Use Of Procalcitonin Research Articles

The utility of procalcitonin in febrile neutropenia.

12040 Background: The utility of procalcitonin (PCT) in febrile neutropenia (FN) in oncology patients on active therapy has not been well validated. FN constitutes a critical oncologic emergency, often characterized by subtle manifestations of infection, and timely diagnosis and treatment is vital. Although a potential harbinger of dangerous infection, FN can also occur without an identifiable infection, in which case hospitalization and antibiotics may be unnecessary. PCT, an amino acid, is elevated specifically during bacterial infections in the non-cancer population and correlates with infection severity. Clinicians employ PCT levels as a diagnostic adjunct, discerning bacterial from viral infections and analyzing PCT changes to guide treatment decisions. We examined oncology patients presenting with FN to correlate PCT levels and trends with confirmed infections. Methods: We identified patients with neutropenic fever, cancer, and a PCT result seen at our institution from 12/1/2017-12/1/2022. Patients were determined to have a confirmed infection if they had a positive bacterial blood culture. Demographics and clinical characteristics were compared between infection status and induction chemotherapy or transplant status using a Wilcoxon Rank Sum test for continuous variables and a Chi-Square or Fisher’s Exact test for categorical variables. Baseline (at time of initial FN) and highest PCT levels were compared by patient and disease characteristics and proven infection using Wilcoxon Rank Sum test. Logistic regression was used to determine the association of log-transformed PCT (baseline and highest) with proven infection (yes/no) while adjusting for covariates. All tests were two-tailed with p< 0.05 considered statistically significant. Results: Of 365 patients, 61 (16.7%) had an identified infection. Median baseline and peak PCT of 1.26 and 1.51 ng/mL, respectively, were significantly greater for these patients as compared to those with negative cultures at 0.54 and 0.65 ng/mL, respectively (P= 0.01 and <0.01). For every unit increase in the log transformed baseline PCT, the odds of having a proven infection increased by 23%. There were no significant differences in patient or clinical characteristics between those with and without infection. Of those admitted for induction chemotherapy and transplant who developed FN, PCT at time of initial fever was higher at 0.97 vs 0.56 ng/mL (p=0.02). Interestingly, median baseline and median peak PCT differed between gender with females 0.51 and males 0.72 ng/mL (p=0.02) at baseline, and 0.63 vs 0.83 ng/mL (p=0.04), respectively, at peak. Conclusions: PCT levels in cancer patients with FN are significantly associated with culture positive infection. This data can help guide treatment and de-escalation of antibiotics in cancer patients admitted with FN. Further evaluation should be taken to determine how to best use PCT to determine the need for admission and antibiotic prescription.

One biomarker does not fit all: tailoring anti-infective therapy through utilization of procalcitonin and other specific biomarkers

ABSTRACT Introduction Considering the ongoing increase in antibiotic resistance, the importance of judicious use of antibiotics through reduction of exposure is crucial. Adding procalcitonin (PCT) and other biomarkers to pathogen-specific tests may help to further improve antibiotic therapy algorithms and advance antibiotic stewardship programs to achieve these goals. Areas covered In recent years, several trials have investigated the inclusion of biomarkers such as PCT into clinical decision-making algorithms. For adult patients, findings demonstrated improvements in the individualization of antibiotic treatment, particularly for patients with respiratory tract infections and sepsis. While most trials were performed in hospitals with central laboratories, point-of-care testing might further advance the field by providing a cost-effective and rapid diagnostic tool in upcoming years. Furthermore, novel biomarkers including CD-64, presepsin, Pancreatic stone and sTREM-1, have all shown promising results for increased accuracy of sepsis diagnosis. Availability of these markers however is currently still limited and there is insufficient evidence for their routine use in clinical care. Expert opinion In addition to new host-response markers, combining such biomarkers with pathogen-directed diagnostics present a promising strategy to increase algorithm accuracy in differentiating between bacterial and viral infections. Recent advances in microbiologic testing using PCR or nucleic amplification tests may further improve the diagnostic yield and promote more targeted pathogen-specific antibiotic therapy.

