Diagnostic Value Of Serum Procalcitonin Research Articles

Diagnostic value of procalcitonin in patients with periprosthetic joint infection: a diagnostic meta-analysis.

The success rate of periprosthetic joint infection (PJI) treatment is still low. Early diagnosis is the key to successful treatment. Therefore, it is necessary to find a biomarker with high sensitivity and specificity. The diagnostic value of serum procalcitonin (PCT) for PJI was systematically evaluated to provide the theoretical basis for clinical diagnosis and treatment in this study. We searched the Web of Science, Embase, Cochrane Library, and PubMed for studies that evaluated the diagnostic value of serum PCT for PJI (from the inception of each database until September 2020). Two authors independently screened the literature according to the inclusion and exclusion criteria. The quality of each selected literature was evaluated by using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) tool. RevMan 5.3 software was used for the quality evaluation. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) were merged by using Meta-DiSc 1.4 software. The area under the curve (AUC) and Q index were calculated after the summary receiver operating characteristic (SROC) was generated. We also performed subgroup analysis. A total of 621 patients were enrolled in the nine studies. The pooled sensitivity of serum PCT for PJI diagnosis was 0.441 [95% confidence interval (CI), 0.384-0.500], the pooled specificity was 0.852 (95% CI, 0.811-0.888), the pooled PLR was 2.271 (95% CI, 1.808-2.853), the pooled NLR was 0.713 (95% CI, 0.646-0.786), and the pooled DOR was 5.756 (95% CI, 3.673-9.026). The area under SROC (the pooled AUC) was 0.76 (0.72-0.79). Q index was 0.6948. This study showed that PCT detection of PJI had poor diagnostic accuracy. Hence, the serum PCT is not suitable as a serum marker for PJI diagnosis.

Diagnostic Value of Serum Procalcitonin and Diastolic Dysfunction for Evaluating the Mortality of Sepsis Patients Admitted in the Intensive Care

Background: Sepsis is a serious condition that can be fatal and has become more common in recent times. The impact of diastolic dysfunction on the early mortality rate of septic patients has not been extensively researched. This study aimed to assess the accuracy of serum procalcitonin (PCT) levels and diastolic dysfunction in predicting the mortality rate of patients diagnosed with sepsis and admitted to the intensive care unit.
 Methods: In this cross-sectional study, 40 sepsis patients admitted to the ICU were examined. Their characteristics were meticulously recorded using the APACHE II and SOFA score questionnaires, and only those who met the criteria underwent echocardiography. In order to evaluate the serum levels of PCT, it was required to take 40 ml of venous blood samples from the patients on the first and fifth days of admission. 
 Results: Out of 40 patients, the average age was 63±17 years. Of these patients, 23 (57.5%) were discharged, while 17 (42.5%) unfortunately passed away. Results showed a notable correlation between diastolic dysfunction, CRP, SOFA score on days 1 and 2, APACHE II score, and PCT on day 5 (P˂0.05). However, when analyzed using logistic regression, only PCT on day 5 showed a significant association with mortality.
 Conclusion: Based on our research, we found that PCT is an essential indicator in predicting the mortality rate of sepsis patients. While there was no significant correlation between diastolic dysfunction and mortality, it should still be considered a critical factor in determining the mortality rate.

Meta-analysis of the diagnostic value of serum procalcitonin for burn sepsis in adults.

Serum procalcitonin (PCT) reflects the infection status of the organism and the severity of the infection. The purpose of this study was to systematically evaluate the diagnostic value of serum PCT for burn sepsis in adults and to provide a factual basis for future clinical diagnosis and decision-making. On August 16, 2022, six databases were searched in this study and a total of 856 studies were found. The retrieved literature was comprehensively evaluated according to the inclusion and exclusion criteria, and the valid data were extracted and included for analysis. The number of true positives, false positives, true negatives and false negatives were used as indicators to evaluate the diagnostic value of serum PCT for burn sepsis in adults. In total, 15 studies met the inclusion criteria. Meta-analysis showed a combined sensitivity of 0.78 (95% CI: 0.69-0.84), a combined specificity of 0.85 (95% CI: 0.77-0.91), a combined positive likelihood ratio of 5.17 (95% CI: 3.25-8.25), a combined negative likelihood ratio of 0.26 (95% CI: 0.19-0.37), and a combined diagnostic ratio of 19.63 (95% CI: 10.17-37.90). The AUC was 0.88 (95% CI: 0.85-0.90). Serum PCT provides good early diagnostic benefits for burn sepsis in adults. More high-quality studies are required to clarify its specific early diagnostic value.

