Procalcitonin and Infection in Elderly Patients
Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Design: Prospective observational study to compare PCT levels in infected and uninfected patients. Setting: Geriatric teaching hospital in Switz...
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| Published in | Journal of the American Geriatrics Society (JAGS) Vol. 53; no. 8; pp. 1392 - 1395 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Oxford, UK
Blackwell Science Inc
01.08.2005
Blackwell Wiley Subscription Services, Inc |
| Subjects | |
| Online Access | Get full text |
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| Abstract | Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.
Design: Prospective observational study to compare PCT levels in infected and uninfected patients.
Setting: Geriatric teaching hospital in Switzerland.
Participants: Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit.
Measurements: Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C‐reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient.
Results: Long‐term corticotherapy, chronic immune diseases, fever of 38°C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False‐negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true‐positive PCT. This finding may also be related to aging per se.
Conclusion: PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. |
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| AbstractList | OBJECTIVESTo compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.DESIGNProspective observational study to compare PCT levels in infected and uninfected patients.SETTINGGeriatric teaching hospital in Switzerland.PARTICIPANTSTwo hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit.MEASUREMENTSDemographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient.RESULTSLong-term corticotherapy, chronic immune diseases, fever of 38 degrees C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se.CONCLUSIONPCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Prospective observational study to compare PCT levels in infected and uninfected patients. Geriatric teaching hospital in Switzerland. Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. Long-term corticotherapy, chronic immune diseases, fever of 38 degrees C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se. PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Design: Prospective observational study to compare PCT levels in infected and uninfected patients. Setting: Geriatric teaching hospital in Switzerland. Participants: Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. Measurements: Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C‐reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. Results: Long‐term corticotherapy, chronic immune diseases, fever of 38°C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False‐negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true‐positive PCT. This finding may also be related to aging per se. Conclusion: PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Design: Prospective observational study to compare PCT levels in infected and uninfected patients. Setting: Geriatric teaching hospital in Switzerland. Participants: Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. Measurements: Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. Results: Long-term corticotherapy, chronic immune diseases, fever of 38C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg-mL or higher, and PCT of 0.5 ng-mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg-mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se. Conclusion: PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Design: Prospective observational study to compare PCT levels in infected and uninfected patients. Setting: Geriatric teaching hospital in Switzerland. Participants: Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. Measurements: Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C‐reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. Results: Long‐term corticotherapy, chronic immune diseases, fever of 38°C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False‐negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true‐positive PCT. This finding may also be related to aging per se. Conclusion: PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Prospective observational study to compare PCT levels in infected and uninfected patients. Geriatric teaching hospital in Switzerland. Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. Long-term corticotherapy, chronic immune diseases, fever of 38 degrees C or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se. PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. [PUBLICATION ABSTRACT] OBJECTIVES: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. DESIGN: Prospective observational study to compare PCT levels in infected and uninfected patients. SETTING: Geriatric teaching hospital in Switzerland. PARTICIPANTS: Two hundred eighteen elderly patients aged 75 and older admitted to an acute geriatric care unit. MEASUREMENTS: Demographic characteristics, comorbidities, Charlson index, general signs (respiratory rate, temperature, pulse rate, confusion, falls, shivering), presence of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, functional