Observational studyPloS one2017
Diagnostic accuracy of procalcitonin, neutrophil-lymphocyte count ratio, C-reactive protein, and lactate in patients with suspected bacterial sepsis.
Observational study in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
108 citing papers in PubMed, 5 syntheses or guidelines pooled it, 214 citations in OpenAlex.
- Non-Infectious Causes for Elevated Procalcitonin.Medicina (Kaunas, Lithuania) · 2026Pooled it
- [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025Guideline
- Accuracy of the neutrophil-to-lymphocyte ratio for the diagnosis of neonatal sepsis: a systematic review and meta-analysis.BMJ open · 2022Pooled it
- Pooled it
- The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis.The Journal of infection · 2019Pooled it
- Characterization of the pathophysiological determinants of diarrheagenic Escherichia coli infection using a challenge model in healthy adults.Scientific reports · 2021Trial
- Early Identification of a Cytokine-Low Immune Phenotype in Suspected Sepsis Using a Point-of-Care Whole-Blood TNF-α Release Assay.Medical sciences (Basel, Switzerland) · 2026Article
- Differentiating Sepsis from Infectious and Non-Infectious Conditions in Patients with Elevated Procalcitonin Levels: Performance of Procalcitonin, CRP, and Lactate.Journal of clinical medicine · 2026Article
- Ruling In and Ruling Out Sepsis Using Likelihood Ratios of a Host Response Assay.Diagnostics (Basel, Switzerland) · 2026Article
- Diagnostic performance of procalcitonin for predicting bloodstream infection and guidance on microbial aetiology: a prospective study at an Egyptian tertiary care hospital.BMC infectious diseases · 2026Article
- Prognostic Value of Maximal and Mean Lactate-to-Albumin (LAR), C-Reactive Protein-to-Albumin (CAR), and Procalcitonin-to-Albumin (PAR) Ratios Beyond ICU Admission in Critically Ill Patients.Journal of clinical medicine · 2026Article
- 7-day longitudinal proteomics of critically ill patients: a pilot study.Scientific reports · 2026Observational
- Calprotectin as a Diagnostic Marker for Lower Respiratory Tract Infection and Sepsis in the Emergency Department.Open forum infectious diseases · 2026Article
- Prognostic Value of 48-Hour Biomarker Reassessment Beyond Admission SOFA for 28-Day Mortality in Sepsis.Diagnostics (Basel, Switzerland) · 2026Article
- Comorbidities, Routine Biomarkers and Early Septic Shock Occurrence in Patients with Sepsis: A Retrospective Longitudinal Study.Diagnostics (Basel, Switzerland) · 2026Article
- MicroRNAs in sepsis: Advances in diagnosis and prognostic monitoring.World journal of critical care medicine · 2026Review
- Sepsis as a complex syndrome: Are combined biomarkers the future of diagnosis and prognosis? Clinical perspective.Immunology letters · 2026Review
- Development of a machine learning-based sepsis prediction model for real-world clinical settings in South Korea: a single-center retrospective study.Journal of Korean biological nursing science · 2026Article
- Interpretable admission-stage machine learning for early Sepsis-3 identification in the emergency department.Frontiers in medicine · 2026Article
- From sepsis biomarker discovery to regulatedFrontiers in medical technology · 2026Review
48 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 4 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly recognition is a key factor to achieve improved outcomes for septic patients. Combinations of biomarkers, as opposed to single ones, may improve timely diagnosis and survival. We investigated the performance characteristics of sepsis biomarkers, alone and in combination, for diagnosis of verified bacterial sepsis using Sepsis-2 and Sepsis-3 criteria, respectively.
methodsProcalcitonin (PCT), neutrophil-lymphocyte count ratio (NLCR), C-reactive protein (CRP), and lactate were determined in a total of 1,572 episodes of adult patients admitted to the emergency department on suspicion of sepsis. All sampling were performed prior to antibiotic administration. Discriminant analysis was used to construct two composite biomarkers consisting of linear combinations of the investigated biomarkers, one including three selected biomarkers (i.e., NLCR, CRP, and lactate), and another including all four (i.e., PCT, NLCR, CRP, and lactate). The diagnostic performances of the composite biomarkers as well as the individual biomarkers were compared using the area under the receiver operating characteristic curve (AUC).
resultsFor diagnosis of bacterial sepsis based on Sepsis-3 criteria, the AUC for PCT (0.68; 95% CI 0.65-0.71) was comparable to the AUCs for the both composite biomarkers. Using the Sepsis-2 criteria for bacterial sepsis diagnosis, the AUC for the NLCR (0.68; 95% CI 0.65-0.71) but not for the other single biomarkers, was equal to the AUCs for the both composite biomarkers. For diagnosis of severe bacterial sepsis or septic shock based on the Sepsis-2 criteria, the AUCs for both composite biomarkers were significantly greater than those of the single biomarkers (0.85; 95% CI 0.82-0.88 for the composite three-biomarker, and 0.86; 95% CI 0.83-0.89 for the composite four-biomarker).
conclusionsCombinations of biomarkers can improve the diagnosis of verified bacterial sepsis in the most critically ill patients, but in less severe septic conditions either the NLCR or PCT alone exhibit equivalent performance.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.