Procalcitonin (PCT) as a Diagnostic Marker of Bacterial Infection in the Patients Admitted for Fever and/or Inflammatory Syndrome to the Internal Medicine Department (PCT-MI)

Levels of PCT (a marker of bacterial infection) are highest during sepsis: in fact, PCT is normally produced by the C cells in the thyroid gland. PCT was initially studied by Assicot1 for distinguishing between bacterial meningitis and viral meningitis. The CALC-I gene codes for PCT. In the absence of infection, the extrathyroid mRNA expression of the CALC-I gene is repressed, and expression is restricted to neuroendocrine thyroid and pulmonary cells. Infection induces the ubiquitous expression of the CALC-I gene. PCT is not transformed into calcitonin in parenchymatous tissues. In a context of sepsis, the whole body acts as a neuroendocrine gland. Sepsis upregulates PCT mRNA expression much more than that of other cytokines.

PCT is used in critical care departments as a diagnostic marker, a guide to treatment (antibiotics are withdrawn if the level falls) and a prognostic marker.

There are few data on the diagnostic use of PCT in an internal medicine department. The available studies yielded contradictory results and only one prospective study has been performed . The objective was to study PCT in non-infectious, inflammatory pathologies and to establish whether PCT could distinguish infections from other inflammatory pathologies in patients in an internal medicine department. In a ROC curve analysis, a PCT threshold of 0.35 µmol/l gave the greatest specificity (88%) and sensitivity (72%). Other studies have been performed but featured small sample sizes and a retrospective design.

Of the various studies performed in internal medicine departments, none included patients presenting with a suspected bacterial infection (according to the clinician's interpretation) and lacking information on their bacterial status. In fact, these diagnoses are a core component of hospitalisation in internal medicine departments for fever or inflammatory syndrome. The investigators intend to include all patients, including those lacking information on their microbiological status).

Study Overview

• Status: Completed
• Conditions: Systemic Inflammatory Response Syndrome; Fever
• Intervention / Treatment: Biological: Procalcitonin (PCT) as a diagnostic marker of bacterial infection

• Study Type: Observational
• Enrollment (Actual): 116

Contacts and Locations

Study Locations

• France
  • Amiens, France, 80054
    • CHU Amiens

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 16 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Patients aged 18 or over hospitalized in the internal medicine department at Amiens University Hospital, presenting with fever (>38.5°C) and/or inflammatory syndrome (CRP >5 mg/l)

Description

Inclusion Criteria:

• Patients aged 18 or over hospitalized in the internal medicine department at Amiens University Hospital, presenting with fever (>38.5°C) and/or inflammatory syndrome (CRP >5 mg/l) and having given their consent will be included.

Exclusion Criteria:

• Haemodialyzed patients.
• Age under 18.
• Legal guardianship.
• Refusal by the patient, or inability to give consent.
• Patients on antibiotics for more than 12 hours at the time of the PCT assay (the half-life of PCT is 22 hours, and the level falls rapidly when antibiotics are administered).
• PCT assays more than 12 hours after hospitalisation.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PCT level	to determine whether PCT is a good diagnostic marker in patients presenting with fever and/or inflammatory syndrome	Day 0

Collaborators and Investigators

• Sponsor: Centre Hospitalier Universitaire, Amiens

Study record dates

Study Major Dates

• Study Start (Actual): February 11, 2016
• Primary Completion (Actual): October 18, 2016
• Study Completion (Actual): October 18, 2016

Study Registration Dates

• First Submitted: September 5, 2016
• First Submitted That Met QC Criteria: September 8, 2016
• First Posted (Estimate): September 13, 2016

Study Record Updates

• Last Update Posted (Actual): January 23, 2019
• Last Update Submitted That Met QC Criteria: January 21, 2019
• Last Verified: January 1, 2019

More Information

Terms related to this study

• Keywords: procalcitonin; bacterial infection
• Additional Relevant MeSH Terms: Pathologic Processes; Inflammation; Disease; Bacterial Infections and Mycoses; Shock; Body Temperature Changes; Syndrome; Infections; Fever; Bacterial Infections; Systemic Inflammatory Response Syndrome
• Other Study ID Numbers: RNI2015-38 Dr Schmidt