864: Usefulness of measuring procalcitonin (PTC) in pregnancy for the initial diagnosis of bacterial infection with systemic features

Abstract

Diagnosing sepsis in pregnancy correctly and timely is a challenge, given the similarities between infection signs and symptoms and pregnancy physiological changes. PCT, a prohormone, rises early in infectious processes, in non pregnant patients. We hypothesize that PTC can be useful in pregnancy to identify and differentiate the origin of infections with systemic features (bacterial vs other causes) Prospective cross-sectional study of cases and controls, conducted between January 2015 and October 2016 at the Hospital Universitario San Vicente Fundación and the Faculty of Medicine of the University of Antioquia (Medellín, Colombia), an IRB approved. The sample size was calculated with a power of 80% and an alpha level of 5%. Definitions from the 2012 surviving sepsis campaign were utilized. PTC was measured in plasma and processed by the BRAHMS technique (enzyme immunoassay test - final fluorescence detection). Exclusion criteria were: taking antibiotics within 4 weeks prior, diabetes, hypertension, known immunosuppression. 98 pregnant patients with suspicion or certainty of infection and 45 without infection were included at admission to the obstetric emergency service. Qualitative variables are presented in frequencies. Quantitative variables are presented as medians, with comparison of PCT levels between groups by the Mann-Whitney U-test. The discriminative capacity of PCT was determined by receiver operating characteristic curve (ROC) analysis. Demographic and clinical characteristics are presented in Table 1. PCT values were higher for patients with bacterial infection than for non-infected women (p ≤0.0001) and for patients with non-bacterial infection (p = 0.027). The area under the ROC curve to discriminate women with bacterial infection from uninfected women was 0.73 (95% CI 0.648-0.826) (Figure 1). A PCT cutoff of 0.06 ng / ml provided the optimal balance between sensitivity and specificity for the diagnosis of bacterial sepsis (60% and 84%, respectively) PTC is a marker that rises significantly in pregnant women with bacterial infection, and it has a strong capacity to identify those with bacterial sepsis. PTC levels can be useful in complementing clinical findings and other tests utilized for the diagnosis of sepsis in pregnancy in a more reliability and timely wayView Large Image Figure ViewerDownload Hi-res image Download (PPT)