Utility of Procalcitonin in Clinical Practice

The rise of multi-resistant infections and complications associated with the overuse of antibiotics has led to the implementation of antibiotic stewardship strategies as a marker of patient safety and quality. Using biomarkers that can accurately predict the presence or absence of bacterial infection, thus signaling the need for antibiotic use, or supporting appropriate and safe discontinuation, has become an increasingly relevant strategy for antibiotic stewardship. Evidence supporting procalcitonin for antimicrobial stewardship has focused mostly on lower respiratory tract infections and sepsis. This review discusses the most relevant evidence to support the use of procalcitonin in clinical practice.

Utility of Procalcitonin and Interleukin-6 As Severe Infection Biomarkers in Adulthematological and Oncological Patients. Real-Life Single Center Prospective Observational Study

Introduction: Hematological and oncology patients represent a vulnerable population to opportunistic infections, mainly due to the disease itself and chemotherapy-induced neutropenia. Therefore, timely antibiotic treatment becomes of even greater importance in order to prevent sepsis related mortality. Serum C-reactive protein (CRP), procalcitonin (PCT) and interleukin-6 (IL-6) have been widely used to facilitate sepsis diagnosis, but their diagnostic and prognostic values are limited. Methods: The purpose of our prospective study was to evaluate the diagnostic accuracy of the above-mentioned biomarkers that were monitored during fever episode for early diagnosis of severe infection and sepsis in immunosuppressed patients in course of chemotherapy. Adult oncological or hematological patients with fever or other clinical signs of infectious episode were included in the study. The study was approved by the independent ethics committee and patients provided written informed consent for the acquisition of biomarker samples. Results: The study population consisted of 51 patients with a median age of 56 year, 59% being male. Around 40% had previous infectious episode including eight patients with sepsis, with 28 patients affected from either lymphoma or multiple myeloma, while others had oncological disease. The patients were hospitalized in course of study for infectious episode in 40% of cases, while others were receiving chemotherapy with a median hospitalization duration of 12 days. Sixty percent of the study population was in disease progression at study entry. Fever was present as a clinical sign in all but two patients, that had low-grade fever (<38°C), with 10 patients having neutropenic fever. More than half of the population had body temperature >39°C, with a median of two daily fever spike episodes and median fever duration of two days. Both lung infection in CT scan and positive blood culture were evidenced in approximately 30% of patients. Twelve patients passed away, ten due to infection while disease progression was the cause of death in two of them.Mean baseline and peak PCT values were 4.2 ng/mL and 15.5 ng/mL (range 0.01-150), mean baseline and peak IL-6 values were 262 pg/mL and 299 pg/mL (range 5.5-1500), while mean baseline and peak CRP values were 115 mg/L and 152 mg/L (range 1-775) respectively. Interestingly, both baseline and peak IL-6 and peak CRP values were associated with survival outcome with p<0.05 (Figure 1A and B) using Wilcoxon-Mann-Whitney test. Furthermore peak CRP values were predictive of blood culture positivity (p=0.0005). Conclusions: Serum biomarker monitoring in onco-hematological patients with infectious episode can be of aid in order to evaluate the severity and use it as a guide of antibiotic treatment response. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Utility of Procalcitonin in the Engraftment Phase of Hematopoietic Stem Cell Transplantation in Children

Utility of Procalcitonin in the Engraftment Phase of Hematopoietic Stem Cell Transplantation in Children

The clinical value of procalcitonin cut-off levels for pediatric patients in the hospital setting.

