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Open Access Research article

Diagnostic and prognostic utilities of multimarkers approach using procalcitonin, B-type natriuretic peptide, and neutrophil gelatinase-associated lipocalin in critically ill patients with suspected sepsis

Mina Hur1, Hanah Kim1, Seungho Lee2, Flavia Cristofano3, Laura Magrini3, Rossella Marino3, Chiara Serena Gori3, Cristina Bongiovanni3, Benedetta Zancla3, Patrizia Cardelli4 and Salvatore Di Somma3*

Author Affiliations

1 Department of Laboratory Medicine, Konkuk University School of Medicine, Seoul, Korea

2 School of Public Health, Seoul National University, Seoul, Korea

3 Department of Medical-Surgery Sciences and Translational Medicine, School of Medicine and Psychology ‘Sapienza’ University of Rome, Emergency Medicine, Sant’ Andrea Hospital, Rome, Italy

4 Department of Clinical and Molecular Medicine, School of Medicine and Psychology, ‘Sapienza’ University, Sant’Andrea Hospital, Rome, Italy

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BMC Infectious Diseases 2014, 14:224  doi:10.1186/1471-2334-14-224

Published: 24 April 2014

Abstract

Background

We investigated the diagnostic and prognostic utilities of procalcitonin (PCT), B-type natriuretic peptide (BNP), and neutrophil gelatinase-associated lipocalin (NGAL) in critically ill patients with suspected sepsis, for whom sepsis was diagnosed clinically or based on PCT concentrations.

Methods

PCT, BNP, and NGAL concentrations were measured in 340 patients and were followed up in 109 patients. All studied biomarkers were analyzed according to the diagnosis, severity, and clinical outcomes of sepsis.

Results

Clinical sepsis and PCT-based sepsis showed poor agreement (kappa = 0.2475). BNP and NGAL showed significant differences between the two groups of PCT-based sepsis (P = 0.0001 and P < 0.0001), although there was no difference between the two groups of clinical sepsis. BNP and NGAL were significantly different according to the PCT staging and sepsis-related organ failure assessment subscores (P < 0.0001, all). BNP and PCT concentrations were significantly higher in the non-survivors than in the survivors (P = 0.0002) and showed an equal ability to predict in-hospital mortality (P = 0.0001). In the survivors, the follow-up NGAL and PCT concentrations were significantly lower than the initial values (148.7 ng/mL vs. 214.5 ng/mL, P < 0.0001; 0.61 ng/mL vs. 5.56 ng/mL, P = 0.0012).

Conclusions

PCT-based sepsis diagnosis seems to be more reliable and discriminating than clinical sepsis diagnosis. Multimarker approach using PCT, BNP, and NGAL would be useful for the diagnosis, staging, and prognosis prediction in the critically ill patients with suspected sepsis.

Keywords:
B-type natriuretic peptide; Neutrophil gelatinase-associated lipocalin; Procalcitonin; Sepsis; Diagnosis; Prognosis