Diagnostic value of serum procalcitonin and C-reactive protein in discriminating between bacterial and nonbacterial colitis: a retrospective study.

Differentiating between bacterial and nonbacterial colitis remains a challenge. We aimed to evaluate the value of serum procalcitonin (PCT) and C-reactive protein (CRP) in differentiating between bacterial and nonbacterial colitis. Adult patients with three or more episodes of watery diarrhea and colitis symptoms within 14 days of a hospital visit were eligible for this study. The patients' stool pathogen polymerase chain reaction (PCR) testing results, serum PCT levels, and serum CRP levels were analyzed retrospectively. Patients were divided into bacterial and nonbacterial colitis groups according to their PCR. The laboratory data were compared between the two groups. The area under the receiver operating characteristic curve (AUC) was used to evaluate diagnostic accuracy. In total, 636 patients were included; 186 in the bacterial colitis group and 450 in the nonbacterial colitis group. In the bacterial colitis group, Clostridium perfringens was the commonest pathogen (n=70), followed by Clostridium difficile toxin B (n=60). The AUC for PCT and CRP was 0.557 and 0.567, respectively, indicating poor discrimination. The sensitivity and specificity for diagnosing bacterial colitis were 54.8% and 52.6% for PCT, and 52.2% and 54.2% for CRP, respectively. Combining PCT and CRP measurements did not increase the discrimination performance (AUC, 0.522; 95% confidence interval, 0.474-0.571). Neither PCT nor CRP helped discriminate bacterial colitis from nonbacterial colitis.

Differential diagnostic value of serum procalcitonin and iron levels in diarrheic neonatal calves caused by Escherichia coli and rotavirus

The most common enteropathogens causing diarrhea in neonatal calves are Escherichia coli (E. coli) and rotavirus. Procalcitonin (PCT) is a parameter that has recently become widely used to determine whether infectious diseases are caused by bacteria. Iron is an essential nutrient for almost all bacterial species, and serum iron levels are used as an inflammatory biomarker. Therefore, in this study, we aimed to investigate the differential diagnosis value of serum iron and procalcitonin levels in E. coli and rotavirus diarrhea. The material of the study consisted of 30 calves 1-15 days old. Three groups were formed: E. coli (n=10), rotavirus (n=10) and control (n=10) groups. Calves in the E. coli group had the highest PCT (P=0.005) and CRP (P=0.003) levels, as well as the lowest Fe (P=0.000) levels. As a result, it was determined that serum Fe levels could be used as an inflammatory marker and PCT levels higher than 50 pg/mL could be used in the differential diagnosis of E. coli diarrhea in calves with 100% sensitivity and 100% specificity.

Meta-analysis of the diagnostic value of procalcitonin in adult burn sepsis.

Sepsis is one of the main causes of death in burn patients, and many studies have suggested that procalcitonin (PCT) is a biomarker for the early diagnosis of sepsis, but the results are controversial. The aim of this study was to evaluate the diagnostic value of serum PCT in adult burn sepsis by conducting a meta-analysis of published studies. The PubMed, Embase, Web of Science, CNKI and China Wanfang databases were searched, and studies on PCT as a marker for the diagnosis of adult burn sepsis from the establishment of the database, to February 1, 2020 were screened. The data were analyzed using Stata v. 15.0 software. A total of 10 studies and 704 patients were included. The combined sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 0.67 (95% CI: 0.48-0.81), 0.87 (95% CI: 0.72-0.95), 5.20 (95% CI: 2.49-10.84), 0.38 (95% CI: 0.24-0.61) and 13.70 (95% CI: 5.72-32.82), respectively. The area under the summary receiver operating characteristic curve (SROC) was 0.85 (95% CI: 0.82-0.88), and the diagnostic threshold was the main source of heterogeneity. Results demonstrate that serum PCT may be used as a useful biomarker for the early diagnosis of burn sepsis in adults, and may be combined with other diagnostic indexes to further improve the sensitivity and specificity.