Utilization of procalcitonin (PCT) is challenging for hospital pediatricians because of uncertainty in clinical interpretation. We used a PCT decision cut-off value (<0.15 ng/mL) to identify if PCT can differentiate bacterial infections from viral and other conditions in pediatric patients who presented for hospital-based care. This retrospective study included PCT tested patients who presented to our children's hospital from 2017 to 2020. We analyzed relevant demographic, laboratory, treatment, and clinical data, including discharge diagnoses consolidated into bacterial infections, viral syndromes, and other conditions by the highest PCT defined as ≤0.15 ng/mL (Group A) or >0.15 ng/mL (Group B). We used regression models to identify factors associated with PCT above decision limits and the role of PCT levels in the duration of antibiotic therapy. Of 238 patients, 32.8% constituted Group A. Bacterial infections represent 25.6% of diagnoses for patients in Group A and 55% for Group B (P<0.001), however, the distribution of bacterial infection types, including bacteremia, was comparable. Number of PCT tests performed and C-reactive protein (CRP) ≥5 mg/L, but no other factors were significantly associated with PCT >0.15 ng/mL. PCT levels did not predict the length of antibiotic therapy, which depended on duration of hospitalization and increased CRP. PCT as a single measurement above or below a decision cut-off value of 0.15 ng/mL does not specify bacterial infections or predict the duration of antibiotic therapy in hospitalized pediatric patients.

Utility of Procalcitonin as a Diagnostic Tool for Sepsis in Intensive Care Units

Introduction/Objective: Sepsis is one of the leading causes of mortality in the intensive care unit (ICU). Its diagnosis is often complex and represents a real clinical challenge. The objective of this study was to evaluate the usefulness of procalcitonin (PCT) as a diagnostic marker of sepsis. Methods: This prospective cohort study included 65 patients hospitalized in the ICU. Demographic and clinical data were collected according to a specific information sheet. All patients underwent an inflammatory assessment including PCT, hypersensitive C - reactive protein (hsCRP), and complete blood count. The Sequential Organ Failure Assessment (SOFA) score was calculated. Patients were classified into septic (SOFA ≥ 2 points) and non-septic (SOFA < 2 points). The Receiver Operating Characteristic (ROC) curve was used to evaluate the diagnostic performance of inflammatory parameters. Results: Of 65 included patients, 46 had developed sepsis. Among the investigated inflammatory markers, PCT has the best discriminative capacity; its area under the curve (AUC), of 0.78, was the highest, followed by the neutrophils to lymphocytes ratio (NLR) and hsCRP with a lower but statically significant AUC. The optimal PCT threshold for sepsis diagnosis was 4.5ng/ml with a specificity of 83% and a sensitivity of 60%. A positive correlation between the PCT levels and the SOFA score was also found (p=0.002). Conclusion: This study provides additional evidence of the performance of PCT in the diagnosis of septic states in patients admitted to ICU. The newly established cut-off value provides the best balance between specificity and sensitivity. Its superiority over conventional inflammatory markers has been demonstrated.

