Utility of Procalcitonin as an Early Diagnostic Marker of Bacteremia in Patients with Acute Fever

Abstract

PurposeProcalcitonin (PCT) is a current, frequently used marker for severe bacterial infection. The aim of this study was to assess the ability of PCT levels to differentiate bacteremic from nonbacteremic patients with fever. We assessed whether PCT level could be used to accurately rule out a diagnosis of bacteremia.Materials and MethodsSerum samples and blood culture were obtained from patients with fever between August 2008 and April 2009. PCT was analyzed using a VIDAS® B.R.A.H.M.S PCT assay. We reviewed the final diagnosis and patient histories, including clinical presentation and antibiotic treatment.ResultsA total of 300 patients with fevers were enrolled in this study: 58 with bacteremia (positive blood culture) (group I); 137 with local infection (group II); 90 with other diseases (group III); and 15 with fevers of unknown origin (group IV). PCT levels were significantly higher in patients with bacteremia than in those with non-bacteremia (11.9 ± 25.1 and 2.5 ± 14.7 ng/mL, respectively, p < 0.001). The sensitivity and specificity were 74.2% and 70.1%, respectively, at a cut-off value of 0.5 ng/mL. A serum PCT level of < 0.4 ng/mL accurately rules out diagnosis of bacteremia.ConclusionIn febrile patients, elevated PCT may help predict bacteremia; furthermore, low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore, PCT assessment could help physicians limit the number of prescriptions for antibiotics.

Is Procalcitonin a more sensitive parameter than other Acute Phase Reactants for early infection in arthroplasty?

“…In the current study, pre-op values of PCT were measured below 0.5 ng/ml. Kim et al demonstrated that a cut-off PCT concentration of 0.4 ng/ml was able to rule out bacteremia in patients with acute fever [7]. In the present study, the average post-op PCT levels for both groups of patients were higher than the normal interval.…”

Procalcitonin in the assessment of bacteraemia in emergency department patients: results of a large retrospective study

“…10 In addition, Kim et al have reported that when PCT cut-off concentrations of 0.05-5.98 ng/mL were used, the PPVs were 14.0-48.0% and NPVs were 94.0-99.0%. 16 These two studies and two additional reports indicate that the PPV at which the PCT concentrations indicate bacteraemia is generally about 50%, although this will differ depending on the cut-off concentration, the patient group, and the hospital. 9,11,16,17 In a recent meta-analysis of studies on bacteraemia markers, Jones et al reported only moderate diagnostic performance for PCT as a single test for diagnosing bacteraemia in emergency department patients, demonstrating a sensitivity of 76% and a specificity of 73% at a cut-off concentration of 0.4-0.5 ng/mL.…”

Procalcitonin and proinflammatory parameters in diabetic foot infection as new predictive factor

“…Infection characterizes the presence of an inflammatory response and tissue injury as a result of host interaction with multiplying bacteria [11]. The early recognition of infection is paramount in the management of diabetic foot disease, thus a rapid and reliable test to rule out bacterial infection would be helpful in decision making [14].…”