Diagnostic Value of Serum Procalcitonin in Patients with Convulsion in Emergency Department, an Observational Study.

Procalcitonin (PCT), a widely used biomarker for bacterial infections, is sometimes measured in convulsion patients to distinguish bacterial infections including bacterial meningitis. However, serum PCT elevation is reported in several other conditions. This study assessed the diagnostic value of serum PCT concentrations in convulsion patients. This study examined a convulsion group: patients admitted to our critical care center during April 2018 through September 2019 via the emergency department presenting with convulsions. Randomly sampled patients admitted without convulsions were categorized as a non-convulsion group. Serum PCT analysis was performed with consideration of whether or not the patient had an infection. Diagnostic values of serum PCT for bacterial infection were evaluated for convulsion and non-convulsion patients using the positive likelihood ratio of PCT. This study found 84 patients as eligible for the convulsion group; 1:2 matched 168 control patients were selected as non-convulsion group members. The positive likelihood ratio for bacterial infection was found to be significantly lower in the convulsion group than in the control group (1.94 vs. 2.65) when setting the positive cut-off for PCT as 0.5 ng/mL. Convulsion patients had a higher PCT value. The positive likelihood ratio for patients without bacterial infection was lower.

Diagnostic value of serum procalcitonin level in the diagnosis of the spontaneous bacterial peritonitis

Introduction: Spontaneous bacterial peritonitis (SBP) is an infectious ascitic fluid with an unknown intraabdominal source. Rapid diagnosis of infection can improve prognosis in cirrhotic patients. Objectives: We aim to determine the diagnostic value of serum procalcitonin (PCT) and C-reactive protein (CRP) in SBP. Patients and Methods: In this cross-sectional study, we included 120 cirrhotic patients with possible diagnosis of SBP asities. Serum and ascitic fluid samples were taken from the patient before initiating antibiotics. The ascitic fluid parameters, serum levels of CRP, PCT and white blood cells were measured and the diagnostic value of the CRP and PCT were evaluated. Results: Of 120 patients, 59.16% had confirmed SBP. PCT with a cutoff of 0.8 ng/mL and CRP with cutoff of 10.5 mg/L had a sensitivity of 90.91% and 86.11% and specificity of 91.5% and 81.25% respectively in diagnosing of SBP. Considering PCT above 0.8 ng/mL and CRP above 10.5 mg/L both, they had the sensitivity and specificity of 96.87% and 83.92% in detecting SBP in cirrhotic patients. Conclusion: Serum PCT and CRP levels could predict SBP in cirrhotic patients while PCT had the most sensitivity and specificity. Considering both parameters, the sensitivity will increase, but the specificity is decreasing. Both PCT and CRP levels could be used as a less invasive method compared to ascites fluid analysis in diagnosing SBP.

The Role of Serum Procalcitonin Level as an Early Marker of Ascitic Fluid Infection in Post Hepatitic Cirrhotic Patients.

The early diagnosis of spontaneous bacterial peritonitis (SBP) has been considered important in the overall patient's survival. Ascitic fluid culture examination performance, in the emergency setting, is time-consuming and not always available, so there is a need for easy to apply, rapid and reliable markers for diagnosis of patients with ascites. The present prospective study aimed to determine the early diagnostic value of serum procalcitonin (PCT) levels in decompensated cirrhotic patients (DCPs) with SBP. 47 HCV cirrhotic patients with ascites were enrolled for this prospective study. The severity of cirrhosis was classified based on the Child-Pugh criteria. All patients were subjected to paracentesis and ascitic fluid (AF) culture. Serum PCT levels were measured using enzyme-linked fluorescence analysis (ELFA). The diagnostic value of serum PCT levels and WBC/PLT ratios for detecting infections were serum PCT levels (3.63 ± 3.47 ng/mL) in DCPs with infections which were significantly higher than in DCPs without infections (0.505 ± 0.230 ng/mL); p < 0.05. The cut-off value for serum PCT levels was 0.7 ng/mL for the diagnosis of infections in DCPs, for which the sensitivity and specificity were 93.1% and 73.2%, respectively. The AUC was 0.91 (95% CI: 0.83-0.99). Serum procalcitonin seems to provide satisfactory diagnostic biomarkers in SBP.

