Diagnostic value of procalcitonin in acutely hospitalized elderly patients

Abstract

The aim of this study was to evaluate procalcitonin as an adjunct to diagnose bacterial infections in older patients. One hundred seventy-two patients admitted to an acute-care geriatric unit during a 6-month period were prospectively included, 39 of them with an invasive bacterial infection. The best cut-off value to rule in a bacterial infection was 0.51 microg/l with sensitivity 64% and specificity 94%. The best cut-off value to rule out a bacterial infection was 0.08 microg/l with sensitivity 97% and specificity 20%. Procalcitonin was inconclusive (between 0.08 and 0.51 microg/l) for 112 admissions. Procalcitonin over 0.51 microg/l was useless 22 times out of 33 (infection already ruled in on clinical grounds) and misleading in eight of the 11 remaining cases (no infection). Procalcitonin below 0.08 microg/l was useless 23 times out of 27 (infection already ruled out on clinical grounds) and misleading in one of the four remaining cases (infection). Despite a good overall diagnostic accuracy, the clinical usefulness of PCT to diagnose invasive bacterial infections in elderly patients hospitalized in an acute geriatric ward appears to be very limited.

Diagnostic value of procalcitonin for bacterial infection in elderly patients - a systemic review and meta-analysis

“…Bacterial infection was diagnosed in 134 patients [overall prevalence, 15.83% (range 9–23%)] (Table ). PCT tests were used in all four studies , and CRP and leucocyte count tests were evaluated in three of them .…”

Diagnostic and prognostic performances of serum procalcitonin in patients with bloodstream infections: A parallel, case-control study comprising adults and elderly

“…27 Among the elderly and immunocompromised patients, however, the classic signs of sepsis may be missing because of decreased inflammatory responses in such patients. 30 In addition, it has been shown that serum PCT levels correlate positively with the severity of inflammatory responses to infections. 31 This can explain why serum procalcitonin is a more reliDiagnostic anD prognostic performances of serum procalcitonin in patients with blooDstream infections: a parallel, case-control stuDy comprising aDults anD elDerly rev assoc Med Bras 2017; 63(6):521-526 525 able indicator of BSIs under 65 years of age.…”

Bacterial Pneumonia in Older Adults

“…The usefulness of PCT in differentiating bacterial pneumonia from other acute illnesses in the real world is controversial. 99,100 In addition, the role of PCT in elderly persons is unclear, because this population group is usually excluded from clinical studies. A recent retrospective study in Italy evaluated the role of CRP in elderly patients who presented to the emergency department with respiratory symptoms and were discharged with or without a final diagnosis of pneumonia.…”