Discuss About The Procalcitonin Critically Trauma Patients?
Procalcitonin (PCT) is a significant diagnostic tool utilized for effectively diagnosing the inflammatory conditions and associated clinical manifestations. The discrimination between the pattern of aseptic inflammation and bacterial infection is made possible with the utilization of PCT intervention (1). PCT approach is a newly invented modality that is evidentially utilized for accurately diagnosing the early onset of severe sepsis and sepsis in the patient population (2). PCT exhibits greater diagnostic specificity in terms of exploring a range of infections that the conventional biomarkers fail to discover in the laboratory settings. Although the blood culture intervention is the standard modality warranting utilization for diagnosing the establishment of bacteremia and sepsis, PCT approach assists clinicians in identifying the beginning stages of the infectious processes for taking calculated decisions in the context of administering antimicrobial therapy (2). PCT intervention helps the treating physicians in terms of undertaking calculated decisions regarding the dosage and length of administration of antibiotic therapy for enhancing the treatment outcomes. Utilization of PCT approach in diagnosing the early onset and establishment of non-infectious manifestations is a subject of debate in the research community (2). The acquisition of an early diagnosis (related to the infectious conditions) is made possible through the systematic utilization of PCT modality and psychology examination intervention with the objective of recommending goal oriented antimicrobial approaches for the suspects of septic manifestations (2). Evidence-based clinical literature affirms the adverse outcomes of the misutilization of antibiotic therapy in terms of elevated mortalities among the burn patients affected with the pattern of the initial shock (3). The inappropriate antimicrobial administration not only elevates the healthcare costs of burn patients but also elevates the pattern of their microbial resistance. Implementation of antimicrobial supervision with the systematic utilization of PCT biomarker leads to the sustained reduction in the frequency of inappropriate antibiotic prescription, its non-systematic administration and cessation in the hospital settings (3). PCT modality proves advantageous in terms of the precise and timely tracking of the beginning of systemic infection in predisposed patients (3). The clinical study by (3) affirms the reciprocal alterations in the serum level of the PCT under the influence of the infectious progression. Similarly, PCT levels decline in accordance with the decline in the systemic infectious process under the influence of antimicrobial intervention.
This signifies the role of PCT modality in influencing the determination of dosage and time of the antimicrobial infection for reducing the scope of occurrence of adverse events among the infected patients (3). Normalization of PCT biomarker value sometimes indicates the development of inflammatory processes (of non-infectious origin). Therefore, periodic assessment of the serum PCT level in the infected patients is necessarily warranted for determining their predisposition in terms of acquiring the pattern of non-inflammatory infectious processes during the length of their stay in the clinical setting (3). Utilization of PCT modality appears beneficial particularly in the late post-traumatic burn tenure that proves to be the preliminary cause of mortalities among the burn patients. The patients experience substantial risk of development of infectious processes during this tenure and therefore PCT intervention assists clinicians in the context of deploying appropriate antibiotic interventions for systematically enhancing the treatment outcomes (3). However, utilization of PCT modality in exploring the extent of deterioration of regulatory pathways in severe burn cases remains questionable. The potential of PCT intervention in effectively tracking the extent of cardiovascular and hydroelectric disruptions caused under the influence of management vascular permeability emanating due to the release of systemic mediators in cases of burn injuries remains questionable in the medical community (3). These clinical complications result in the development of hypovolemia that becomes the leading cause of death of the burn patients. Effectiveness of PCT modality requires further exploration in this context with the objective of its systematic utilization in the burn settings (3). The research analysis by (4) confirms the utilization of serum PCT in the context of tracking the onset, progression and establishment of peritoneal infection in the setting of ascites and end-stage liver disease. The intensity of peritoneal infection is determined by the extent of serum PCT elevation in the affected patients (4). Evidence-based research literature indicates the elevation of serum PCT marker in cases of fungal manifestations of intra-abdominal origin (5). Utilization of PCT intervention is substantiated in cases of necrotizing pancreatitis as well as post-operative (intra-abdominal) infections (5). However, the detailed analysis of PCT pathways in intra-abdominal infection settings in the need of today and warrants effective undertaking by the research community. In my own ward, the physicians recommend the utilization of PCT modality in diagnosing the pattern of lower respiratory tract infections. In many clinical scenarios, the administration of PCT biomarker utility helps in identifying the early onset and progression of acute lower respiratory tract infections of respiratory origin. However, PCT modality is not prevalently utilized in tracking the pattern of bacterial progression in cases of upper respiratory tract infections. Evidence-based