Diagnostic value of serum procalcitonin for diagnosis of bacterial infection in patients with chronic kidney disease under hemodialysis

Introduction: Bacterial infections are common causes of mortality and morbidity among chronic kidney disease (CKD) patients under hemodialysis. Objectives: In this study the diagnostic value of serum procalcitonin for diagnosis of bacterial infections in patients with CKD under hemodialysis was assessed. Patients and Methods: In this cross-sectional comparative investigation, 47 patients with CKD under hemodialysis were enrolled to the study. We studied the relationship of serum procalcitonin (PTC) and C-reactive protein (CRP) levels (before and after dialysis) with "positive bacterial culture" and "systemic inflammatory response syndrome (SIRS)" results. Sensitivity and specificity were determined by ROC test. Results: Serum PTC before and after dialysis as well as the CRP before dialysis had no significant association with positive bacterial culture (P=0.492, P=0.1 and P=0.268 respectively), however after-dialysis CRP had a significant association with positive bacterial culture (P=0.032). Conclusion: According to the obtained results, it may be concluded that the diagnostic value of serum PTC for diagnosis of positive culture bacterial infections in hemodialysis patients is not satisfactory since the serum CRP level especially after dialysis is more useful.

Procalcitonin and other inflammatory markers in patients with sepsis and septic shock: A single-center experience

Objective: The objective of the study was to compare the diagnostic value of serum procalcitonin (PCT), C-reactive protein (CRP), lactic acid, and white blood cells (WBC) as markers of sepsis in critically ill patients in the main tertiary hospital in Qatar. Materials and Methods: The PCT levels and other inflammatory markers (CRP, lactic acid, and WBC) were retrospectively reviewed in 137 consecutive adult patients with a suspected diagnosis of sepsis who admitted to the Internal Medicine inpatient service (i.e., Medical Wards and Medical Intensive Care Unit) at Hamad General Hospital, Qatar. The serum PCT was measured by chemiluminescence immunoassay and the results were compared with commonly used inflammatory markers between the patients with and without proven sepsis. Results: A significantly higher PCT level was observed among patients with severe sepsis and septic shock compared to those without sepsis (19.34 ± 50 and 25.91 ± 61.3 vs. 4.72 ± 10, respectively; P = 0.011). No significant differences were found in CRP and WBC between these groups. Nonsurvivors of both septic and nonseptic groups had a mean PCT level of 22.48 ± 8.26 significantly higher than that measured in survivors of both the groups (P = 0.01), a difference not evident in other inflammatory parameters. Conclusions: PCT is a highly efficient inflammatory laboratory parameter for the diagnosis of severe sepsis and septic shock, but WBC and CRP levels were of little value. PCT value assists in the diagnosis of septic shock, hence supporting appropriate disposition of patients. The levels of PCT also have prognostic implications with regard to mortality suggesting intensification of antibiotic therapy and supportive measures including appropriate family counseling.

Predictive value of serum procalcitonin and hypersensitive C-reactive protein levels in patients with acute cerebral infarction complicated with infection

