Efficacy of Procalcitonin in the Early Diagnosis of Bacterial Infections in a Critical Care Unit

Abstract

Procalcitonin (PCT) is a marker of severe bacterial infections and organ failure due to sepsis. The purpose of the present study was to identify the appropriate cutoff level of PCT based on the findings of a blood culture and polymerase chain reaction (PCR). The PCT levels were measured in 116 patients in an intensive care unit who were suspected of having bacteremia, to examine its relationship with a blood culture or PCR. The PCT levels were significantly high in patients with bacteremia, but they were also moderately high in some patients who were positive for fungus DNA. The area under the curve was significantly higher for PCT than for C-reactive protein. The appropriate cutoff values of PCT for bacteremia were 0.38 microg/L for the high negative predictive value and 0.83 microg/L for the high positive predictive value. Procalcitonin was slightly related to mortality, and the combination of a blood culture and PCR was thus found to increase the sensitivity for mortality. These findings suggest that PCT is useful for the diagnosis of bacteremia and that the diagnostic value of PCT in combination a with blood culture and PCR for bacterial infection or mortality further increases.

Predictive value of procalcitonin decrease in patients with severe sepsis: a prospective observational study

“…High PCT concentrations in septic shock or blood culture-positive patients were found in other studies [15,36,37]. Using PCT levels of greater than 0.5 ng/mL as the diagnostic criteria could decrease the need for blood cultures in patients with community-acquired pneumonia by 52% while still identifying 88% of positive cultures [38].…”

Usefulness of several biomarkers in the management of septic patients: C-reactive protein, procalcitonin, presepsin and mid-regional pro-adrenomedullin

“…A large number of studies support the relevant role of PCT as biomarker for the diagnosis of sepsis [12][13][14][15][16][17][18][19]. We would Brought to you by | Carleton University OCUL Authenticated Download Date | 6/22/15 10:29 PM like to contribute through the comparison of PCT with three biomarkers, the well known CRP and the relatively recent presepsin and MR-proADM, in ICU patients regardless of the affected organ that was the origin of sepsis.…”

“…This could be due to the fact that our study was conducted exclusively in patients admitted in the ICU service that met criteria of SS or SSh according to the Surviving Sepsis Campaign [1], the case/control design that considered as controls, non-septic patients from the same ICU [12,13,17,18], and also to the fact that for evaluating the diagnostic efficiency of SSh and SS we used as gold standard the discharge report to confirm the pathology both in cases and controls. However, a recent article review the sepsis definitions because the possible interchangeably concepts of sepsis and SS.…”

Early procalcitonin kinetics and adequate empiric antibiotic therapy in critically ill

“…Another important finding of the current study is that CRP did not differentiate between the appropriate and inappropriate groups within the first 48 hours while changes in the PCT levels gave a significant signal within the first 24 hours regarding the adequacy of empirical antibiotic therapy. This is in accordance with previously published data indicating that CRP is a "slow" marker and not as reliable as PCT in the critically ill [83,84]. The same holds true for body temperature, which as with other studies, highlights that its use for guiding antimicrobial therapy is questionable [35].…”