Role Of Serum Procalcitonin Research Articles

Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis

Abstract Background Early diagnosis and initial therapy are important to reduce the complications of acute bacterial meningitis (ABM). The gold standard in diagnosing bacterial meningitis is by demonstrating the presence of bacteria in cerebrospinal fluid (CSF) samples via CSF cultures. However, CSF culture requires at least a day or more, and has limited sensitivity. Serum procalcitonin (PCT) is one of the most sensitive biomarkers for identification of bacterial from non-bacterial meningitis. This study was done to evaluate serum PCT as a marker to help in ABM diagnosis specially after oral antibiotics intake or when cerebrospinal fluid (CSF) culture is negative and to assess its correlation with outcome of ABM in children. Methods This is a prospective cohort study that included children who presented to Ain Shams University Children hospital over a period of 6 months. Participants were confirmed cases of ABM (laboratory- confirmed by culture) or suspected to have ABM (presented with sudden onset high fever and signs of meningeal irritation with CSF examination showing at least one of the following: 1. turbid appearance; 2. leukocytosis (> 100cells/mm3); 3. leukocytosis (10-100 cells/mm3) and either an a) elevated protein (> 100 mg/dl) or b) decreased glucose (< 40mg/dl)). The PCT levels were measured on admission and 72hours after treatment. Results A total of 38 ABM cases participated in this study. All the 38 cases showed elevated levels of PCT on admission. There was a significant drop in the mean of PCT level after 72h of treatment compared to level on admission (7.1±6.5 vs. 11.4±3.7, p = 0.001) respectively. There was a significant difference in the mean of PCT level between cases with good outcome (full recovery) versus poor outcome (death or neurological sequalae), on admission (7.2±2.8 vs. 13.2±4.4, p < 0.001) and 72h after treatment (4.2±3.5 vs. 12.9±5.3, p < 0.001) respectively. Conclusion Serum PCT levels were high in all patients with ABM, including those who received oral antimicrobials for 1-3 days before admission. The decline in PCT levels after treatment was associated with good outcome in our cohort.

The Role of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker for Sepsis in Major Burn Patients: A Prospective Study

The Role of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker for Sepsis in Major Burn Patients: A Prospective Study

The role of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker for Sepsis in Major Burn Patients: A Prospective Study

The role of Serum Procalcitonin as a Diagnostic and Prognostic Biomarker for Sepsis in Major Burn Patients: A Prospective Study

The Role of Serum Procalcitonin in The Diagnosis and Detection of The Outcome of Acute Bacterial Meningitis in Children

The Role of Serum Procalcitonin in The Diagnosis and Detection of The Outcome of Acute Bacterial Meningitis in Children

Role of Serum Procalcitonin in Prediction of Severity in Patients with Acute Cholangitis

Abstract Background Cholangitis is one of the commonest emergencies encountered by gastroenterologists that may warrant drainage of biliary system. Serum procalcitonin (PCT) is an important biomarker of cholangitis with a potential to guide early therapeutic decision. Materials and Methods We did a retrospective analysis of prospectively maintained data of patients admitted in the hospital from March 2018 to September 2020 with a diagnosis of acute cholangitis based on Tokyo 18 guidelines (TG-18). All the demographic parameters, biochemical and hematological parameters, and the result were recorded. Results One-hundred two patients were admitted to our hospital with a mean age of 51.07 ± 7.99 years, among which 58.5% (59/102) were females with most common etiology being choledocholithiasis (64%). Fever, jaundice, and abdominal pain were seen in 78% (80/102), 73.3% (74/102), and 76.9% (78/102) of patients, respectively. Organ failure was seen in 29.3% (29/102) of patients with most common organ failure being acute kidney injury. Mild, moderate, and severe cholangitis as per TG-13 was seen in 43.9, 26.8, and 29.3% of patients, respectively. Elevated PCT levels were associated with severe disease (76.7 vs. 26.5%, p < 0.05). Forty-three percent (44/102) patients were managed with delayed biliary drainage, while the majority of remaining specifically with raised PCT levels needed early endoscopic intervention. Conclusion In this retrospective analysis, we showed that most common etiology of cholangitis in was choledocholithiasis. Raised serum PCT levels were significantly associated with increased severity of cholangitis.