To analyze the changes of early procalcitonin (PCT) and hypersensitive C-reactive protein (hs-CRP) in patients with acute cerebral infarction, and to explore the predictive value of both for acute cerebral infarction with infection. 206 acute cerebral infarction patients admitted to the department of neurology of Feicheng Mining Center Hospital from May 2014 to May 2019 were enrolled. Clinical data of patients and serum PCT and hs-CRP levels at 24, 48 and 72 hours after onset were collected. Patients were divided into infected group (n = 69) and non-infected group (n = 137) according to whether infection occurred within 5 days after onset. And 60 healthy people in the same period were selected as the healthy control group. The trends of serum PCT and hs-CRP levels in each group were analyzed. The receiver operating characteristic (ROC) curve was used to analyze the values of serum PCT and hs-CRP levels in identifying acute cerebral infarction with infection. The serum level of PCT at 24, 48 and 72 hours in the infected group and the non-infected group were significantly higher than those in the healthy control group, and the serum level of PCT at 48 hours and 72 hours in the infected group were significantly higher than those in the non-infected group (μg/L: 0.28±0.08 vs. 0.19±0.03, 0.31±0.07 vs. 0.15±0.06, both P < 0.05). Compared with 24 hours, the serum PCT level in the infected group at 48 hours and 72 hours were significantly increased, but decreased in the non-infected group. The serum hs-CRP level in the infected group at 24, 48 and 72 hours were significantly higher than those in the non-infected group and the healthy control group (mg/L: 5.86±1.73 vs. 5.45±1.08, 5.25±1.33; 8.01±2.41 vs. 5.67±2.13, 5.25±1.33; 14.25±2.19 vs. 12.30±1.87, 5.25±1.33; all P < 0.05). And the serum hs-CRP level in the non-infected group at 72 hours was significantly higher than that in the healthy control group. Compared with 24 hours, the serum hs-CRP level in the infected group and non-infected group at 48 hours and 72 hours were significantly increased. It was shown by ROC curve analysis that serum PCT and hs-CRP levels at 24 hours had no predictive value for infection in patients with acute cerebral infarction [area under ROC curve (AUC) was 0.440, 0.576 respectively, both P > 0.05]. At 48 hours, the AUC of serum PCT in diagnosis of acute cerebral infarction with infection was 0.850 [95% confidence interval (95%CI) = 0.784-0.916], the sensitivity and specificity were 66.7% and 97.8% when the cut-off of PCT was 0.25 μg/L; the AUC of serum hs-CRP was 0.759 (95%CI = 0.689-0.830), the sensitivity and specificity were 66.7% and 76.6% when the cut-off of hs-CRP was 6.80 mg/L; the AUC of PCT combined with hs-CRP was 0.911 (95%CI = 0.859-0.964), the sensitivity was 90.5%, the specificity was 86.9%. At 72 hours, the AUC of serum PCT in diagnosis of acute cerebral infarction with infection was 0.952 (95%CI = 0.916-0.989), the sensitivity and specificity were 89.9% and 93.4% when the cut-off of PCT was 0.23 μg/L; the AUC of serum hs-CRP was 0.753 (95%CI = 0.678-0.828), the sensitivity and specificity were 60.9% and 83.2% when the cut-off of hs-CRP was 14.01 mg/L; the AUC of PCT combined with hs-CRP was 0.954 (95%CI = 0.918-0.991), the sensitivity was 97.1%, and the specificity was 89.8%. The results showed that the diagnostic value of serum PCT at 48 hours and 72 hours were higher than those of hs-CRP, and the predictive value of PCT combined with hs-CRP was higher than those of single index. Acute cerebral infarction itself has an effect on serum PCT level; serum PCT level above 0.23 μg/L at 72 hours after onset and reference to serum hs-CRP level have a high predictive value for the diagnosis of infection in patients with acute cerebral infarction.

The value of serum procalcitonin in acute meningitis in children

Early diagnosis and initial therapy are important to reduce the complications of bacterial meningitis. We aimed to evaluate the diagnostic value of serum procalcitonin in children with acute meningitis. We included 40 children (4 months–14 years) suspected to have acute meningitis in our study. Based on the clinical scenario, physical examination and complete analysis of cerebrospinal fluid, patients were assigned into two groups: bacterial meningitis group (24 patients) and aseptic meningitis group (16 patients). Twenty-five apparently healthy children of matched age and sex served as a control group. Procalcitonin, C-reactive protein, and leukocyte count were measured initially at the time of admission and again after 72 h. Initially, patients with bacterial meningitis showed statistically significant higher values of serum procalcitonin than both patients with aseptic meningitis and the control groups (p < 0.001). After 72 h of treatment, patients of bacterial meningitis group showed statistically significant lower values of serum procalcitonin than their initial values (P < 0.05). The cutoff point of procalcitonin needed for early diagnosis of bacterial meningitis was >10 ng/ml at the time of admission. However, values of procalcitonin >2 ng/ml had 100% sensitivity. Whereas, the specificity, negative predictive value and positive predictive value of procalcitonin were 63%, 100%, and 67% respectively. Serum Procalcitonin can be used as an early diagnostic marker of acute bacterial meningitis and its differentiation from aseptic meningitis. In acute bacterial meningitis, it can be used to follow the response to antibiotic therapy.

Procalcitonin may not be a differential diagnostic marker for bacterial infection in febrile patients with chronic gouty arthritis.