research literature advocates the requirement of elevating the sensitivity of PCT modality with the objective of monitoring the extent of bacterial invasion in patients affected with infectious respiratory tract manifestations (6). The pattern of lower respiratory tract infection (LRTI) includes the diseases like pneumonia, asthma, chronic obstructive pulmonary disease (COPD) (acute exacerbation) as well as acute bronchitis (6). Physicians configure antibiotic interventions in accordance with the recorded levels of PCT biomarker in LRTI cases (6). The standard diagnostic modality utilized in my clinical setting for diagnosing the pattern of lower and upper urinary tract infections attributes to the CRP (C-reactive protein) intervention. The clinical findings by (7) also indicate the diagnostic potential of CRP modality in terms of differentiating the pattern of lower and upper urinary tract infections. However, the PCT modality proves more specific and sensitive in terms of diagnosing the onset of pyelonephritis in comparison to the CRP intervention (8). Therefore, PCT biomarker is the modality of choice warranted for tracking the progression of bacterial invasion in lower and upper urinary tract infections associated with renal involvement (8). The research investigation by (9) indicates the significance of PCT biomarker in terms of increasing the precision of diagnosing the onset of various infectious processes affecting the lungs, heart, abdomen and blood of the patient population.
Summary of the Article
The systematic analysis by (9) evidentially investigates the potential of PCT biomarker intervention in terms of enhancing the diagnostic accuracy in patients affected with the pattern of bacterial infections and associated symptomatology. The outcomes of this diagnostic intervention positively influence the clinicians’ decisions regarding the extent and duration of administration of antimicrobial therapy to the population of interest (9). The entire research intervention revolves around the systematic diagnostic assessment of sepsis and lower respiratory tract infectious processes. The study findings reveal the high efficacy of PCT modality in precisely diagnosing infectious conditions attributing to acute heart failure, meningitis, postoperative bacterial infections and urinary tract and respiratory tract infections (9). PCT biomarker modality exhibits high potential in terms of reducing unnecessary utilization of antimicrobial treatment for treating low-risk conditions across the inpatient setting. These low-risk conditions could include the pattern of COPD exacerbation and bronchitis (9). The regular assessment of PCT pathways and kinetics in the hospital setting lead to the considerable reduction in the antibiotic administration duration, as revealed by the study findings (9). In many clinical scenarios, (as identified by the study intervention) physicians effectively ceased antimicrobial intervention in accordance with the analysis of the PCT findings (9). The study findings consider PCT biomarker modality as the safest diagnostic intervention that substantially reduces the risk of treatment failures, infection relapse and associated mortalities in patients affected with various contagious conditions (9). The systematic analysis of the serum PCT levels in various disease conditions assists in evidently determining the prognosis of various disease conditions attributing to sepsis, abdominal infection and pancreatitis (9). The non-application of PCT modality in various non-infectious as well as chronic disease conditions makes it a subject of further investigation by the research community. The suboptimal specificity and sensitivity of PCT biomarker intervention in selected disease processes warrants the requirement of careful monitoring of serum PCT levels for retaining the precision level of the diagnostic outcomes (9). The systematic analysis evaluated various study designs including RCT and observational interventions and explored the effectiveness of PCT modality in undertaking safe discharge management of patients after the administration of surgical interventions. The study outcomes confirmed the reduction in the length of antimicrobial intervention in cases of pulmonary fibrosis, community-acquired pneumonia, bronchitis, asthma, AECOPD and upper respiratory tract infections (9). The study findings also revealed the capacity of PCT modality in terms of identifying the pattern of bacterial superinfection in patients affected with congestive heart failure (9). PCT biomarker modality proves effective in terms of predicting the adverse prognostic outcomes bacterial endocarditis and associated clinical manifestations (9). PCT-guided intervention evidently reduces the length of exposure to antibiotic therapy in patients affected with the disease conditions like a urinary tract infection, pancreatitis, peritonitis and abdominal infections (9). PCT modality exhibits high diagnostic value in cases of appendicitis associated with adverse clinical complications. This intervention evidentially reduces the length of antibiotic intervention as well as associated moralities in patients affected with the pattern of septic shock and severe sepsis (9). The sustained reduction in the PCT level in the peri-operative period affirms the absence of infectious processes and facilitates the timely discharge of the treated patient (9). PCT modality proves beneficial in diagnosing the pattern of infection in the setting of rheumatoid arthritis. Serum PCT levels evidentially identify the onset and progression of deep venous thrombosis and erysipelas in the hospital setting (9). Analysis of CSF lactate and serum PCT levels assists in tracking the development of bacterial meningitis that reciprocally reduces the duration of antibiotic administration in the affected patients (9).
