Fm. Brunkhorst et al., Discrimination of infectious and noninfectious causes of early acute respiratory distress syndrome by procalcitonin, CRIT CARE M, 27(10), 1999, pp. 2172-2176
Objective: To test the sepsis marker procalcitonin (PCT) for its applicabil
ity to discriminate between septic and nonseptic causes of acute respirator
y distress syndrome (ARDS).
Design: Prospective study, assessing the course of PCT serum levels in earl
y (within 72 hrs after onset) ARDS. The three other inflammation markers ne
opterin, interleukin-6 (IL-6), and C-reactive protein (CRP) were tested in
parallel.
Setting: Twenty-four-bed medical intensive care unit of a 1,990-bed primary
hospital, providing health care for an estimated 39,000 patients.
Patients: Twenty-seven patients, 18 male and nine female, aged 16-85 yrs, w
ith early ARDS of known cause (17 with septic and ten with nonseptic ARDS)
were enrolled in a prospective study between May 1994 and May 1995.
Interventions: Serum samples were drawn every 4-6 hrs for measurement of PC
T, neopterin, IL-6, and CRP concentrations. Brood cultures, tracheal aspira
tes, and urine samples were obtained every 12-24 hrs. In 24 of 27 patients,
bronchoscopic cultures were also obtained. Clinical sepsis criteria as def
ined by the American College of Chest Physicians/Society of Critical Care M
edicine Consensus Conference were checked daily.
Measurements and Main Results: Assessment of inflammation marker serum leve
ls in septic vs, nonseptic ARDS. PCT serum levels were significantly higher
(p < .0005) in the patients with septic ARDS than in patients with nonsept
ic ARDS within 72 hrs after onset of ARDS. There was no overlap between the
two groups. Also, neopterin allowed a differentiation (p < .005), although
a substantial overlap between serum levels of septic and nonseptic patient
s was observed. No discrimination could be achieved by determination of GRP
and IL-6 levels.
Conclusion: PCT determination in early ARDS could help to discriminate betw
een septic and nonseptic underlying disease.