Procalcitonin as a marker of bacterial infection in the emergency department: an observational study

Yi-Ling Chan, Ching-Ping Tseng, Pei-Kuei Tsay, Shy-Shin Chang, Te-Fa Chiu, Jih-Chang Chen, Yi-Ling Chan, Ching-Ping Tseng, Pei-Kuei Tsay, Shy-Shin Chang, Te-Fa Chiu, Jih-Chang Chen

Abstract

Introduction: Procalcitonin (PCT) has been proposed as a marker of infection in critically ill patients; its level is related to the severity of infection. We evaluated the value of PCT as a marker of bacterial infection for emergency department patients.

Methods: This prospective observational study consecutively enrolled 120 adult atraumatic patients admitted through the emergency department of a 3000-bed tertiary university hospital in May 2001. Fifty-eight patients were infected and 49 patients were not infected. The white blood cell counts, the serum C-reactive protein (CRP) level (mg/l), and the PCT level (ng/ml) were compared between the infected and noninfected groups of patients.

Results: A white blood cell count >12,000/mm3 or <4000/mm3 was present in 36.2% of the infected patients and in 18.4% of the noninfected patients. The best cut-off serum levels for PCT and CRP, identified using the Youden's Index, were 0.6 ng/ml and 60 mg/l, respectively. Compared with CRP, PCT had a comparable sensitivity (69.5% versus 67.2%), a lower specificity (64.6% versus 93.9%), and a lower area under the receiver operating characteristic curve (0.689 versus 0.879). PCT levels, but not CRP levels, were significantly higher in bacteremic and septic shock patients. Multivariate logistic regression identified that a PCT level >/= 2.6 ng/ml was independently associated with the development of septic shock (odds ratio, 38.3; 95% confidence interval, 5.6-263.5; P < 0.001).

Conclusions: PCT is not a better marker of bacterial infection than CRP for adult emergency department patients, but it is a useful marker of the severity of infection.

Figures

Figure 1
Figure 1
C-reactive protein (CRP) and procalcitonin (PCT) concentrations in infected and noninfected patients. Bar represents the median.
Figure 2
Figure 2
Receiver operating characteristic curves of C-reactive protein (open circle), of procalcitonin (solid triangle), and of the white blood cell count (open triangle) in (a) the diagnosis of infection and (b) predicting septic shock.
Figure 3
Figure 3
Median C-reactive protein (CRP) and procalcitonin (PCT) concentrations in bacteremic patients, nonbacteremic patients, noninfected patients, systemic inflammatory response syndrome (SIRS) patients, sepsis patients, and septic shock patients. * P < 0.001.

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