Procalcitonin (PCT) is the 116 amino acid precursor of the hormone calcitonin, produced by the C cells of the thyroid. Its synthesis is upregulated in bacterial infection and downregulated by viral infection. Consequently, with the increasing development of antibiotic resistance, interest has focused on the ability of this marker to not only diagnose infection but to tailor antibiotic treatment and help reduce the development of antibiotic resistance. The value of PCT depends on the specific clinical situation and pretest probability of disease. This article discusses the role of PCT in these different situations, namely primary care, the emergency department and the intensive care unit. The true cost effectiveness of this test remains difficult to prove as evidence for the potential impact of using PCT on slowing the development of bacterial resistance remains largely circumstantial.
Introduction: Accurate and early detection of sepsis poses a significant challenge in burn populations. Our objective was to assess whether procalcitonin is a marker of blood culture positive sepsis in moderate to severe paediatric burns. Methods: We analysed procalcitonin levels in 27 children admitted with burns of 15-65% total body surface area. Procalcitonin was measured at admission (baseline), 24 and 48 h post-admission and during periods of suspected sepsis (diagnosed against pre-defined criteria). Patients were categorised into controls with no episodes of suspected sepsis (n ¼ 10) and those with episodes of suspected sepsis (n ¼ 17). The latter were split into two groups based on blood culture results: culture positive (bacteraemia) and culture negative patients. Results: Baseline procalcitonin levels increased with burn size (odds ratio (95% confidence interval): 1.15 (1.02-1.29)). Suspected sepsis patients had larger burns than controls (median 31 vs. 20%; p ¼ 0.003). Only 5/23 suspected sepsis episodes were blood culture positive. Procalcitonin levels were similar in culture positive and culture negative patients (p ¼ 0.43). Sensitivity for predicting positive blood culture was 100% (95% confidence interval: 47.8-100.0%) but specificity was only 22.2% (95% confidence interval: 6.4-47.6%). Area under the curve was poor at 0.62 (95% confidence interval: 0.33-0.90). There was no significant change in procalcitonin levels from baseline to septic episode in either group (positive: p ¼ 0.35; negative: p ¼ 0.95). Conclusion: We conclude that evidence for the use of procalcitonin to diagnose bacteraemia in this population is poor, with burn size playing a significant role implying a correlation with systemic inflammation rather than sepsis.
Having recently taken up a new post and office, I was lucky enough to inherit a series of Annals dating back to the 1970s. I'm sure there are some out there with an older and more extensive archive but I none the less felt compelled to explore and share some of my discoveries with you.In my laboratory we are about to embark on the purchase and evaluation of new analysers. I was consequently tempted by an article looking at the Greiner Selective Analyser. 1 It described the evaluation of six of the 18 available methods in terms of reliability, accuracy and precision. Economy of operation, temperature control and electrical/mechanical safety were also assessed! The analyser was capable of performing up to 30 different tests, selected on the basis of a pattern of holes punched in card, and worked at a rate of 300 tests per hour. Compare this to today's analysers with over 1200 tests per hour and an extensive menu of over 170 plus tests.Correlations were performed against an SMA 12/60 analyser -there was not a difference plot in sight. I think the best part for me was (and I quote) 'inspection was made to see if injury could be caused to the operator by electrical shock or mechanical means during normal operation of the machine. . .'. I'm assuming operator consent and ethical approval for this assessment was obtained?Demand management in the 1970s presented some interesting ideas and concepts. 2 The article was introduced by the question 'If a visitor from a distant world arrived in the department of chemical pathology, one of his first comments may be to ask. . ..'; the same may apply today. The author questions the continued survival of the chloride test and the value of producing results which were not asked for or tests requested only for their known availability. Sound familiar? The article suggests the issue is caused by clinical research, medical consultations and the laboratory working in isolation and the increase in automation. Diabetes,
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