***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT In previous smaller trials , a procalcitonin ( PCT ) algorithm reduced antibiotic use in patients with lower respiratory tract infections ( LRTIs ) . OBJECTIVE To examine whether a PCT algorithm can reduce antibiotic exposure without increasing the risk for serious adverse outcomes . DESIGN , SETTING , AND PATIENTS A multicenter , noninferiority , r and omized controlled trial in emergency departments of 6 tertiary care hospitals in Switzerl and with an open intervention of 1359 patients with mostly severe LRTIs r and omized between October 2006 and March 2008 . INTERVENTION Patients were r and omized to administration of antibiotics based on a PCT algorithm with predefined cutoff ranges for initiating or stopping antibiotics ( PCT group ) or according to st and ard guidelines ( control group ) . Serum PCT  was measured locally in each hospital and instructions were Web-based . MAIN OUTCOME MEASURES Noninferiority of the composite adverse outcomes of death , intensive care unit admission , disease-specific complications , or recurrent infection requiring antibiotic treatment within 30 days , with a predefined noninferiority boundary of 7.5 % ; and antibiotic exposure and adverse effects from antibiotics . RESULTS The rate of overall adverse outcomes was similar in the PCT and control groups ( 15.4 % [ n = 103 ] vs 18.9 % [ n = 130 ] ; difference , -3.5 % ; 95 % CI , -7.6 % to 0.4 % ) . The mean duration of antibiotics exposure in the PCT vs control groups was lower in all patients ( 5.7 vs 8.7 days ; relative change , -34.8 % ; 95 % CI , -40.3 % to -28.7 % ) and in the subgroups of patients with community-acquired pneumonia ( n = 925 , 7.2 vs 10.7 days ; -32.4 % ; 95 % CI , -37.6 % to -26.9 % ) , exacerbation of chronic obstructive pulmonary disease ( n = 228 , 2.5 vs 5.1 days ; -50.4 % ; 95 % CI , -64.0 % to -34.0 % ) , and acute bronchitis ( n = 151 , 1.0 vs 2.8 days ; -65.0 % ; 95 % CI , -84.7 % to -37.5 % ) . Antibiotic-associated adverse effects were less frequent in the PCT group ( 19.8 % [ n = 133 ] vs 28.1 % [ n = 193 ] ; difference , -8.2 % ; 95 % CI , -12.7 % to -3.7 % ) . CONCLUSION In patients with LRTIs , a strategy of PCT guidance compared with st and ard guidelines result ed in similar rates of adverse outcomes , as well as lower rates of antibiotic exposure and antibiotic-associated adverse effects . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N95122877 To assess the diagnostic value of procalcitonin ( PCT ) , interleukin (IL)-6 , IL-8 , and st and ard measurements in identifying critically ill patients with sepsis , we performed prospect i ve measurements in 78 consecutive patients admitted with acute systemic inflammatory response syndrome ( SIRS ) and suspected infection . We estimated the relevance of the different parameters by using multivariable regression modeling , likelihood-ratio tests , and area under the receiver operating characteristic curves ( AUC ) . The final diagnosis was SIRS in 18 patients , sepsis in 14 , severe sepsis in 21 , and septic shock in 25 . PCT yielded the highest discriminative value , with an AUC of 0.92 ( CI , 0.85 to 1.0 ) , followed by IL-6 ( 0.75 ; CI , 0.63 to 0.87 ) , and IL-8 ( 0.71 ; CI , 0.59 to 0.83 ; p < 0.001 ) . At a cutoff of 1.1 ng/ml , PCT yielded a sensitivity of 97 % and a specificity of 78 % to differentiate patients with SIRS from those with sepsis-related conditions . Median PCT concentrations on admission ( ng/ ml , range ) were 0.6 ( 0 to 5.3 ) for SIRS ; 3.5 ( 0.4 to 6.7 ) for sepsis ; 6.2 ( 2.2 to 85 ) for severe sepsis ; and 21.3 ( 1.2 to 654 ) for septic shock ( p < 0.001 ) . The addition of PCT to a model based solely on st and ard indicators improved the predictive power of detecting sepsis ( likelihood ratio test ; p = 0.001 ) and increased the AUC value for the routine value-based model from 0.77 ( CI , 0.64 to 0.89 ) to 0.94 ( CI , 0.89 to 0.99 ; p = 0.002 ) . In contrast , no additive effect was seen for IL-6 ( p = 0.56 ) or IL-8 ( p = 0.14 ) . Elevated PCT concentrations appear to be a