Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study

Abstract

Purpose. To investigate whether absolute value of procalcitonin (PCT) or the change (delta-PCT) is better indicator of infection in intensive care patients. Materials and Methods. Post hoc analysis of a prospective observational study. Patients with suspected new-onset infection were included in whom PCT, C-reactive protein (CRP), temperature, and leukocyte (WBC) values were measured on inclusion (t 0) and data were also available from the previous day (t −1). Based on clinical and microbiological data, patients were grouped post hoc into infection- (I-) and noninfection- (NI-) groups. Results. Of the 114 patients, 85 (75%) had proven infection. PCT levels were similar at t −1: I-group (median [interquartile range]): 1.04 [0.40–3.57] versus NI-group: 0.53 [0.16–1.68], p = 0.444. By t 0 PCT levels were significantly higher in the I-group: 4.62 [1.91–12.62] versus 1.12 [0.30–1.66], p = 0.018. The area under the curve to predict infection for absolute values of PCT was 0.64 [95% CI = 0.52–0.76], p = 0.022; for percentage change: 0.77 [0.66–0.87], p < 0.001; and for delta-PCT: 0.85 [0.78–0.92], p < 0.001. The optimal cut-off value for delta-PCT to indicate infection was 0.76 ng/mL (sensitivity 80 [70–88]%, specificity 86 [68-96]%). Neither absolute values nor changes in CRP, temperature, or WBC could predict infection. Conclusions. Our results suggest that delta-PCT values are superior to absolute values in indicating infection in intensive care patients. This trial is registered with ClinicalTrials.gov identifier: NCT02311816.

Procalcitonin Increase Is Associated with the Development of Critical Care-Acquired Infections in COVID-19 ARDS

“…As such, our study employed a predetermined rise in PCT, utilising trends in serial PCT levels rather than a critical tipping point as an indicator for secondary infection, which could be adopted in clinical practice. PCT kinetics have been successfully used to detect nosocomial infections and to monitor the appropriateness of antimicrobial therapy [ 25 , 26 , 27 , 28 , 29 , 30 ]. Our definition of PCT rise was based on these previous trials, to provide an easily accessible clinical tool at the bedside.…”

Response to “The role of procalcitonin in the diagnosis and management of infections in the field of obstetrics and gynecology”

“…3 However, there is evidence that the trend of PCT could be clinically more useful than a single concentration. 4 This seems to be the case also in obstetrics. Some parturients may have high PCT early after delivery without evident infection.…”

Role of repeat procalcitonin estimation at 48 hours for outcome in pregnancy associated sepsis: a prospective observational study

“…PCT continues to be investigated in several observational and interventional studies. It has been demonstrated to have good performance characteristics for the identification of bacterial infection and sepsis [2,[17][18][19][20][21]. However, the evidence on PCT guided antibiotic therapy is less forthcoming.…”