Abstract:
OBJECTIVE:First, to determine whether procalcitonin (PCT) significantly adds diagnostic value in terms of sensitivity and specificity to a common set of markers of infection, including C-reactive protein (CRP), at the Emergency Department. Second, to create a simple scoring rule implementing PCT values. Third, to determine and compare associations of CRP and PCT with clinical outcomes. DESIGN:The additional diagnostic value of PCT was determined using multiple logistic regression analysis. A score was developed to help distinguish patients with a culture-proven bacterial infection from patients not needing antibiotic treatment using 16 potential clinical and laboratory variables. The prognostic value of CRP and PCT was determined using Spearman's correlation and logistic regression. SETTING:Emergency Department of a 310-bed teaching hospital. PATIENTS:Patients between 18 and 85 years old presenting with fever to the Emergency Department. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:A total of 211 patients were studied (infection confirmed, n = 73; infection likely, n = 58; infection not excluded, n = 46; no infection, n = 34). CRP and chills were the strongest predictors for the diagnosis of bacterial infection. After addition of PCT to these parameters, model fit significantly improved (p = .003). The resulting scoring rule (score = 0.01 * CRP + 2 * chills + 1 * PCT) was characterized by an AUC value of 0.83 (sensitivity 79%; specificity of 71%), which was more accurate than physician judgment or SIRS (systemic inflammatory response syndrome). PCT levels were significantly associated with admission to a special care unit, duration of intravenous antibiotic use, total duration of antibiotic treatment, and length of hospital stay, whereas CRP was related only to the latter two variables. CONCLUSIONS:These data suggest that PCT may be a valuable addition to currently used markers of infection for diagnosis of infection and prognosis in patients with fever at the Emergency Department.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
de Kruif MD,Limper M,Gerritsen H,Spek CA,Brandjes DP,ten Cate H,Bossuyt PM,Reitsma PH,van Gorp ECdoi
10.1097/CCM.0b013e3181b9ec33subject
Has Abstractpub_date
2010-02-01 00:00:00pages
457-63issue
2eissn
0090-3493issn
1530-0293pii
00003246-201002000-00014journal_volume
38pub_type
杂志文章abstract:BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broa...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181eb3ccd
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units. DESIGN:A prospective active surveillance before-after study. The stud...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182657916
更新日期:2012-12-01 00:00:00
abstract::Sixty-four (48%) of 133 children with hematologic malignancy who were admitted to three pediatric ICUs died. Children who required management because of airway obstruction or after general anesthesia had the best outlook (mortality rate of 7% or less); those children who required major circulatory support or mechanica...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198808000-00005
更新日期:1988-08-01 00:00:00
abstract:OBJECTIVE:The goals of this review article are to review the importance and value of standardized definitions in clinical research, as well as to propose the necessary tools and infrastructure needed to advance nosology and medial taxonomy to improve the quality of clinical trials in the field of critical care. DATA S...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181920ee8
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVES:Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fib...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003806
更新日期:2019-08-01 00:00:00
abstract::The definition of sepsis has been recently modified to accommodate emerging knowledge in the field, while at the same time being recognized as challenging, if not impossible, to define. Here, we seek to clarify the current understanding of sepsis as one that has been typically framed as a disorder of inflammation to o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002172
更新日期:2017-02-01 00:00:00
abstract::The aim of this study was to assess prospectively the variations of serum phosphorus concentration (P) after onset of mechanical ventilation (MV) in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory acidosis. In 14 COPD patients, we measured P, PaCO2, and pH, immediately before MV (H0), ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198911000-00005
更新日期:1989-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiology and pharmacokinetics of a novel hemoglobin-based oxygen carrier of bovine origin. DESIGN:Randomized, single-blind, placebo-controlled, dose-escalation study. SETTING:The Upjohn Research Clinics (Kalamazoo, MI). SUBJECTS:Normal healthy adult men between the ages of 18 and 45 yrs. ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199605000-00006
更新日期:1996-05-01 00:00:00
abstract::Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). We treated seven consecutive children in cardiac arrest with high dose ep...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198912000-00004
更新日期:1989-12-01 00:00:00
abstract::The heart rate variability (HRV) of 82 patients exhibiting sinus rhythm and admitted for possible myocardial infarction (MI) was evaluated. Using a simple information entropy measure to quantify the HRV, patients subsequently diagnosed with MI or experiencing significant dysrhythmia (n = 35) exhibited less entropy (0....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198801000-00014
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVES:Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function he...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003272
更新日期:2018-09-01 00:00:00
abstract::We used metoprolol orally or iv in 25 patients with multifocal atrial tachycardia that was complicating severe cardiopulmonary illness, and we observed its effect on heart rate and rhythm, BP, and arterial blood gases. All patients showed a dramatic slowing of heart rate, averaging 54.0 +/- 4.0 beat/min (p less than ....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198701000-00004
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVE:To compare two forms of continuous renal replacement therapy, continuous venovenous hemofiltration (CVVH) vs. continuous venovenous hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the blood of patients with systemic inflammatory response syndrome and acute renal failure. DESIGN:R...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199812000-00027
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its effi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000065270.53951.9E