325. Empiric Antibiotics for COVID-19 and the Utility of Procalcitonin

BackgroundBacterial coinfection in COVID-19 is infrequent, yet empiric antibiotic use is common. The objectives of this study were to investigate the effect of empiric antibiotics on time to resolution of COVID-19 pneumonia, elucidate the impact of COVID-19 on procalcitonin levels, and determine the incidence of respiratory bacterial coinfection.MethodsThis was a retrospective study of adult patients hospitalized with COVID-19 between June 1, 2020 and September 30, 2020. Patients were included if they had at least one procalcitonin level. They were excluded if admitted to an intensive care unit within 24 hours of presentation or received antibiotics for an indication besides pneumonia. Patients were stratified into 4 groups based on procalcitonin level and receipt of antibiotics. The primary outcome was time to clinical resolution of pneumonia. A key secondary outcome was incidence of confirmed respiratory bacterial coinfection.ResultsA total of 199 patients were included. Patients with a procalcitonin greater than 0.25 ng/mL who received antibiotics had a longer median time to clinical resolution of pneumonia, 8 days (95% CI, 4 to 11 days) vs. 3 or 4 days in other groups (P< 0.001). Additionally, this same group required greater baseline oxygen supplementation, had more comorbidities, and increased mortality compared to all other groups. Median time to clinical resolution of pneumonia was also longer in patients who received antibiotics compared to those who did not (5 vs. 4 days, P=0.017) and in those with a procalcitonin greater than 0.25 ng/mL compared to those with PCT less than or equal to 0.25 ng/mL (7 vs. 4 days, P< 0.001). Renal dysfunction was more prevalent in patients with an elevated procalcitonin (45% vs. 17.5%). The overall incidence of confirmed respiratory bacterial coinfection was 1.5%.ConclusionIrrespective of procalcitonin level, empiric antibiotics were not associated with a shorter time to resolution of COVID-19 pneumonia in non-critically ill patients. Elevated procalcitonin is likely a reflection of the severity of COVID-19 disease and baseline renal function rather than bacterial infection. Additionally, the overall incidence of confirmed bacterial coinfection in non-critically ill patients hospitalized with COVID-19 was low.Disclosures Kiya D. Mohadjer, PharmD, BCPS, BCIDP, Eli Lilly and Company (Shareholder)Gilead Sciences (Shareholder)

Does procalcitonin have clinical utility in the management of paediatric community-acquired pneumonia? A PRO/CON debate.

Although the overwhelming majority of community-acquired pneumonia (CAP) in children is caused by viral infections, treatment of CAP is among the most common indications for antibiotic use in children. This is largely driven by the imprecision of clinical diagnostic tools to differentiate viral from bacterial pneumonia and highlights the need for improved approaches to optimizing management of CAP in children. In this issue of JAC-Antimicrobial Resistance, we present a PRO/CON debate that discusses the clinical utility of procalcitonin in children with CAP.

Utility of Procalcitonin Over C-Reactive Protein and WBC as an Early and Rapid Diagnostic Marker of Bacterial Infections in Febrile Patients with or no Hemoculture Results as Gold Standard in a Malaria Endemic Zone of Cameroon

Background & objectives: Early identification of bacterial infection in patients with fever is important for prompt and specific treatment. However, the available biomarkers such as C-reactive protein (CRP) and leukocyte counts are not specific to bacterial diagnosis. This study aimed to assess the diagnostic value of procalcitonin (PCT) over CRP and leukocyte counts for bacterial infection screening in febrile patients while awaiting their hemoculture results, which takes up to 7 Days before results are available though it is the gold standard for the diagnosis of bacterial infections. Methods: Blood samples were collected from febrile patients between January and July 2020 then processed for blood cultures. PCT, CRP and WBC levels were measured. The patients were divided into two groups according to the final diagnosis: bacterial infection group (group1) and non-bacterial infection group (group 2).SPSS version 20.0 software package was used for data analysis and normally distributed variables were calculated using mean, standard deviation and ANOVA test while median and range were used for variables without a normal distribution. Significance testing was done using Kruskal-Wallis h test and Wilcoxon two sample test and the diagnostic accuracy was assessed by calculating the area (AUC) under the receiver operating characteristic curve (ROC). Results: There were significant (P<0.05) difference in the levels of PCT, CRP and WBC among the two groups. The PCT levels of patients in the bacterial infections group were significantly higher than those in the nonbacterial infections group (27.9 vs., 11.7 P < 0.001). The best cut-off value to detect bacterial infections was 1.46 ng/ml for PCT. PCT, CRP and WBC had areas under the curve of 0.71, 0.66 and 0.45 respectively and sensitivity of 100%, 72.7% and 27.3% respectively. Interpretation & conclusions: Our results showed that PCT was a valuable marker for the early and rapid diagnosis of bacterial infections in febrile patients in our setting when compared to CRP and WBC. However, prospective and large scale studies are warranted to confirm these findings in Cameroon.