promising indicator of sepsis in newly admitted , critically ill patients capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection Background : Procalcitonin is released in response to bacterial infection and it is not released in Inflammatory and viral diseases . Objective : To show the diagnostic efficacy and prognostic value of procalcitonin for sepsis . Methods : A consecutive series of 103 patients with suspected sepsis were admitted to the intensive care unit over a 2-year period . During the first 24 hours of the admission procalcitonin , C-reactive protein , and complement proteins were determined . The diagnostic efficacy was tested with predictive values , likelihood ratios , receiver operating characteristic curves , and multiple logistic regression . The association of procalcitonin with mortality was assessed by the Multivariate Cox proportional hazards model . Results : Procalcitonin had a better positive likelihood ratio than C-reactive protein —2.2 ( 95 % confidence interval : 1.3 - 3.7 ) versus 1.1 ( 95 % confidence interval : 0.9 - 1.2 ) . Sequential Organ Failure Assessment yielded the highest discriminative value , with an area under the curve of 0.82 ( 95 % confidence interval : 0.73 - 0.92 ) , followed by procalcitonin ( 0.81 ; 95 % confidence interval : 0.72 - 0.89 ) . Multivariate regression analysis showed  procalcitonin  ( adjusted odds ratio : 3.8 ; 95 % confidence interval : 1.2 - 11.8 ) and Sequential Organ Failure Assessment score ( adjusted odds ratio : 5.3 ; 95 % confidence interval : 1.4 - 19.9 ) as the only variables independently associated with infection . Multivariate Cox regression analysis revealed that procalcitonin was not independently associated with mortality . Conclusions : The diagnostic accuracy of procalcitonin was higher than C-reactive protein and complement proteins . Procalcitonin in combination with Sequential Organ Failure Assessment was useful to diagnose infection . C-reactive protein , Sequential Organ Failure Assessment score , age , and gender showed to be helpful to improve the prediction of mortality risk , but not procalcitonin Background A comparison of the amount of and the kinetics of induction of procalcitonin ( PCT ) with that of C-reactive protein ( CRP ) during various types of and severities of multiple trauma , and their relation to trauma-related complications , was performed . Methods Ninety adult trauma patients admitted to the intensive care unit of our tertiary care hospital were evaluated in a prospect i ve case study . During the initial 24 hours after trauma the Injury Severity Score , the Sepsis-related Organ Failure Assessment score , and the Acute Physiology and Chronic Health Evaluation II score were evaluated .  PCT , CRP , the sepsis criteria ( American College of Chest Physicians/Society of Critical Care Medicine definitions ) , and the Sepsis-related Organ Failure Assessment score  were measured at days 1–7 , as well as at days 14 and 21 , concluding the observation period with the 28-day survival . Results The induction of PCT and CRP  varied in patients suffering from trauma .  PCT  increased only moderately in most patients and peaked at day 1–2 after trauma , the concentrations rapidly declining thereafter . CRP ubiquitously increased and its kinetics were much slower . Complications such as sepsis , infection , blood transfusion , prolonged intensive care unit treatment , and poor outcome were more frequent in patients with initially high PCT ( > 1 ng/ml ) , whereas increases of CRP showed no positive correlation . Conclusion In patients with multiple trauma due to an accident , the PCT level provides more information than the CRP level since only moderate amounts of PCT are induced , and higher concentrations correlate with more severe trauma and a higher frequency of various complications , including sepsis and infection . Most importantly , the moderate trauma-related increase of PCT and the rapidly declining concentrations provide a baseline value near to the normal range at an earlier time frame than for CRP , thus allowing a faster and