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVES:Our primary goal was to evaluate the impact on in-hospital mortality rate of adequate empirical antibiotic therapy, after controlling for confounding variables, in a cohort of patients admitted to the intensive care unit (ICU) with sepsis. The impact of adequate empirical antibiotic therapy on early (<3 days...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000098031.24329.10
更新日期:2003-12-01 00:00:00
abstract:OBJECTIVE:To determine the ability of somatosensory evoked potentials (SEP) compared with clinical findings to monitor and predict recovery in patients suffering from closed head injury with predominantly diffuse axonal injury (DAI). DESIGN:Prospective cohort study. SETTING:Neurologic intensive care unit (ICU) of a u...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200103000-00005
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the role of cholesterol and lipoproteins in children with severe meningococcal sepsis. DESIGN:Retrospective observational study. SETTING:A university-affiliated pediatric intensive care unit. PATIENTS:Fifty-seven patients admitted to the pediatric intensive care unit with meningococcal sepsis o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000171272.50888.ad
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVES:To determine whether contemporary β-lactam anti-infective dosing recommendations in critically ill children achieve concentrations associated with maximal anti-infective activity. The secondary objective was to describe the microbiological and clinical outcomes associated with β-lactam therapeutic drug manag...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002817
更新日期:2018-02-01 00:00:00
abstract::Vecuronium's short half-life and minimal cardiopulmonary side-effects make it a suitable drug for continuous infusion. Vecuronium is used frequently in critically ill patients to increase their total compliance and to minimize the adverse effects of mechanical ventilation. This crossover, prospective study evaluates t...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198910000-00004
更新日期:1989-10-01 00:00:00
abstract:INTRODUCTION:The difficult airway is a common problem in adult critical care patients. However, the challenge is not just the establishment of a safe airway, but also maintaining that safety over days, weeks, or longer. AIMS:This review considers the management of the difficult airway in the adult critical care enviro...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e31817d7ae1
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVES:To investigate whether admission B-type natriuretic peptide levels predict the development of acute kidney injury in acute coronary syndromes. DESIGN:Prospective study. SETTING:Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center. PATIENTS:Six-hundred thirty-nine ac...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000025
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVES:Pneumothorax is a frequent complication during mechanical ventilation. Electrical impedance tomography (EIT) is a noninvasive tool that allows real-time imaging of regional ventilation. The purpose of this study was to 1) identify characteristic changes in the EIT signals associated with pneumothoraces; 2) d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31816a0380
更新日期:2008-04-01 00:00:00
abstract::Severe complications sometimes occur in critically ill patients during intrahospital transport. Possible causes may be inadequate ventilation, insufficient monitoring, interrupted application of vasoactive drugs, or disconnections and accidental extubation. We constructed a transport unit equipped with a respirator; c...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199012000-00024
更新日期:1990-12-01 00:00:00
abstract:OBJECTIVE:Recent in vivo studies of both septic humans and animals demonstrate that leukocyte delivery is attenuated to sites remote from the primary infection. The mechanisms for this are not entirely clear. L-selectin is integral to rolling, the first step in leukocyte recruitment to an inflammatory site. L-selectin ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200101000-00024
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVES:In postcardiac surgery patients, we often noticed that monitored tidal volumes exceeded the ventilator settings. We investigated whether cardiogenic oscillation causes overestimation of tidal volume. DESIGN:Prospective, observational, clinical study. SETTING:Surgical intensive care unit in a national heart...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000129487.25203.1f
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:Preliminary experimental data suggest that selective β1-blockers may improve ex vivo cardiac function in animal sepsis. Currently, the effects of esmolol on in vivo cardiac function and on vascular function are unknown. The present study was designed to examine the effects of the β1-selective blocker esmolol ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001078
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:Transarterial chemoembolization is a widely used therapy for the treatment of hepatocellular carcinoma. A rare adverse event is acute respiratory distress syndrome from pulmonary embolization of Lipiodol, an iodinated oil commonly used during the procedure. The objective of this report is to describe an atypi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000307
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:The aim of the present study was to characterize pulmonary surfactant properties in children undergoing cardiovascular surgery with cardiopulmonary bypass. DESIGN:Prospective clinical trial. SETTING:University hospital pediatric intensive care unit. PATIENTS:Fifty pediatric patients with congenital cardiac...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200301000-00045
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVES:Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines. We examined the effect of hydrocortisone on shock reversal, hemodynamics, and survival in this particular setting. DESIGN:Prospective, randomized, double-...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199804000-00010
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVES:Under "Rory's Regulations," New York State Article 28 acute care hospitals were mandated to implement sepsis protocols and report patient-level data. This study sought to determine how well cases reported under state mandate align with discharge records in a statewide administrative database. DESIGN:Observa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003005
更新日期:2018-05-01 00:00:00