The Diagnostic Utility of Procalcitonin for the Detection of Infection among Systemic Lupus Erythematosus Patients in a Tertiary Care Hospital

Background: Clinical manifestations of infection in patients with systemic lupus erythematosus (SLE) are variable and involve significant diagnostic challenges. Delays in diagnosis and treatment strongly affect the clinical outcomes and mortality. The elevation of one’s serum procalcitonin (PCT) level may be a diagnostic biomarker of infection in SLE. Objective: To determine the diagnostic accuracy of PCT for bacterial and fungal infections in patients with SLE. Materials and Methods: Samples of serum PCT were prospectively collected in all patients with SLE admitted to medical wards at Siriraj Hospital, a tertiary care center, between February 2011 and March 2012. Results: One hundred twenty-four patients with SLE were enrolled. The mean age was 31.9±10.9 years. The median disease duration of SLE was five years. The Median Mexican SLE Disease-Activity Index Score was 8 (IQR 6 to 11.8). Ninety-five percent of patients had active SLE and 70% of them were treated with prednisolone of more than 15 mg/day or equivalent doses of other corticosteroids. The serum PCT levels of SLE patients with infection (n=39; median 0.52 ng/mL, IQR 0.15 to 1.49) were significantly increased, compared to those of SLE patients with no infection (n=85; median 0.09 ng/mL, IQR 0.04 to 0.16), p&lt;0.001. The cut-off point of elevated serum PCT (0.5 ng/mL) for the diagnosis of bacterial or fungal infections in patients with SLE had sensitivity, specificity, positive predictive value, and negative predictive values of 51.3%, 95.3%, 83.3%, and 81%, respectively. The independent factors associated with elevated serum PCT levels of 0.5 ng/mL or more were the presence of a bacterial or fungal infection, a low hemoglobin level, and serum Cr of 2 mg/dL or more. Conclusion: The elevation of one’s serum PCT level may be a useful biomarker to detect bacterial and fungal infections in patients with SLE. Keywords: Systemic lupus erythematosus; Procalcitonin; Sensitivity; Specificity; Infection; Sepsis; Flare

Pneumonia Severity in Children: Utility of Procalcitonin in Risk Stratification

To determine if serum procalcitonin, an indicator of bacterial etiology in pneumonia in all ages and a predictor of severe pneumonia in adults, is associated with disease severity in children with community-acquired pneumonia. We prospectively enrolled children 2 months to <18 years with clinical and radiographic pneumonia at 2 children's hospitals (2014-2019). Procalcitonin samples were obtained at presentation. An ordinal outcome scale of pneumonia severity was defined: very severe (intubation, shock, or death), severe (intensive care admission without very severe features and/or high-flow nasal cannula), moderate (hospitalization without severe or very severe features), and mild (discharge). Hospital length of stay (LOS) was also examined. Ordinal logistic regression was used to model associations between procalcitonin and outcomes. We estimated adjusted odds ratios (aORs) for a variety of cut points of procalcitonin ranging from 0.25 to 3.5 ng/mL. The study included 488 children with pneumonia; 30 (6%) were classified as very severe, 106 (22%) as severe, 327 (67%) as moderate, and 25 (5%) as mild. Median procalcitonin in the very severe group was 5.06 (interquartile range [IQR] 0.90-16.83), 0.38 (IQR 0.11-2.11) in the severe group, 0.29 (IQR 0.09-1.90) in the moderate group, and 0.21 (IQR 0.12-1.2) in the mild group. Increasing procalcitonin was associated with increasing severity (range of aORs: 1.03-1.25) and increased LOS (range of aORs: 1.04-1.36). All comparisons were statistically significant. Higher procalcitonin was associated with increased severity and LOS. Procalcitonin may be useful in helping clinicians evaluate pneumonia severity.

Utility of procalcitonin as an early diagnostic marker of bacteremia in individuals with periodontitis Stage II and III.

