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Title:	Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis
Author:	Rodríguez, Alejandro H.; Avilés Jurado, Francesc X.; Díaz, Emili; Schuetz, Philipp; Trefler, Sandra I.; Solé Violán, Jordi; Cordero, Lourdes; Vidaur, Loreto; Estella, Ángel; Pozo Laderas, Juan C.; Socias, Lorenzo; Vergara, Juan C.; Zaragoza, Rafael; Bonastre, Juan; Guerrero, José Eugenio; Suberviola, Borja; Cillóniz, Catia; Restrepo, Marcos I.; Martín Loeches, Ignacio; SEMICYUC/GETGAG Working Group
Notes:	Objectives: To define which variables upon ICU admission could be related to the presence of coinfection using CHAID (Chi-squared Automatic Interaction Detection) analysis. Methods: A secondary analysis from a prospective, multicentre, observational study (2009-2014) in ICU patients with confirmed A(H1N1)pdm09 infection. We assessed the potential of biomarkers and clinical variables upon admission to the ICU for coinfection diagnosis using CHAID analysis. Performance of cut-off points obtained was determined on the basis of the binominal distributions of the true (+) and true (−) results. Results: Of the 972 patients included, 196 (20.3%) had coinfection. Procalcitonin (PCT; ng/mL 2.4 vs. 0.5, p < 0.001), but not C-reactive protein (CRP; mg/dL 25 vs. 38.5; p = 0.62) was higher in patients with coinfection. In CHAID analyses, PCT was the most important variable for coinfection. PCT <0.29 ng/mL showed high sensitivity (Se = 88.2%), low Sp (33.2%) and high negative predictive value (NPV = 91.9%). The absence of shock improved classification capacity. Thus, for PCT <0.29 ng/mL, the Se was 84%, the Sp 43% and an NPV of 94% with a post-test probability of coinfection of only 6%. Conclusion: PCT has a high negative predictive value (94%) and lower PCT levels seems to be a good tool for excluding coinfection, particularly for patients without shock.
Subject(s):	-Influenzavirus -Pèptids -Influenza viruses -Peptides
Rights:	cc-by-nc-nd (c) The British Infection Association, 2016 http://creativecommons.org/licenses/by-nc-nd/3.0/es
Document type:	Article Article - Accepted version
Published by:	Elsevier
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