Serum procalcitonin as a biomarker of bloodstream infection & focal bacterial infection in febrile patients

Abstract

Background & objectives: Bacteraemia is a serious form of infection in patients presenting with fever, thus, there is a necessity for a biomarker for rapid diagnosis of bacteraemia in such patients to make better therapeutic decisions. This study was conducted to measure the serum procalcitonin (PCT) levels at the time of initial presentation as a biomarker for identifying bacteraemia and as a predictor of mortality in patients admitted with acute fever. Methods: Four hundred and eighty patients, who presented with acute fever requiring admission to a tertiary care teaching hospital in south India, were prospectively studied. All patients were evaluated with a detailed history, physical examination, laboratory and imaging studies. Baseline serum PCT was measured for each patient within six hours of admission. Results: Among patients with single infectious cause (n=275), significantly higher median serum PCT levels were evident in bacteraemia compared to leptospirosis ( P =0.002), dengue ( P <0.001), scrub typhus ( P <0.001) and evident focus of infection without bacteraemia ( P =0.036). By receiver-operator characteristic curve analysis, at a cut-off value of >3.2 ng/ml, the sensitivity and specificity of serum PCT levels in predicting bacteraemia were 81.1 and 63.3 per cent, respectively. As per the worst-case scenario analysis, 91 (18.9%) patients had a poor outcome and these had significantly higher median serum PCT levels compared to survivors (n=389) [9.46 (2.03-44.4) vs. 1.23 (0.34-7.645); P <0.001]. At a cut-off value of >3.74 ng/ml, serum PCT levels at initial presentation predicted in-hospital mortality with a sensitivity and specificity of 67 and 67.5 per cent, respectively. Interpretation & conclusions: Our observations suggest that serum PCT level may be a useful biomarker for identifying bacteraemia as well as predicting mortality in patients with acute fever requiring admission to hospital.

Evaluation of Plasmatic Procalcitonin in Healthy, and in Systemic Inflammatory Response Syndrome (SIRS) Negative or Positive Colic Horses

“…Procalcitonin (PCT) has been studied over the last few years as a biomarker of inflammation and/or infection, both in human [22] and in large animal species [13][14][15][16][17][18][19][20][21][23][24][25][26]. The aims of this study were to evaluate the potential differences in plasma PCT concentrations between healthy vs. SIRS-negative vs. SIRS-positive horses in order to understand if PCT can be a useful biomarker to distinguish between these conditions and drive clini-cal decisions of equine veterinarians and SIRS score in order to verify if this biomarker could be useful for the evaluation of SIRS severity.…”