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Critical Care Research and Practice
Volume 2011, Article ID 594645, 6 pages
http://dx.doi.org/10.1155/2011/594645
Research Article

In Critically Ill Patients, Serum Procalcitonin Is More Useful in Differentiating between Sepsis and SIRS than CRP, Il-6, or LBP

1Intensive Care Unit of the Reinier de Graaf Groep, Reinier de Graafweg 3-11, 2625AD Delft, The Netherlands
2Department of Medical Immunology of the Reinier de Graaf Groep, Reinier de Graafweg 3-11, 2625AD Delft, The Netherlands
3Department of Microbiology of the Reinier de Graaf Groep, Reinier de Graafweg 3-11, 2625AD Delft, The Netherlands

Received 25 November 2010; Revised 21 February 2011; Accepted 18 March 2011

Academic Editor: Clifford Scott Deutschman

Copyright © 2011 Iwan A. Meynaar et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We studied the usefulness of serum procalcitonin (PCT), interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP) levels and C-reactive protein (CRP) levels, in differentiating between systemic inflammatory response syndrome (SIRS) and sepsis in critically ill patients. Methods. In this single centre prospective observational study we included all consecutive patients admitted with SIRS or sepsis to the ICU. Blood samples for measuring CRP, PCT, IL-6 and LBP were taken every day until ICU discharge. Results. A total of 76 patients were included, 32 with sepsis and 44 with SIRS. Patients with sepsis were sicker on admission and had a higher mortality. CRP, PCT, IL-6 and LBP levels were significantly higher in patients with sepsis as compared to SIRS. With PCT levels in the first 24 hours after ICU admission <2 ng/mL, ssepsis was virtually excluded (negative predictive value 97%). With PCT >10 ng/mL, sepsis with bacterial infection was very likely (positive predictive value 88%). PCT was best at discriminating between SIRS and sepsis with the highest area under the ROC curve (0.95, 95% CI 0.90–0.99). Discussion. This study showed that PCT is more useful than LBP, CRP and IL-6 in differentiating sepsis from SIRS.