Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis

Rodríguez, Alejandro H. ; Avilés-Jurado, Francesc X. ; Díaz, Emili ; Schuetz, Philipp ; Trefler, Sandra I. ; Solé-Violán, Jordi ; Cordero, Lourdes ; Vidaur, Loreto ; Estella, Ángel ; Pozo Laderas, Juan C. ; Socias, Lorenzo ; Vergara, Juan C. ; Zaragoza, Rafael ; Bonastre, Juan ; Guerrero, José E. ; Suberviola, Borja ; Cilloniz, Catia. ; Restrepo, Marcos I. ; Martín-Loeches, Ignacio ; Cobo, Pedro ; Martins, Javier ; Carbayo, Cecilia ; Robles-Musso, Emilio ; Cárdenas, Antonio ; Fierro, Javier ; Fernández, Dolores Ocaña ; Sierra, Rafael ; Huertos, Mª Jesús ; Carmona Pérez, Mª Luz ; Pozo Laderas, Juan Carlos ; Guerrero, R. ; Robles, Juan Carlos ; León, Melissa Echevarría ; Gómez, Alberto Bermejo ; Márquez, Enrique ; Rodríguez-Carvajal, Manuel ; Estella, Ángel ; Pomares, José ; Ballesteros, José Luis ; Romero, Olga Moreno ; Fernández, Yolanda ; Lobato, Francisco ; Prieto, José F. ; Albofedo-Sánchez, José ; Martínez, Pilar ; de la Torre, María Victoria ; Nieto, María ; Sola, Estefanía Camara ; Díaz Castellanos, Miguel Angel ; Soler, Guillermo Sevilla ; Leyba, Carlos Ortiz ; Garnacho-Montero, José ; Hinojosa, Rafael ; Fernández, Esteban ; Loza, Ana ; León, Cristóbal ; López, Samuel González ; Arenzana, Angel ; Ocaña, Dolores ; Navarrete, Inés ; Beryanaki, Medhi Zaheri ; Sánchez, Ignacio ; Pérez Alé, Manuel ; Poullet Brea, Ana Mª ; Machado Casas, Juan Francisco ; Serón, Carlos (Universidad de Zaragoza)

Resumen: 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.

Idioma: Inglés

DOI: 10.1016/j.jinf.2015.11.007

Año: 2016

Publicado en: JOURNAL OF INFECTION 72, 2 (2016), 143-151
ISSN: 0163-4453

Factor impacto JCR: 4.201 (2016)

Categ. JCR: INFECTIOUS DISEASES rank: 16 / 84 = 0.19 (2016) - Q1 - T1

Factor impacto SCIMAGO: 2.049 - Microbiology (medical) (Q1) - Infectious Diseases (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)