Clinical Uses of PCT and MR-proADM

The rapid identification and risk assessment of sepsis in the ICU

Clinical use of PCT and MR-proADM in sepsis diagnosis and risk assessment 

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In which patients should PCT and MR-proADM be measured?

In patients where sepsis is suspected, or at least possible. In addition, it should be measured in those who have recently undergone major surgery or are at risk of developing complications.

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When should PCT and MR-proADM be measured?

At the time of admission, and then daily or every two days during ICU stay in order to monitor the progression of the infection, as well as offer a real-time prognosis. Even if MR-proADM levels are low on admission, the effects of sepsis, severe sepsis or septic shock may result in further non-bacterial complications, which can go undetected by PCT testing alone.

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How to interpret PCT and MR-proADM results?

PCT is a marker of the inflammatory response of the human body to bacterial infections, whereas the main function of MR-proADM is to offer a short term mortality prognosis in sepsis, severe sepsis and septic shock patients. Please refer to tabl below in order to interpret the potential PCT and MR-proADM combinations. Furthermore, MR-proADM has the additional benefit of being elevated in some viral infections29 and fungal infections30.

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Time to decrease the level of care?

Estimates put the daily cost of an occupied ICU bed at between €1160 and €2025 in several European countries in 200831, with the potential costs in 2015 being far in excess of these numbers. Therefore, it is both financially and clinically important to transfer patients to an intermediate ward as soon as there is no risk to their health. By combining a diagnostic and prognostic marker with existing clinical scores, the faster transfer of patients to an intermediate ward might become an option, based on the patient’s short- to mid-term prognosis.

 

Possible interpretations

High and stable PCT values can indicate a failure in treatment, which may arise from factors such as inadequate antibiotic therapy, incorrect dosage, incorrect administration schedule, or incorrect diagnosis of the initial infection’s foci, amongst others. In addition, high MR-proADM levels indicate a high risk of mortality and/or adverse complications. Low PCT levels indicate that a systemic bacterial infection is unlikely, however high MR-proADM values indicate an elevated risk to the patient's health due to possible factors such as:•a severe alternative infection; post surgery complications; additional unknown complications as a result of the initial infection;•comorbidities. Low PCT levels indicate a systemic infection is unlikely, however a localized infection is possible, which can be potentially detected using MR-proADM41. MR-proADM levels are higher than normal, so the likelihood of a nonsevere fungal or viral infection, or some other non-bacterial, organ specific complication, might exist.Diagnosis of systemic bacterial infection/sepsis using PCT6, 33, and estimated prognosis groupings for MR-proADM. Cut-off values were based on values found in the literature. Optimal cut-off values to predict mortality were found in a range of different sepsis groups, including severe sepsis patients only (2.5 nmol/L) on day 517, in patients suffering from sepsis, severe sepsis or septic shock on admission (3.9 nmol/L)10 (kindly reproduced from work by Bruno Viaggi, Careggi University Hospital ICU, Italy)

 

 

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