ObjectiveThis study aimed to examine the diagnostic value of serum procalcitonin (PCT) levels for identifying bacterial infection in febrile patients with chronic gouty arthritis.MethodsSixty-six febrile patients with chronic gouty arthritis were divided into non-bacterial infection (n = 45) and bacterial infection groups (n = 21). PCT levels were measured by an immunoassay. Other laboratory parameters, including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cells (WBCs), and the neutrophil ratio were extracted from medical records. Receiver-operating characteristic curves were used to evaluate diagnostic values and accuracy.ResultsSerum PCT levels, the ESR, CRP levels, WBC count, and neutrophil ratio were not different between the groups. To assess the ability of PCT to discriminate bacterial infection in febrile patients with chronic gouty arthritis (cut-off value: 0.5 ng/mL), the sensitivity and specificity of PCT were 22.2% and 61.5%, respectively. The area under the curve (AUC) of serum PCT levels was 0.526. The AUCs of related inflammatory indicators were 0.530 for the ESR, 0.635 for CRP, 0.577 for the WBC count, and 0.712 for the neutrophil ratio.ConclusionSerum PCT levels may not be a good biomarker for bacterial infection in febrile patients with chronic gouty arthritis.

Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department.

BackgroundFew studies compared the diagnostic value of procalcitonin with a combination of other tests including lactate and high-sensitivity C-reactive protein in the prediction of pathogenic bacteremia in emergency department adult patients.MethodsWe performed a retrospective study assessing the differences in performances of procalcitonin at a cutoff of 0.5 ng/mL, lactate at a cutoff of 19.8 mg/dL, high-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL and their combinations for predicting bacteremia in emergency department adult patients. Sensitivity, specificity, overall accuracy, positive-test and negative-test likelihood, and diagnostic odds ratio with 95% confidence interval for each test combination were calculated for comparison. The receiver operating characteristic curve for every single test were compared using DeLong’s method. We also performed a sensitivity analysis in two expanded patient cohorts to assess the discriminative ability of procalcitonin or test combination.ResultsA total of 886 patients formed the initial patient cohort. The area under the receiver operating characteristic curve for discriminating positive blood culture was: procalcitonin = 0.72 (95% CI [0.69–0.75]) with a derived optimal cutoff at 3.9 ng/mL; lactate 0.69 (0.66–0.72) with an optimal cutoff at 17.9 mg/dL; high-sensitivity C-reactive protein 0.56 (0.53–0.59) with an optimal cutoff of 13 mg/dL; with pairwise comparisons showing statistically significant better performance of either procalcitonin or lactate outperforming high-sensitivity C-reactive protein. To predict positive blood cultures, the diagnostic odds ratio for procalcitonin was 3.64 (95% CI [2.46–5.51]), lactate 2.93 (2.09–4.14), and high-sensitivity C-reactive protein 0.91 (0.55–1.55; P = 0.79). About combined tests, the diagnostic odds ratio for procalcitonin and lactate increases were 3.98 (95% CI [2.81–5.63]) for positive blood culture prediction. Elevated procalcitonin level rendered a six-fold increased risk of positive gram-negative bacteremia with a diagnostic odds ratio of 6.44 (95% CI [3.65–12.15]), which showed no further improvement in any test combinations. In the sensitivity analysis, as a single test to predict unspecified, gram-negative and gram-positive bacteremia, procalcitonin performed even better in an expanded cohort of 2,234 adult patients in terms of the diagnostic odds ratio.DiscussionsFor adult emergency patients, procalcitonin has an acceptable discriminative ability for bacterial blood culture and a better discriminative ability for gram-negative bacteremia when compared with lactate and high-sensitivity C-reactive protein. High-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL performed poorly for the prediction of positive bacterial culture.

Procalcitonin as a diagnostic biomarker for septic shock and bloodstream infection in burn patients from the Formosa Fun Coast dust explosion.