score (Functional Independence Measurement (FIM)) biological parameters (PCT, C-reactive protein (CRP), leukocytes, albumin), and definite diagnosis at admission were collected prospectively for each patient. RESULTS: Long-term corticotherapy, chronic immune diseases, fever of 38 degrees Celsius or higher, white blood cell count, pulse rate, FIM, SIRS, sepsis, CRP of 3 mg/mL or higher, and PCT of 0.5 ng/mL or higher were associated with an infection at admission. In multivariate analysis, only sepsis and CRP of 3 mg/mL or higher were still associated with an infection; PCT levels do not show any significant association in the multivariate analysis. In addition, when PCT had good specificity (94%), it had low sensitivity (24%). False-negative PCT was related to lower severity of infection (lower inflammatory reaction and lower acute renal failure) than true-positive PCT. This finding may also be related to aging per se. CONCLUSION: PCT may be useful to identify severely ill elderly patients admitted to an acute geriatric ward but not to discriminate patients with infection from those without. Tables, References. Adapted from the source document. |
| Author | Herrmann, François Michel, Jean-Pierre Krause, Karl Heinz Stucker, Fabien Gavazzi, Gaëtan Graf, Jean-Daniel |
| Author_xml | – sequence: 1 givenname: Fabien surname: Stucker fullname: Stucker, Fabien organization: From theDepartment of Rehabilitation and Geriatrics, †Central Laboratory of Clinical Chemistry, and ‡Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland – sequence: 2 givenname: François surname: Herrmann fullname: Herrmann, François organization: From theDepartment of Rehabilitation and Geriatrics, †Central Laboratory of Clinical Chemistry, and ‡Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland – sequence: 3 givenname: Jean-Daniel surname: Graf fullname: Graf, Jean-Daniel organization: From theDepartment of Rehabilitation and Geriatrics, †Central Laboratory of Clinical Chemistry, and ‡Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland – sequence: 4 givenname: Jean-Pierre surname: Michel fullname: Michel, Jean-Pierre organization: From theDepartment of Rehabilitation and Geriatrics, †Central Laboratory of Clinical Chemistry, and ‡Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland – sequence: 5 givenname: Karl Heinz surname: Krause fullname: Krause, Karl Heinz organization: From theDepartment of Rehabilitation and Geriatrics, †Central Laboratory of Clinical Chemistry, and ‡Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland – sequence: 6 givenname: Gaëtan surname: Gavazzi fullname: Gavazzi, Gaëtan organization: From theDepartment of Rehabilitation and Geriatrics, †Central Laboratory of Clinical Chemistry, and ‡Biology of Aging Laboratory, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland |
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| Keywords | Human Infection Gerontology Mortality Procalcitonin Epidemiology Elderly Geriatrics |
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| References_xml | – volume: 30 start-page: 1091 year: 2001 end-page: 1096 article-title: Procalcitonin in pyelonephritis and acute community‐acquired pneumonia in adults publication-title: Presse Med (French) – volume: 114 start-page: 205 year: 2002 end-page: 210 article-title: Procalcitonin in patients with acute myocardial infarction publication-title: Wien Klin Wochenschr – volume: 36 start-page: 889 year: 2000 end-page: 894 article-title: C‐reactive protein, procalcitonin and interleukin‐8 in the primary diagnosis of infections in cancer patients publication-title: Eur J Cancer – volume: 28 start-page: 68 year: 2000 end-page: 73 article-title: Procalcitonin and C‐reactive protein levels in community‐acquired pneumonia publication-title: Correlation with etiology and prognosis – volume: 31 start-page: 1250 year: 2003 end-page: 1256 article-title: 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference publication-title: Crit Care Med – volume: 35 start-page: 156 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| Snippet | Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.... To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Prospective... Objectives: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.... To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers. Prospective... OBJECTIVES: To compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological markers.... OBJECTIVESTo compare the usefulness of procalcitonin (PCT) in detecting infection in elderly patients with that of other clinical and biological... |
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| SubjectTerms | Aged Aged, 80 and over Aging - physiology Biological and medical sciences Biological markers Biomarkers - blood Calcitonin - blood Calcitonin Gene-Related Peptide Diagnostic tests elderly Elderly people Female General aspects Humans Infection Infection - diagnosis Infections Male Medical sciences Mortality Older people Predictive Value of Tests procalcitonin Prospective Studies Protein Precursors - blood Sensitivity and Specificity Sepsis Systemic Inflammatory Response Syndrome - diagnosis |
| Title | Procalcitonin and Infection in Elderly Patients |
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