tailieunhanh - Báo cáo y học: "In critically ill patients the procalcitonin level can be misleading"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: In critically ill patients the procalcitonin level can be misleading. | Koeze et al. Critical Care 2011 15 422 http content 15 2 422 CRITICAL CARE LETTER L_ In critically ill patients the procalcitonin level can be misleading Jacqueline Koeze1 MG Ron Hendrix2 Frank AJTM van den Bergh3 René ML Brouwer4 and Jan G Zijlstra1 See related research by Karlsson etal. http content 14 6 R205 related research by van Nieuwkoop etal. http content 14 6 R206 and related commentary by Wolff and Bouadma http content 14 6 1007 Three recently published articles in Critical Care concerning the usefulness of procalcitonin PCT in critically ill patients elicited this cautionary comment of the present article s title 1-3 . PCT has been introduced as a test with high sensitivity and specificity for bacterial infection in patients in the emergency department. The test s negative predictive value is thought to be sufficient to withhold antibiotics in cases of low PCT 4 5 . PCT has also been evaluated as a diagnostic tool in critically ill patients. This would be of help because there is no immediately available test that proves or disproves a bacterial infection. Especially the number of true and false negative patients cannot be estimated. We therefore cannot determine the test characteristics of PCT in these patients. We can determine with more certainty the true positive patients and measure their PCT level. Between March 2007 and April 2008 we registered all patients presenting to the emergency department the ICU or wards of internal medicine meeting the criteria of the Surviving Sepsis Campaign guidelines for severe sepsis or septic shock. In these patients we measured the PCT level with the PCT-Q test Brahms Henningsdorf Germany at presentation and microbiological analysis blood cultures sputum cultures and urine cultures was performed. Microbiological proven sepsis was defined by a positive blood culture result except cultures with Staphylococcus epidermidis or by positive culture results other than .