Infection is the most common cause of death following burn injury. The study was conducted to compare the diagnostic value of serum procalcitonin (PCT) with the other current benchmarks as early predictors of septic shock and bloodstream infection in burn patients. We included 24 patients admitted to the Burn Unit of a medical center from June 2015 to December 2015 from the Formosa Fun Coast dust explosion. We categorized all patients at initial admission into either sepsis or septic shock groups. Laboratory tests including the worst PCT and C-reactive protein (CRP) levels, platelet (PLT), and white blood cell (WBC) count were performed at <48h after admission. Patients were also classified in two groups with subsequent bacteremia and non-bacteremia groups during hospitalization. Significantly higher PCT levels were observed among participants with septic shock compared to those with sepsis (47.19 vs. 1.18ng/mL, respectively; p<0.001). Patients with bacteremia had significantly elevated PCT levels compared to patients without bacteremia (29.54 versus 1.81ng/mL, respectively, p<0.05). No significant differences were found in CRP levels, PLT, and WBC count between the two groups. PCT levels showed reasonable discriminative power (cut-off: 5.12ng/mL; p=0.01) in predicting of bloodstream infection in burn patients and the area under receiver operating curves was 0.92. PCT levels can be helpful in determining the septic shock and bloodstream infection in burn patients but CRP levels, PLT, and WBC count were of little diagnostic value.

Diagnostic value of serum procalcitonin for early postoperative bacterial infection after pediatric ;living donor liver transplantation

Objective To analyze the diagnostic value of serum procalcitonin (PCT) for early postoperative bacterial infection after pediatric living donor liver transplantation. Methods A retrospective study was conducted in pediatric patients after living donor liver transplantation recipients admitted to department of critical care medicine of Beijing Friendship Hospital affiliated to Capital Medical University during June 2013 to October 2015. According to the clinical data, all pediatric patients were divided into infection group(n=60) and non-infection group (n=100). Primary disease, PCT post operation day 1 to day 5 for non-infection group and day 1 to day 9 for infection group, temperature, white blood cell, cold ischemia time, warm ischemia time, operation time, volume of blood loss during operation were recorded. All parameters above were compared between groups. Receiver operating characteristic (ROC) curve was plotted, and the diagnostic value of PCT was evaluated. Results PCT of both groups were elevated after liver transplantation, there was a markedly resolution in non-infection group within 48 to 72 hours.PCT of pediatric patients with bacterial infection was significantly higher than that of non-infected patients, and the difference was of greatly significant (4.62±1.39) ng/ml vs (0.85±0.19) ng/ml, t=26.56, P=0.00. ROC curve showed that the peak level of PCT might be valuable in the diagnosis of bacterial infection(AUC=0.985). There was no significant difference of cold ischemia time[(109.92±19.22) min vs (108.04±13.20) min, t=1.05, P=0.29], warm ischemia time[(1.49±0.17) min vs (1.52±0.12) min, t=1.08, P=0.28], operation time[(8.01±0.77)vs (8.00±1.05) h, t=0.06, P=0.94], WBC[(8.95±1.69)×109/L vs (8.98±2.00)×109/L, t=-0.08, P=0.93]and body temperature[(37.5±0.7) vs (37.5±0.8) ℃, t=-0.05, P=0.96]on the first day after surgery between infection and non-infection groups. Amount of bleeding in infection group was higher than that of non infection group[(650.87±90.36) ml vs (240.29±67.67) ml, t=32.33, P=0.00], there was longer length of ICU stay in the infection group[(11.01±1.81)d vs (6.03±1.65)d, t=17.78, P=0.00]. Conclusion Peak PCT level was a valuable indicator for early postoperative bacterial infection after pediatric living donor liver transplantation.(Chin J Lab Med, 2017, 40: 46-49) Key words: Bacterial infections; Liver transplantation; Procalcitonin

Diagnostic Value of Serum Procalcitonin in Early Infection after Internal Fixation for Traumatic Fracture.

This study aimed to observe the changes of serum procalcitonin (PCT) and C-reactive protein (CRP) concentrations after internal fixation for traumatic fracture and to discuss the diagnostic value of these two indicators in early infection after internal fixation for traumatic fracture. Patients who received internal fixation for traumatic fracture at our hospital from June 2014 to December 2016 were included. They were divided into infection group (12 cases) and non-infection group (166 cases), depending on whether infection occurred. Venous blood samples were collected from cases in both groups on day 1, day 4, and day 9 after surgery. Changes in PCT and CRP levels were detected at different time points. As compared with the non-infection group, PCT and CRP levels were significantly increased at each time point after surgery in the infection group. The sensitivity of PCT combined with CRP in the detection of early infection after surgery was higher than that of either used alone. The serum PCT level can be used as an early diagnostic indicator of infection after internal fixation for traumatic fracture. The combined use of PCR and CRP levels can increase the sensitivity of detection.

