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PCT and sTREM-1: the markers of infection in critically ill patients?
Marcus J Schultz1, Rogier M Determann
1Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.j.schultz@amc.uva.nl
Abstract:
Critically ill patients frequently suffer from sepsis or localized infections. Diagnosing sepsis can be a challenge since several of its signs overlap with those found with other inflammatory states. Recognition of localized infections can at times be difficult too. While microbiological cultures of blood or other specimens are frequently used to distinguish infection from non-infectious conditions, this diagnostic technique lacks sensitivity and specificity. In addition, there is often a considerable time delay since bacterial cultures may require 24-48 h for analysis, which may be too long for a treatment decision in critically ill patients. Also, the reliability of microbiological cultures decreases in case of prior antimicrobial therapy. Use of biologic markers such as procalcitonin (PCT) or soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) have been suggested to improve recognition of patients with true infection and facilitate decisions of whether or not to treat. Unfortunately, neither PCT nor sTREM-1 fulfill all expectations. Data on the diagnostic value, in particular of sTREM-1, are contradicting. The combination of systemic PCT and local and/or systemic sTREM-1 could be useful in distinguishing patients with infection from those with non-infectious illness, though. Results from several randomized intervention studies on PCT-guided antimicrobial therapy in sepsis or lower respiratory tract infections show the superiority of PCT in clinical decision making. At present, randomized intervention studies on the potential antimicrobial stewardship of sTREM-1 are lacking.
Insights
Diagnosing infections in critically ill patients is challenging. Biomarkers like procalcitonin (PCT) and sTREM-1 show promise, with PCT demonstrating superiority in guiding antimicrobial therapy decisions for sepsis.
Area of Science:
- Critical care medicine
- Infectious disease diagnostics
- Biomarker research
Background:
- Sepsis and localized infections are common in critically ill patients.
- Diagnosing infections is difficult due to overlapping symptoms with other inflammatory conditions.
- Microbiological cultures have limitations including low sensitivity, specificity, and time delays.
Purpose of the Study:
- To evaluate the diagnostic utility of biomarkers procalcitonin (PCT) and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in critically ill patients.
- To explore the potential of combining PCT and sTREM-1 for improved infection diagnosis.
- To assess the role of PCT in guiding antimicrobial therapy.
Main Methods:
- Review of existing diagnostic techniques for infection in critically ill patients.
- Analysis of data on the diagnostic performance of PCT and sTREM-1.
- Examination of results from randomized intervention studies on PCT-guided therapy.
Main Results:
- Neither PCT nor sTREM-1 alone fully meet diagnostic expectations, with conflicting data on sTREM-1.
- Combining systemic PCT with local/systemic sTREM-1 may aid in distinguishing infection from non-infectious conditions.
- PCT-guided antimicrobial therapy has shown superiority in clinical decision-making for sepsis and lower respiratory tract infections.
Conclusions:
- PCT is a valuable tool for guiding antimicrobial therapy in critically ill patients with suspected infections.
- Further research, including randomized intervention studies, is needed to establish the antimicrobial stewardship potential of sTREM-1.
- Combined biomarker strategies may offer enhanced diagnostic accuracy for infection in critical care settings.