Role of serum procalcitonin in the diagnosis and monitoring of treatment response in treatment-naïve subjects with chronic pulmonary aspergillosis

BackgroundInterferon-gamma (IFN-γ) down-regulates plasma procalcitonin (PCT), marker of inflammation. Chronic pulmonary aspergillosis (CPA) is associated with low IFN-γ levels. Thus, plasma PCT may be elevated in CPA and could have a role in diagnosing and monitoring treatment response in CPA. Herein, we investigate the diagnostic performance of plasma PCT in CPA. MethodsWe extracted the demographic, clinical, radiological, treatment outcomes, and plasma PCT levels of CPA subjects and controls (previously treated pulmonary tuberculosis with radiological abnormalities on CT chest [diseased controls] and treatment naïve active pulmonary tuberculosis [PTB]). We treated CPA subjects with six months of oral itraconazole. We took 0.25 ng/mL as a cut-off value for PCT. The study’s primary objective was to ascertain the diagnostic performance of PCT in diagnosing CPA. The key secondary outcome was to study the change in the plasma PCT levels after itraconazole therapy. ResultsWe included 190 CPA cases and 40 controls (diseased controls [n = 20] and active PTB [n = 20]). PCT was elevated (≥0.25 ng/mL) in only 7 (3.7%) subjects with CPA. The sensitivity and specificity of PCT (≥0.25 ng/mL) were 3.7% (1.5–7.4%) and 100 (91.2–100%), respectively. The area under the curve for plasma PCT was 0.48 (95% confidence interval, 0.39–0.58). The plasma PCT values were available in 93 subjects at six months. There was a significant decline in the median plasma levels of PCT after treatment; however, the PCT levels either increased or remained the same in 45% of the subjects. ConclusionPlasma procalcitonin has poor performance in diagnosing and following subjects with CPA.

Dynamics of Serum Procalcitonin Can Predict Outcome in Patients of Infected Pancreatic Necrosis: A Prospective Analysis.

Timely intervention can alter outcome in patients of infected pancreatic necrosis (IPN) but lacks adequate biomarker. Role of serum procalcitonin (PCT) in the management of IPN is understudied, and hence, this study was planned. All patients of acute pancreatitis with IPN without prior intervention were included. Baseline demographic, radiological and laboratory parameters were documented. PCT was measured at baseline, prior to intervention, and thereafter every 72h. Patients were grouped into those having baseline PCT < 1.0ng/mL and those with PCT ≥ 1.0ng/mL and various outcome measures werecompared. Of the 242 patients screened, 103 cases(66 males; 64.1%) with IPN were grouped into 2: PCT < 1.0ng/mL (n = 29) and PCT ≥ 1.0ng/mL (n = 74). Patients with baseline PCT ≥ 1.0ng/mL had significantly more severe disease scores. 16 out of 19 patients with rise in PCT on day-7 post-intervention expired. PCT ≥ 1.0ng/mL group had higher need for ICU (p = 0.001) and mortality (p = 0.044). PCT > 2.25ng/mL (aOR 22.56; p = 0.013)at baseline and failure in reduction of PCT levels to < 60% of baseline at day-7 post-intervention (aOR 53.76; p = 0.001) were significant mortality predictors. Baseline PCT > 1.0ng/mL is associated with poor outcome. PCT > 2.25ng/mL and failure in reduction of PCT levels to < 60% of its baseline at day-7 post-intervention can identify high-mortality risk patients.

Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis

Role of Serum Procalcitonin in Monitoring the Response to Treatment of Pediatric Bacterial Meningitis

