Advertisement

Pcv-aCO2 and procalcitonin levels for the early diagnosis of bloodstream infections caused by gram-negative bacteria

  • Author Footnotes
    1 The first two authors, Zhong-hua Wang and Xue-biao Wei, contributed equally to this work.
    Zhong-hua Wang
    Footnotes
    1 The first two authors, Zhong-hua Wang and Xue-biao Wei, contributed equally to this work.
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Author Footnotes
    1 The first two authors, Zhong-hua Wang and Xue-biao Wei, contributed equally to this work.
    Xue-biao Wei
    Footnotes
    1 The first two authors, Zhong-hua Wang and Xue-biao Wei, contributed equally to this work.
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Xiao-long Liao
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Sheng-long Chen
    Affiliations
    Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Wei-xin Guo
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Pei-hang Hu
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Yan Wu
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • You-wan Liao
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Tie-he Qin
    Correspondence
    Corresponding authors. Shou-hong Wang and Tie-he Qin, Department of Critical Care Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; (E-mail address: [email protected]).
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Shou-hong Wang
    Correspondence
    Corresponding authors. Shou-hong Wang and Tie-he Qin, Department of Critical Care Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, Guangdong, China; (E-mail address: [email protected]).
    Affiliations
    Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
    Search for articles by this author
  • Author Footnotes
    1 The first two authors, Zhong-hua Wang and Xue-biao Wei, contributed equally to this work.

      Abstract

      Background

      The central venous-to-arterial carbon dioxide difference (Pcv-aCO2) is a biomarker for tissue perfusion, but the diagnostic value of Pcv-aCO2 in bacteria bloodstream infections (BSI) caused by gram-negative (GN) bacteria remains unclear. This study evaluated the expression levels and diagnostic value of Pcv-aCO2 and procalcitonin (PCT) in the early stages of GN bacteria BSI.

      Methods

      Patients with BSI admitted to the intensive care unit at Guangdong Provincial People's Hospital between August 2014 and August 2017 were enrolled. Pcv-aCO2 and PCT levels were evaluated in GN and gram-positive (GP) bacteria BSI patients.

      Results

      A total of 132 patients with BSI were enrolled. The Pcv-aCO2 (8.32 ± 3.59 vs 4.35 ± 2.24 mmHg p = 0.001) and PCT (30.62 ± 34.51 vs 4.92 ± 6.13 ng/ml p = 0.001) levels were significantly higher in the GN group than in the GP group. In the diagnosis of GN bacteria BSI, the area under the receiver operating characteristic curve (AUROC) for Pcv-aCO2 was 0.823 (95% confidence interval (CI): 0.746–0.900). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.90%, 88.00%, 74.07% and 78.21%, respectively. The AUROC for PCT was 0.818 (95% CI: 0.745–0.890). The sensitivity, specificity, PPV and NPV were 57.90%, 94.67%, 71.93% and 74.67%, respectively.

      Conclusions

      Pcv-aCO2 and PCT have similar and high diagnostic value for the early diagnosis of BSI caused by GN bacteria.

