Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report

Pierre Emmanuel Charles, Emmanuel Kus, Serge Aho, Sébastien Prin, Jean-Marc Doise, Nils-Olivier Olsson, Bernard Blettery, Jean-Pierre Quenot, Pierre Emmanuel Charles, Emmanuel Kus, Serge Aho, Sébastien Prin, Jean-Marc Doise, Nils-Olivier Olsson, Bernard Blettery, Jean-Pierre Quenot

Abstract

Background: The usefulness of procalcitonin (PCT) measurement in critically ill medical patients with suspected nosocomial infection is unclear. The aim of the study was to assess PCT value for the early diagnosis of bacterial nosocomial infection in selected critically ill patients.

Methods: An observational cohort study in a 15-bed intensive care unit was performed. Seventy patients with either proven (n = 47) or clinically suspected but not confirmed (n = 23) nosocomial infection were included. Procalcitonin measurements were obtained the day when the infection was suspected (D0) and at least one time within the 3 previous days (D-3 to D0). Patients with proven infection were compared to those without. The diagnostic value of PCT on D0 was determined through the construction of the corresponding receiver operating characteristic (ROC) curve. In addition, the predictive value of PCT variations preceding the clinical suspicion of infection was assessed.

Results: PCT on D0 was the best predictor of proven infection in this population of ICU patients with a clinical suspicion of infection (AUROCC = 0.80; 95% CI, 0.68-0.91). Thus, a cut-off value of 0.44 ng/mL provides sensitivity and specificity of 65.2% and 83.0%, respectively. Procalcitonin variation between D-1 and D0 was calculated in 45 patients and was also found to be predictive of nosocomial infection (AUROCC = 0.89; 95% CI, 0.79-0.98) with a 100% positive predictive value if the +0.26 ng/mL threshold value was applied. Comparable results were obtained when PCT variation between D-2 and D0, or D-3 and D0 were considered. In contrast, CRP elevation, leukocyte count and fever had a poor predictive value in our population.

Conclusion: PCT monitoring could be helpful in the early diagnosis of nosocomial infection in the ICU. Both absolute values and variations should be considered and evaluated in further studies.

Figures

Figure 1
Figure 1
Flow chart of the study. PCT: procalcitonin; VAP: Ventilator Associated Pneumonia; ICU: Intensive Care Unit.
Figure 2
Figure 2
Kinetic of procalcitonin in the serum of patients with (black line) or without (gray line) nosocomial infection in the ICU. PCT: procalcitonin.*: p < 0.05.
Figure 3
Figure 3
ROC curves of PCT D0 (A) and ΔPCTD-1, D0 *(B) for differentiating between patients with or without nosocomial infection in the ICU: AUROCC = 0.80; 95% CI, 0.68–0.91 and 0.89; 95% CI, 0.79–0.98, respectively. ICU: intensive care unit; PCT: procalcitonin; ΔPCTD-1, D0 = PCT D0 – PCT D-1; D0: day when infection is suspected. *available in 45 out of the 70 included patients.

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