Role of procalcitonin in diagnosis of community acquired pneumonia in Children

BackgroundThe role of serum Procalcitonin (PCT) in adults in diagnosis of Community acquired pneumonia (CAP) is well established, however, role in pediatric CAP remains controversial.ObjectivesThe objective of this study was to investigate the utility of serum procalcitonin in differentiating bacterial community-acquired lower respiratory tract infection from non-bacterial respiratory infection in children; radiologically confirmed pneumonia was used as the reference. In addition, we assessed the utility of adding the PCT assay to the clinical criteria for diagnosis of pneumonia.Study designSubanalysis of a larger prospective,multicentriccohort study.ParticipantsChildren, 2 months to 59 months of age, attending paediatric OPD of 5 urban tertiary care hospitals, suffering from acute respiratory infection (ARI).InterventionDetailed clinical history and examination findings of enrolled children were recorded on predesigned case record form. Samples for PCT were obtained at admission and were measured centrally at the end of the study except for one site using VIDAS® B.R.A.H.M.S PCT kit (Biomerieux SA, France).OutcomesSensitivity and specificity of procalcitonin for diagnosis of radiologically confirmed pneumonia.ResultsSerum Procalcitonin was measured in 370 patients; median (IQR) age of these children being 12 (7, 22) months, 235 (63.5%) were boys. The median (IQR) serum procalcitonin concentration was 0.1(0.05, 0.4) ng/mL.Sensitivity and specificity of raised PCT (> 0.5 ng/mL) for pneumonia as per any CXR abnormalities were 29.7% and87.5%,(P < 0.001) respectively. Raised PCT was also significantly associated with consolidation (34.5%,79.2%,P < 0.02)and pleural effusion(54.6%,79%,P < 001). Adding PCT to the existing clinical criteria of WHO did not improve the sensitivity for diagnosis of pneumonia. PCT was significantly higher in children with severe pneumonia.ConclusionPositive PCT (> 0.5 ng/mL) is significantly associated with radiographic pneumonia but not with pneumonia based on WHO criteria.However, it can act as a surrogate marker for severe pneumonia.

Role of serum procalcitonin in predicting the surgical outcomes of acute calculous cholecystitis.

Acute calculous cholecystitis (AC) is a syndrome of right upper quadrant pain, fever, and leukocytosis associated with gallbladder inflammation. In the preoperative planning, the severity of AC should be considered as well as time of onset of symptoms and patient comorbidities. The aim of the present study was to investigate the role of an early PCT assessment in the emergency department in predicting the outcomes of laparoscopic surgery for AC. Retrospective, mono-centric study conducted in a teaching urban hospital. We evaluated all patients admitted to our ED from January 1st, 2015, to December 31st, 2019, underwent laparoscopic cholecystectomy for AC having a preoperative PCT determination in ED. A total of 2285 patients in our ED were admitted for AC. Among them 822 patients were treated surgically, 174 had a PCT determination in ED. Median age was 63 [50-74]. Overall, 33 patients (19.0%) had major complications (MC): 32 needed an open surgery conversion, and 3 among them deceased. Multivariate analysis demonstrated that PCT, WBC, BUN, and CCI were significantly associated to MC in our cohort. When we calculated the area under the ROC curve with regard to MC, a procalcitonin value > 0.09 at admission had sensitivity = 84.8% [68.1-94.9] and specificity = 51.8% [43.2-60.3] for the occurrence of MC. Our results, suggest that a PCT > 0.09ng/mL at ED admission, could be associated to a poor surgical outcome in patients treated by laparoscopic surgery for AC.

The Role of Early Procalcitonin Determination in the Emergency Departiment in Adults Hospitalized with Fever

Background and Objectives: Fever is one of the most common presenting complaints in the Emergency Department (ED). The role of serum procalcitonin (PCT) determination in the ED evaluation of adults presenting with fever is still debated. The aim of this study was to evaluate if, in adults presenting to the ED with fever and then hospitalized, the early PCT determination could improve prognosis. Materials and Methods. This is a retrospective, mono-centric study, conducted over a 10-year period (2009–2018). We analyzed consecutive patients ≥18 years admitted to ED with fever and then hospitalized. According to quick sequential organ failure assessment (qSOFA) at admission, we compared patients that had a PCT determination vs. controls. Primary endpoint was overall in-hospital mortality; secondary endpoints were in-hospital length of stay, and mortality in patients with bloodstream infection and acute respiratory infections. Results. The sample included 12,062 patients, median age was 71 years and 55.1% were men. In patients with qSOFA ≥ 2 overall mortality was significantly lower if they had a PCT-guided management in ED, (20.5% vs. 26.5%; p = 0.046). In the qSOFA < 2 group the mortality was not significantly different in PCT patients, except for those with a final diagnosis of bloodstream infection. Conclusions. Among adults hospitalized with fever, the PCT evaluation at ED admission was not associated with better outcomes, with the possible exception of patients affected by bloodstream infections. However, in febrile patients presenting to the ED with qSOFA ≥ 2, the early PCT evaluation could improve the overall in-hospital survival.

