• M Oberhoffer, W Karzai, A Meier-Hellmann, D Bögel, J Fassbinder, and K Reinhart.
• Department of Anesthesiology and Intensive Care Medicine, Friedrich-Schiller-University, Jena, Germany.
• Crit. Care Med. 1999 Sep 1;27(9):1814-8.

ObjectivesTo determine correlations and predictive strength of surrogate markers (body temperature, leukocyte count, C-reactive protein [CRP], and procalcitonin [PCT]) with elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in septic patients.DesignProspective consecutive case series.SettingSurgical intensive care unit (ICU) of a university hospital.PatientsA total of 175 patients experiencing intensive care unit stays >48 hrs categorized for sepsis according to ACCP/ SCCM Consensus Conference criteria.Measurements And Main ResultsCRP and PCT were both significantly correlated with TNF-alpha and IL-6. Based on the area-under-the-curve of the receiver operating characteristics curves, predicting capability was highest for PCT (0.814 for TNF-alpha >40 pg/mL and 0.794 for IL-6 >500 pg/mL), moderate with CRP (0.732 and 0.716, respectively), and lowest for leukocyte count (0.493 and 0.483, respectively) and body temperature (0.587 and 0.589, respectively). Sensitivity, specificity, positive, and negative predictive values and test effectiveness all followed this same pattern of being highest for PCT followed by CRP, with leukocyte count and body temperature being lowest.ConclusionPCT may be an early and better marker of elevated cytokines than the more classic criteria of inflammation.

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