=4]METHODS:[/h] 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.
[h=4]RESULTS:[/h] 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<0.29ng/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 <0.29ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%.
[h=4]CONCLUSION:[/h] 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.
Copyright ? 2015. Published by Elsevier Ltd.
[h=4]KEYWORDS:[/h] CHAID analysis; Community-acquired pneumonia; Influenza A(H1N1)pmd; Procalcitonin; Prognosis; Respiratory Coinfection; septic shock
PMID: 26702737 [PubMed - as supplied by publisher]