Role of serum procalcitonin in monitoring the response to treatment of pediatric meningitis

Introduction: A good early diagnostic and prognostic marker for bacterial meningitis will decreasethe morbidity and mortality due to this infection. Serum procalcitonin has been evaluated forusefulness in diagnosis and as a prognostic marker in bacterial meningitis. Methods: Children from5 months to 15 years of age who were cases of bacterial meningitis as per WHO Criteria and wereadmitted to the Pediatric Department in SKIMS Srinagar, Jammu, and Kashmir were taken for thestudy. A total of 45 bacterial meningitis cases participated in this prospective study. Serum PCT wasmeasured by a fluorescence immunoassay using QDX Insta check with a detection limit of 0.25-100ng/ml. Data were analyzed using standard statistical tests using SPSS 20. Results: The meanserum PCT on admission in ng/ml in the present study for bacterial meningitis was14.9293±4.49122 and after 72 hours mean serum PCT was 12.4386±4.40964). A significant drop(mean difference = 2.49086; p=0.000) in serum procalcitonin was seen after 72 hours followingantibacterial treatment. Conclusion: It was concluded that serum PCT can be used as a goodprognostic marker to see the response to treatment in bacterial meningitis.

Diagnosis and Application of Serum Procalcitonin in Lower Respiratory Tract Infections

The role of serum procalcitonin in early diagnosis of lower respiratory tract bacterial infections is tested and studied. The prognosis of ventilator-associated pneumonia group and nonventilator-associated pneumonia group were compared. There was no significant difference between ventilator-associated pneumonia group and nonventilator-associated pneumonia group before mechanical ventilation. After mechanical ventilation, procalcitonin, C-reactive protein and white blood cells in ventilator-associated pneumonia group were significantly higher than those in nonventilator-associated pneumonia group (t=1.62-2.31, P<0.05) and the body temperature was also elevated, which is not significant. The sensitivity and specificity of procalcitonin in diagnosing ventilator-associated pneumonia were 86 and 91 %, respectively. Procalcitonin level in Gram negative bacteria group was significantly higher than that in Gram positive bacteria group (t=1.99, P<0.05). Immunofluorescence quantitative assay was used to detect respiratory infection patients and the treatment of some patients was monitored. At the same time, white blood cells and C-reactive protein were compared with procalcitonin. The sensitivity and specificity of procalcitonin in bacterial infections of respiratory system are obviously higher than those of traditional C-reactive protein and white blood cells. It can be used for early diagnosis of bacterial infections quickly. This study provided important clinical evidence in judging the severity and prognosis of infection and is helpful for rational use of antibiotics.

P1.03-44 Role of Serum Procalcitonin as Diagnostic Biomarker of Pneumonia in Lung Cancer Patient

P1.03-44 Role of Serum Procalcitonin as Diagnostic Biomarker of Pneumonia in Lung Cancer Patient

Procalcitonin and white blood cell as predictors of urosepsis in urinary tract obstruction patients at Sanglah Hospital Denpasar

Introduction: Patients with urinary tract obstruction are often accompanied by urinary tract infections. In some cases, it develops into urosepsis that increases mortality. Early detection capability is essential. The purpose of this study was to determine the role of serum procalcitonin (PCT), nitrite urine (NU) and white blood cell (WBC) as urosepsis predictors in patients with urinary obstruction.&#x0D; Methods: This is a cross-sectional study involving 36 samples carried out at our hospital using consecutive sampling technique from December 2016 to February 2017. Statistical analyses used were a bivariate test and multivariate test using Poisson regression.&#x0D; Results: From the bivariate test analysis, serum PCT level of ≥0.25 ng/ml, positive result for NU, and a WBC amount of ≥12,000 cells/mm3 were predictors for urosepsis. In the multivariate test, we obtained a PCT serum level of ≥0.25 ng/ml, and WBC of ≥12,000 cells/mm3 were true predictors of urosepsis in patients with urinary tract obstructions with infections.&#x0D; Conclusion: Serum PCT and WBC can be used as a predictor of urosepsis in patients with urinary tract obstruction.

