Serum Procalcitonin Level, Viral Polymerase Chain Reaction Analysis, and Lower Respiratory Tract Infection

Musher, Daniel M.; Bebko, Serge P.; Roig, Ingrid L.

doi:10.1093/infdis/jit579

Cited by 25 publications

(23 citation statements)

References 6 publications

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“…In previous studies, PCT had been suggested to be a helpful biomarker for early diagnosis of sepsis in critically ill patients [12], lower respiratory tract infection [13], and community-acquired pneumonia [14]. Similarly, in our study, we found that serum PCT levels might be useful as an independent diagnostic marker for AIS.…”

Section: Discussionsupporting

confidence: 83%

Serum procalcitonin as a diagnostic marker in acute ischemic stroke

Tian¹,

Zhang

et al. 2015

NeuroReport

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The aim of the study was to assess the relationship between procalcitonin (PCT) serum levels and acute ischemic stroke (AIS) in a Chinese sample. All consecutive patients with first-ever AIS between January 2012 and December 2013 were recruited to participate in the study. PCT levels and National Institutes of Health Stroke Scale scores were evaluated at the time of admission. Logistic regression analysis was used to evaluate the risk for stroke according to serum PCT levels. The results indicated that serum PCT levels were significantly higher in AIS patients as compared with normal controls (P<0.0001). PCT levels increased with increasing severity of stroke, as defined by the National Institutes of Health Stroke Scale score. After adjusting for all other possible covariates, PCT level was found to be associated with an increased risk for AIS, with an adjusted odds ratio of 2.244 (95% confidence interval 1.563-3.756, P<0.0001). On the basis of the receiver operating characteristic curve, the optimal cutoff value of serum PCT levels as an indicator for auxiliary diagnosis of AIS was projected to be 1.20 ng/ml, which yielded a sensitivity of 79.6% and a specificity of 72.1%, with the area under the curve at 0.801 (95% confidence interval 0.762-0.844). An elevated serum level of PCT was a novel, independent diagnostic marker of AIS in the Chinese sample. Further study is needed to confirm these results.

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Section: Discussionsupporting

confidence: 83%

Serum procalcitonin as a diagnostic marker in acute ischemic stroke

Tian¹,

Zhang

et al. 2015

NeuroReport

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“…However, these markers are sensitive to inter-patient variability, including time from symptom onset, clinical syndrome, and pathogen species [22][23][24][25][26][27]. For example, multiple studies found that procalcitonin is valuable for guiding antimicrobial therapy duration and for predicting disease severity [28][29][30], however its diagnostic accuracy for detecting bacterial etiology in cases such as sepsis and pneumonia has been challenged [23,[31][32][33][34]. Elevated CRP levels are suggestive of a bacterial infection [35], but similar levels may be observed in patients with some viral strains (e.g., adenovirus and influenza) [36], and inflammatory diseases.…”

mentioning

confidence: 99%

A Novel Host-Proteome Signature for Distinguishing between Acute Bacterial and Viral Infections

et al. 2015

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Bacterial and viral infections are often clinically indistinguishable, leading to inappropriate patient management and antibiotic misuse. Bacterial-induced host proteins such as procalcitonin, C-reactive protein (CRP), and Interleukin-6, are routinely used to support diagnosis of infection. However, their performance is negatively affected by inter-patient variability, including time from symptom onset, clinical syndrome, and pathogens. Our aim was to identify novel viral-induced host proteins that can complement bacterial-induced proteins to increase diagnostic accuracy. Initially, we conducted a bioinformatic screen to identify putative circulating host immune response proteins. The resulting 600 candidates were then quantitatively screened for diagnostic potential using blood samples from 1002 prospectively recruited patients with suspected acute infectious disease and controls with no apparent infection. For each patient, three independent physicians assigned a diagnosis based on comprehensive clinical and laboratory investigation including PCR for 21 pathogens yielding 319 bacterial, 334 viral, 112 control and 98 indeterminate diagnoses; 139 patients were excluded based on predetermined criteria. The best performing host-protein was TNF-related apoptosis-inducing ligand (TRAIL) (area under the curve [AUC] of 0.89; 95% confidence interval [CI], 0.86 to 0.91), which was consistently up-regulated in viral infected patients. We further developed a multi-protein signature using logistic-regression on half of the patients and validated it on the remaining half. The signature with the highest precision included both viral- and bacterial-induced proteins: TRAIL, Interferon gamma-induced protein-10, and CRP (AUC of 0.94; 95% CI, 0.92 to 0.96). The signature was superior to any of the individual proteins (P<0.001), as well as routinely used clinical parameters and their combinations (P<0.001). It remained robust across different physiological systems, times from symptom onset, and pathogens (AUCs 0.87-1.0). The accurate differential diagnosis provided by this novel combination of viral- and bacterial-induced proteins has the potential to improve management of patients with acute infections and reduce antibiotic misuse.

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“…The etiology of the remaining 48% is unknown. The infections could be caused by a virus outside the scope of the multiplex assay used, or it could be bacterial or other (12). Regardless of the pathogen causing the ARI, participants did not produce clinically important levels of PCT.…”

Section: Discussionmentioning

confidence: 93%

Procalcitonin Levels in Acute Respiratory Infection

et al. 2016

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Procalcitonin (PCT) is a biomarker of inflammation that is used to help make clinical decisions, like starting antibiotics or admitting a patient to the hospital. While PCT levels have been widely studied in pneumonia, levels in less severe acute respiratory infections (ARI) have not been well studied. To measure PCT levels in otherwise healthy adults during ARI, we followed 99 healthy adults during the cold and flu season, collecting blood specimens for PCT testing at baseline, and when participants presented with ARI. Ninety-six percent of the ARI samples had PCT levels <0.05 ng/mL. The remaining 4% were <0.25 ng/mL. These data suggest that PCT is not a useful test in ARI of mild-to-moderate severity.

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Serum Procalcitonin Level, Viral Polymerase Chain Reaction Analysis, and Lower Respiratory Tract Infection

Cited by 25 publications

References 6 publications

Serum procalcitonin as a diagnostic marker in acute ischemic stroke

Serum procalcitonin as a diagnostic marker in acute ischemic stroke

A Novel Host-Proteome Signature for Distinguishing between Acute Bacterial and Viral Infections

Procalcitonin Levels in Acute Respiratory Infection

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