      Key Indexing Terms

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of the Medical Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • McNamara J.F.
        • Righi E.
        • Wright H.
        • et al.
        Long-term morbidity and mortality following bloodstream infection: a systematic literature review.
        J Infect. 2018; 77: 1-8
        • Wacker C.
        • Prkno A.
        • Brunkhorst F.M.
        • et al.
        Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis.
        Lancet Infect Dis. 2013; 13: 426-435
        • Brodska H.
        • Malickova K.
        • Adamkova V.
        • et al.
        Significantly higher procalcitonin levels could differentiate gram-negative sepsis from gram-positive and fungal sepsis.
        Clin Exp Med. 2013; 13: 165-170
        • Guo S.Y.
        • Zhou Y.
        • Hu Q.F.
        • et al.
        Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis.
        Am J Med Sci. 2015; 349: 499-504
        • Yan S.T.
        • Sun L.C.
        • Jia H.B.
        • et al.
        Procalcitonin levels in bloodstream infections caused by different sources and species of bacteria.
        Am J Emerg Med. 2017; 35: 579-583
        • Wittayachamnankul B.
        • Chentanakij B.
        • Sruamsiri K.
        • et al.
        The role of central venous oxygen saturation, blood lactate, and central venous-to-arterial carbon dioxide partial pressure difference as a goal and prognosis of sepsis treatment.
        J Crit Care. 2016; 36: 223-229
        • Munford RS.
        Severe sepsis and septic shock: the role of gram-negative bacteremia.
        Annu Rev Pathol. 2006; 1: 467-496
        • Laupland KB.
        Incidence of bloodstream infection: a review of population-based studies.
        Clin Microbiol Infect. 2013; 19: 492-500
        • De Waele J.J.
        • Dhaese S.
        Antibiotic stewardship in sepsis management: toward a balanced use of antibiotics for the severely ill patient.
        Expert Rev Anti Infect Ther. 2019; 17: 89-97
        • Bissonnette L.
        • Bergeron MG.
        Diagnosing infections–current and anticipated technologies for point-of-care diagnostics and home-based testing.
        Clin Microbiol Infect. 2010; 16: 1044-1053
        • Opota O.
        • Jaton K.
        • Greub G.
        Microbial diagnosis of bloodstream infection: towards molecular diagnosis directly from blood.
        Clin Microbiol Infect. 2015; 21: 323-331
        • Bassetti M.
        • Russo A.
        • Righi E.
        • et al.
        Role of procalcitonin in bacteremic patients and its potential use in predicting infection etiology.
        Expert Rev Anti Infect Ther. 2019; 17: 99-105
        • Ryoo S.M.
        • Han K.S.
        • Ahn S.
        • et al.
        The usefulness of C-reactive protein and procalcitonin to predict prognosis in septic shock patients: a multicenter prospective registry-based observational study.
        Sci Rep. 2019; 9: 6579
        • Watanabe Y.
        • Oikawa N.
        • Hariu M.
        • et al.
        Ability of procalcitonin to diagnose bacterial infection and bacteria types compared with blood culture findings.
        Int J Gen Med. 2016; 9: 325-331
        • Liu H.H.
        • Zhang M.W.
        • Guo J.B.
        • et al.
        Procalcitonin and C-reactive protein in early diagnosis of sepsis caused by either gram-negative or gram-positive bacteria.
        Ir J Med Sci. 2017; 186: 207-212
        • Gutierrez-Gutierrez B.
        • Morales I.
        • Perez-Galera S.
        • et al.
        Predictive value of the kinetics of procalcitonin and C-reactive protein for early clinical stability in patients with bloodstream infections due to gram-negative bacteria.
        Diagn Microbiol Infect Dis. 2019; 93: 63-68
        • He C.
        • Wang B.
        • Wang Y.F.
        • et al.
        Can procalcitonin be used to diagnose Gram-negative bloodstream infection? Evidence based on a meta-analysis.
        Eur Rev Med Pharmacol Sci. 2017; 21: 3253-3261
        • Covington E.W.
        • Roberts M.Z.
        • Dong J.
        Procalcitonin monitoring as a guide for antimicrobial therapy: a review of current literature.
        Pharmacotherapy. 2018; 38: 569-581
        • Ronco C.
        Lipopolysaccharide (LPS) from the cellular wall of Gram-negative bacteria, also known as endotoxin, is a key molecule in the pathogenesis of sepsis and septic shock. Preface.
        Blood Purif. 2014; 37: 1
        • Du W.
        • Liu D.W.
        • Wang X.T.
        • et al.
        Combining central venous-to-arterial partial pressure of carbon dioxide difference and central venous oxygen saturation to guide resuscitation in septic shock.
        J Crit Care. 2013; 28: e1-e5
        • Weil M.H.
        • Rackow E.C.
        • Trevino R.
        • et al.
        Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation.
        N Engl J Med. 1986; 315: 153-156
        • Ospina-Tascon G.A.
        • Umana M.
        • Bermudez W.F.
        • et al.
        Can venous-to-arterial carbon dioxide differences reflect microcirculatory alterations in patients with septic shock?.
        Intensive Care Med. 2016; 42: 211-221
        • Rhodes L.A.
        • Erwin W.C.
        • Borasino S.
        • et al.
        Central Venous to arterial CO2 difference after cardiac surgery in infants and neonates.
        Pediatr Crit Care Med. 2017; 18: 228-233
        • Chen T.
        • Pan T.
        • Luo X.
        • et al.
        High central venous-to-arterial CO2 difference is associated with poor outcomes in patients after cardiac surgery: a propensity score analysis.
        Shock. 2019; 52: 583-589
        • Kocsi S.
        • Demeter G.
        • Erces D.
        • et al.
        Central venous-to-arterial CO2 gap is a useful parameter in monitoring hypovolemia-caused altered oxygen balance: animal study.
        Crit Care Res Pract. 2013; 2013583598
        • Bakker J.
        • Vincent J.L.
        • Gris P.
        • et al.
        Veno-arterial carbon dioxide gradient in human septic shock.
        Chest. 1992; 101: 509-515
        • van Beest P.A.
        • Lont M.C.
        • Holman N.D.
        • et al.
        Central venous-arterial pCO(2) difference as a tool in resuscitation of septic patients.
        Intensive Care Med. 2013; 39: 1034-1039
        • Mallat J.
        • Pepy F.
        • Lemyze M.
        • et al.
        Central venous-to-arterial carbon dioxide partial pressure difference in early resuscitation from septic shock: a prospective observational study.
        Eur J Anaesthesiol. 2014; 31: 371-380
        • Vallee F.
        • Vallet B.
        • Mathe O.
        • et al.
        Central venous-to-arterial carbon dioxide difference: an additional target for goal-directed therapy in septic shock?.
        Intensive Care Med. 2008; 34: 2218-2225
        • Helmy T.A.
        • El-Reweny E.M.
        • Ghazy FG.
        Prognostic value of venous to arterial carbon dioxide difference during early resuscitation in critically ill patients with septic shock.
        Indian J Crit Care Med. 2017; 21: 589-593
        • He H.
        • Long Y.
        • Liu D.
        • et al.
        The prognostic value of central venous-to-arterial CO2 difference/arterial-central venous O2 difference ratio in septic shock patients with central venous O2 saturation≥80.
        Shock. 2017; 48: 551-557
        • He H.W.
        • Liu D.W.
        • Long Y.
        • et al.
        High central venous-to-arterial CO2 difference/arterial-central venous O2 difference ratio is associated with poor lactate clearance in septic patients after resuscitation.
        J Crit Care. 2016; 31: 76-81
        • Sagana R.
        • Hyzy RC.
        Achieving zero central line-associated bloodstream infection rates in your intensive care unit.
        Crit Care Clin. 2013; 29: 1-9