Role of serum procalcitonin as a marker for diagnosing neonatal sepsis

Background: Neonatal sepsis is a continuing problem causing significant burden on health care, especially in developing world. As blood culture has low sensitivity in diagnosis of neonatal sepsis, strong clinical suspicion along with combination of different laboratory tests is required. The data available for extensively studied acute phase reactant, procalcitonin (PCT) remains controversial. This study was done to assess role of PCT alone and in combination with different tests for diagnosing neonatal sepsis.Methods: Blood samples of 275 neonates (&gt;35 weeks of gestation) admitted to NICU, with suspicion of neonatal sepsis were collected for bacterial culture, serum procalcitonin level and sepsis screen (CRP, mESR, I/T ratio, Total Leucocyte Count, Absolute Neutrophil Count).Results: Blood culture was positive in 30.5% of enrolled neonates. At a cut-off value of 0.5 ng/ml the sensitivity, specificity, PPV, NPV of serum PCT in neonatal sepsis cases was 73.8%, 47.1%, 48%, 80.4% respectively. Serum PCT was found raised in 60 (48.8%) clinically suspected cases of neonatal sepsis where sepsis screen and blood culture both were negative, also it was not raised in 17 (32.7%) of clinically suspected cases of septicemia where both blood culture and sepsis screen were positive. Amongst other individual tests, CRP was found to have best sensitivity (79.7%) and NPV (85%) followed by PCT (73.8% and 80.4%) while best specificity was found for I/T ratio (93.7%) followed by mESR (89%) for diagnosis of neonatal sepsis with positive blood culture. Best NPV was seen for combination of PCT+CRP+I/T ratio (95.6%) for the suspected cases of neonatal sepsis.Conclusions: Thus, we conclude that serum PCT can play a useful role when combined with other test markers but may not find its way as a sole diagnostic marker for diagnosing neonatal sepsis in term/near term babies.

The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

Role of Serum Procalcitonin in Children with Community Acquired Pneumonia

Role of Serum Procalcitonin in Children with Community Acquired Pneumonia

Role of Serum Procalcitonin as a Marker of Neonatal

Role of Serum Procalcitonin as a Marker of Neonatal

The Role of Serum Procalcitonin, Interleukin-6, and Fibrinogen Levels in Differential Diagnosis of Diabetic Foot Ulcer Infection.

Aims We aimed to evaluate the roles of interleukin-6 (IL-6), PCT, and fibrinogen levels in the differential diagnosis of the patients with infected diabetic foot ulcer (IDFU) and noninfected diabetic foot ulcer (NIDFU) and to compare those with C-reactive protein (CRP), white blood cell (WBC), and erythrocyte sedimentation rate (ESR). Methods Patients over 18 years with a diagnosis of type 2 diabetes mellitus and DFU who were followed up in our hospital between 1 January 2016 and 1 January 2017 were included in the study. In addition to this patient group, patients with diabetes but without DFU were determined as the control group. Results Thirty-eight patients with IDFU, 38 patients with NIDFU, and 43 patients as the control group were included in the study. Fifty-six point three percent of the patients who participated in the study were males, and the mean age was 61.07 ± 11.04 years. WBC, ESR, CRP, IL-6, and fibrinogen levels of the cases with IDFU were determined to be significantly higher compared to the cases in NIDFU (p < 0.01). The area under the ROC curve (AUROC) value was highest for CRP (0.998; p < 0.001), and the best cut-off value for CRP was 28 m/L. The best cut-off values for fibrinogen, IL-6, ESR, and WBC were 480 mg/dL, 105.8 pg/mL, 31 mm/h, and 11.6 (103 μ/L), respectively. Conclusion Serum PCT levels were not found to be effective in the discrimination of IDFU and NIDFU. Serum IL-6 and fibrinogen levels seem to be two promising inflammatory markers in the discrimination of IDFU.