more valid prediction of sepsis during the early period after trauma Procalcitonin serum level has been recommended as a new marker of bacterial infectious diseases . The aim of this prospect i ve , multicenter study was to determine the clinical usefulness of procalcitonin in differentiating patients with sepsis from those with severe sepsis . Eighty-two patients were enrolled : 20 without systemic inflammatory response syndrome ( SIRS ) , 9 with SIRS , 34 with sepsis , and 19 with severe sepsis . The patients with severe sepsis had significantly higher  procalcitonin levels ( median , 36.1 ng/ml ) than those with sepsis ( median , 0.6 ng/ml ) . With a procalcitonin cutoff value of 2.0 ng/ml , sensitivity for the detection of severe sepsis and specificity for the detection of sepsis were 94.7 % and 78.1 % , respectively . A good correlation was found between the serum procalcitonin level and the Sepsis-Related Organ Failure Assessment ( SOFA ) score ( r = 0.680 ) , although no correlation was found between the C-reactive protein ( CRP ) level and the SOFA score . In conclusion , the procalcitonin serum level may be useful not only for aiding the diagnosis of sepsis but also for discriminating between sepsis and severe sepsis BACKGROUND / AIMS In surgical sepsis , the rapid identification of source of infection at an early stage after surgery or serious trauma is crucial for favorable outcome . The discrimination between local and generalized infection is critical for correct treatment . METHODOLOGY In a r and omized , controlled , single-centre study we investigated 72 patients with severe sepsis after major abdominal surgery or surgery for multiple trauma . Patients were divided in 2 groups : in the first group ( PCT , n=38 ) , more important role in the treatment decision was given to  PCT level ( severe sepsis with PCT > 2 ng/mL signalled bacteremia and pushed us to change antibiotics and intravascular devices , severe sepsis with PCT < or = 2 ng/mL prompted use of ultrasonography and /or CT , followed by repeated surgery in patients with localized infection ) . The control group ( CON , n=34 ) was treated by st and ard evaluation of all parameters by consultant surgeon . We investigated 28-day all-cause mortality , sepsis-related complications , the duration of stay in the intensive care unit , and ventilated days . RESULTS The hospital mortality was in PCT group 26 % and 38 % in control group ( p = 0.28 ) . Average SOFA score was 7.9 + /- 2.8 in PCT group vs. 9.3 + /- 3.3 ( p = 0.06 ) . The decline of ICU days ( 16.1 + /- 6.9 vs. 19.4 + /- 8.9 ; p = 0.09 ) and ventilated days ( 10.3 + /- 7.8 vs. 13.9 + /- 9.4 ; p = 0.08 ) in PCT group was observed , but the difference was not significant . CONCLUSIONS We observed a clear tendency to decrease extent of multiple organ dysfunction syndrome in patients , in which therapeutic decision was made earlier using procalcitonin as an additional marker separating local infection from generalized one BACKGROUND Sepsis and organ dysfunction are common and likely contribute to death after burn trauma . We sought to define relationships between sepsis , severe multiple organ dysfunction ( MOD ) , and death after burn trauma . METHODS Adults with > or = 20 % total body surface area burns were prospect ively enrolled . Information regarding infection , severity of sepsis , and organ failure was collected daily . Risk factors ( e.g. , age , burn size , shock ) were analyzed for their association with severe MOD , complicated sepsis , and death . We characterized the temporal relationship between organ failure and sepsis . RESULTS Of 175 patients , 27 % developed severe MOD , 17 % developed complicated sepsis , and 22 % died .  Full-thickness burn size , age , and inhalation injury were associated with M 
    Output:
    
The collective findings of the included studies demonstrated benefit of incorporating procalcitonin assay into clinical sepsis determination .
However , it appears procalcitonin assay is a safe and beneficial addition to the clinical diagnosis of sepsis in the burn intensive care unit