Diagnostic value of serum procalcitonin compared with c-reactive protein for postoperative wound infection of surgically treated trochanteric fracture

Introduction Because of the high prevalence of postoperative infection and its impact on mortality and morbidity in patients undergoing orthopedic and nonorthopedic procedures, a reliable marker for the diagnosis of infection would be of great importance. There has been an increasing use of procalcitonin (PCT) measurements in identifying systemic bacterial infections. This study was carried out to investigate the value of serum PCT level versus the C-reactive protein (CRP) in the diagnosis of postoperative inflammatory response with or without sepsis after trochanteric fracture surgery in the elderly. Patients and methods The study was carried out in El-Hadara University Hospital on 60 American Society of Anesthesiologists physical status I and II patients aged above 50 years scheduled for peritrochanteric hip fracture surgery [dynamic hip screw (DHS), dynamic condylar screw, gamma nail, cemented bipolar, cemented Thompson, and Austin Moore]. Blood samples for PCT, CRP, and white blood cells (WBCs) were drawn on day 0 (preoperatively) and days 1, 3, 5, and 7 postoperatively. The samples were collected at the same hour in the morning for each patient. Results The age ranged from 65.0 to 90.0 years with a mean of 77.0±8.66 years. There were 15 (25.0%) male and 45 (75.0%) female patients. Ten (16.7%) patients underwent cemented bipolar operation, 28 (46.7%) patients were treated with DHS, and four (6.7%) were treated with cemented Thompson, and 18 (30.0%) were treated with gamma nail. In the studied group, 15 (25%) patients had proven local wound sepsis on culture and sensitivity performed on day 3, and 45 (75%) patients were not infected. There was a significantly higher difference in the infected ones than in the noninfected ones as regards WBCs, PCT, and CRP changes. In the infected group seven (46.7%) patients were treated with DHS, four (26.7%) with cemented bipolar, two (13.3%) with cemented Thompson, and two (13.3%) were treated with gamma nail. Conclusion We could conclude that PCT is an earlier and more specific marker of wound infections compared with CRP or WBC count after trochanteric fractures in the elderly.

Diagnostic value of procalcitonin and other related inflammatory markers for severe sepsis and septic shock: A single tertiary center experience

Background/objective: Several inflammatory biomarkers of infection including procalcitonin (PCT) and C – reactive protein (CRP) have been shown to be useful in diagnosis of infection in different clinical settings. The purpose of this study was to determine the diagnostic value of serum PCT, CRP and White Blood Cells (WBC) as markers of sepsis in critically ill patients in Qatar. Materials and methods: The PCT levels and other related inflammatory markers (CRP and WBC) were measured in 137 adult patients with a suspected diagnosis of sepsis and admitted to Internal Medicine inpatient service (i.e., Medical Wards and Medical Intensive Care Unit) at Hamad General Hospital, Hamad Medical Corporation-Qatar during the period from January 2011 to December 2013. Results: The serum PCT was measured by chemoluminiscence immunoassay and the results were compared with other inflammatory markers between the patients with and without proven sepsis. A significantly higher PCT level was observed among patients with severe sepsis and septic shock compared to those without sepsis (19.34 ± 50 and 25.91 ± 61.3 vs. 4.72 ± 10, respectively; (p = 0.011). No significant differences were found in CRP and WBC between these groups. Non-survivors of both septic and non-septic groups had a mean PCT level of 22.48 ± 8.26 significantly higher than that measured in survivors of both groups (p = 0.01), a difference not evident in other inflammatory parameters. Conclusion: PCT is a highly efficient inflammatory laboratory parameter for the diagnosis of severe sepsis and septic shock but WBC and CRP levels were of little value. PCT value assists in diagnosis of septic shock hence supporting appropriate disposition of patients. Levels of PCT also have prognostic implications with regards to mortality suggesting intensification of antibiotic therapy and supportive measures including appropriate family counseling.