Critical Analysis of the Article
The greatest limitation of the research intervention by (9) relates to the fact that the authors did not undertake an in-depth review and analysis of each of the discussed disease types in the context of determining their diagnostic analysis with the sole utilization of PCT biomarker utility. The research analysis by briefly discussed regarding the reduction in the duration of antibiotic therapy as well as antibiotic exposure with the utilization of PCT intervention. However, the study failed to undertake statistical analysis for comparing the rate of antibiotic prescription and the relative predisposition of antibiotic exposure in the clinical setting of asthma. The study also did not analyse the pulmonary functionality of the asthmatic patients after undergoing reduction in the duration of antibiotic therapy in accordance with the PCT analysis. Therefore, the PCT findings in relation to the asthmatic diagnostic assessment (undertaken with the objective of acquiring the goal oriented therapeutic outcomes) appear questionable that warrants their further investigation through prospective research studies. This requirement is also revealed by the evidence-based analysis that affirms the requirement of establishing secondary end-points for exploring the pulmonary functionality of the asthmatic patients as well as their serum PCT levels (during the follow-up period) after the complete cessation of antibiotic therapy (10). Another limitation of the research analysis by (9) relates to the lack of comparative analysis of PCT modality with other similar interventions on a wider scale. A limited comparison of PCT intervention with CRP modality in UTI cases might not suffice the requirement of utilizing PCT biomarker approaches in precisely diagnosing the initial stages of various infectious processes as well as contagious conditions. The comparative assessment of CRP with markers including IL-8, IL-6, CRP and cytokines is necessarily required for understanding it’s true diagnostic potential for various infectious and non-infectious disease conditions (11). The researchers also need to investigate the influence of external factors on the serum levels of various biomarkers for objectively reducing the probability of existence of confounding factors and associated bias in the diagnostic accuracy. For example, the CRP level considerably elevates under the influence of trauma that might not affirm the existence of urinary tract infection (12). Similarly, PCT level could substantially elevate immediately after the administration of surgical intervention (13). The researchers need to explore the extent of these elevations under the influence of external circumstances in the context of including or excluding the respective biomarker modalities while undertaking the diagnostic analysis of the diseased patient. For example, the serum level of IL-6 biomarker might elevate beyond 1000 pg/mL in cases of severe systemic inflammation and intra-amniotic infection (14). Similarly, lactate levels could elevate above 4 mmol/L in cases of organ dysfunction associated with severe sepsis. The serum CRP level might elevate beyond 50 mg/mL following the administration of major and minor surgical interventions and 11 mg/L in the setting of rheumatoid arthritis (15). These evidence-based findings substantially indicate the requirement of conducting prospective systematic studies as well as RCT and observational interventions for configuring predefined benchmarks regarding the optimal and suboptimal concentration of the PCT in relation to various disease outcomes. This will evidently improve the evidence-based utilization of PCT intervention and improve the diagnostic accuracy of this modality for the systematic acquisition of the therapeutic benefits. Contrarily, the greatest strength of the research analysis by (9) attributes to the fact that it systematically evaluated a range of randomized controlled interventions and observational studies for affirming the diagnostic accuracy of PCT modality in the context of improving the therapeutic management of various infectious conditions and their associated adverse manifestations.
The evidence-based analysis of the findings by (9) indicates the requirement of conducting prospective double blinded randomized controlled interventions with the objective of determining the diagnostic potential of PCT biomarker approach in marketing the onset of various infectious as well as inflammatory disease conditions. The study findings also substantiate the requirement of analysing the application of PCT intervention on a wider-scale with the objective of tracking the establishment of chronic and well as non-infectious disease conditions across the community environment. Indeed, prospective enhancement in the precision (i.e. specificity and sensitivity) of PCT biomarker modality will eventually improve the associated antibiotic stewardship in various clinical settings.
Maus U, Andereya S, Gravius S, Ohnsorge JA, Miltner O, Niedhart C. Procalcitonin (PCT) as diagnostic tool for the monitoring of spondylodiscitis. Zeitschrift f?r Orthop?die und Unfallchirurgie. 2009; 147(1): p. 59-64.
Riedel S. Procalcitonin and the role of biomarkers in the diagnosis and management of sepsis. Diagnostic Microbiology and Infectious Disease. 2012; 73(3): p. 221-227.
Cabral L, Afreixo V, Almeida L, Paiva JA. The Use of Procalcitonin (PCT) for Diagnosis of Sepsis in Burn Patients: A Meta-Analysis. PLoS One. 2016; 11(12).
Wu J, Jiang F, Zeng T, Xu H, Lei Y, Zhong S, et al. Role of serum procalcitonin assay for diagnosis of spontaneous bacterial peritonitis in end-stage liver diseases. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2014; 36(1): p. 37-41.
Watkins RR, Lemonovich TL. Serum procalcitonin in the diagnosis and management of intra-abdominal infections. Expert Review of Anti-Infective Therapy. 2012; 10(2): p. 197-205.
Wr?blewski T, Marcisz C. Procalcitonin as a biomarker of acute lower respiratory tract infections. Expert Opinion on Medical Diagnostics. 2009; 3(1): p. 67-69.
Agrawal P, Pandey A, Sompura S, Pursnani ML. Role of blood C - reactive protein levels in upper urinary tract infection and lower urinary tract infection in adult patients (>16 years). The Journal of the Association of Physicians of India. 2013; 61(7): p. 462-463.
Xu RY, Liu HW, Liu JL, Dong JH. Procalcitonin and C-reactive protein in urinary tract infection diagnosis. BMC Accounting. 2014.
Sager R, Kutz A, Mueller B, Schuetz P. Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Medicine. 2017.ang J, Long W, Yan L, Zhang Y, Xie J, Lu G, et al. Procalcitonin guided antibiotic therapy of acute exacerbations of asthma: a randomized controlled trial. BMC Infectious Diseases. 2013.
Meisner M. Update on Procalcitonin Measurements. Annals of Laboratory Medicine. 2014; 34(4): p. 263–273.
NCBI. CRP C-reactive protein [ Homo sapiens (human) ]. USA: NCBI; 2017. Report No.: Gene ID: 1401.
Sakran JV, Michetti CP, Sheridan MJ, Richmond R, Waked T, Aldaghlas T, et al. The utility of procalcitonin in critically ill trauma patients. The Journal of Trauma and Acute Care Surgery. 2012; 73(2): p. 413-418
Chaemsaithong P, Romero R, Docheva N, Chaiyasit N, Bhatti G, Pacora P, et al. Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intra-amniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes. The Journal of Maternal-Fetal and Neonatal Medicine. 2017;: p. 1-17.
Graf J, Scherzer R, Grunfeld C, Imboden J. Levels of C-Reactive Protein Associated with High and Very High Cardiovascular Risk Are Prevalent in Patients with Rheumatoid Arthritis. PLoS One. 2009; 4(7).