The aim of the present study is to assess the ability of procalcitonin (PCT) to differentiate between periodontal health and Stage II and III periodontitis. We further assessed, if PCT can reflect early bacteremia induced by non-surgical periodontal treatment (NSPT). Sixty-four systemically healthy individuals were divided into Group I, periodontally healthy, and Group II, Stage II and III periodontitis. NSPT was done for both the groups. Standardized serum and salivary samples were obtained and analyzed for PCT levels using highly sensitive double antibody sandwich enzyme-linked immunosorbent assay at baseline and 2 weeks. In addition, the serum levels of PCT were recorded at immediate and 1-hour post-NSPT. Mean PCT levels (saliva=0.03ng/mL and serum=0.05ng/mL) in periodontally healthy group were considerably lower than that in the periodontitis group (saliva=0.22ng/mL and serum=1.85ng/mL) with significant intergroup comparison at P< 0.001. Post NSPT the mean serum PCT values increased from 1.854ng/mL to 1.871ng/mL at the immediate interval and remained at 0.879ng/mL after 2 weeks at P< 0.001. Spearman correlation showed highly significant positive correlation between serum and salivary PCT values to clinical attachment level (CAL) at P< 0.001 and rho=0.78 and 0.75, respectively. Linear regression model showed serum PCT to be a significant predictor for CAL. Screening for serum PCT levels in patients with periodontitis could act not only as a guide to assess the bacterial load and use of antibiotics but also as a predictor for CAL loss in patients with periodontitis.

Utility of Procalcitonin in Differentiating Acute Chest Syndrome from Vaso-Occlusive Crisis in Sickle Cell Disease

Background: Acute chest syndrome (ACS) frequently complicates sickle cell disease (SCD) and is a leading cause of hospitalization and mortality. Many factors have been implicated in ACS, including infections, thrombosis, fat and pulmonary emboli. However, a clear etiology is not defined in 50% of the cases and ACS is considered a clinical endpoint for different pathogenic processes (Vichinsky et al 2000). The non-specific nature of ACS makes diagnostic tests challenging, and there are no serum tests clinical used to aid diagnosis. Procalcitonin (PCT) is a prohormone of calcitonin and serum PCT rises within hours of an inflammatory stimulus. PCT has clinical utility as a marker of severe systemic inflammation, infection, and sepsis (Becker et al. 2008). Few studies have evaluated PCT as a biomarker for ACS in patients presenting with vaso-occlusive crises (VOC). Two studies have reported no difference in PCT (Biemond et al. 2018 and Stankovic et al 2011), while one study reported higher PCT between ACS and VOC (Patel et al 2014). Methods: We retrospectively reviewed 106 patients with SCD who presented to the emergency department with fever and painful crises during 2015-2019. The patients were divided into two categories based on discharge diagnoses - patients with VOC only (n=88) and patients with ACS (n=18). Inclusion criteria for both groups were patients with SCD, 17 years and older and PCT measurement on presentation. Exclusion criteria were defined as patients who had received empiric antibiotics prior to PCT testing. Data collected on presentation included genotype, age, gender, complete blood count, PCT, creatinine, total bilirubin and hydroxyurea use. Length of stay was recorded. Data was analyzed between the two groups using descriptive statistics and accounting for unequal variances, withp-value set at 0.05 for significance. Results: Demographics and clinical characteristics are summarized in Table 1 (Figure). The sample included primarily adult males (77%), with about two-thirds on hydroxyurea. Genotype HbSS (73.6%) was most prevalent followed by HbSC (22.6%) and HbSβ (3.8%). The ACS group had a higher percentage of HbSS, lower use of hydroxyurea and higher mean bilirubin. Mean PCT for the ACS group was 0.52 ng/mL (range, 0.05-2.04), compared to 0.31 ng/mL (range, 0.02-6.82) in the VOC group; withp=0.084. ROC analysis showed a PCT&amp;gt;0.5ng/mL had 39% sensitivity and 85% specificity for ACS in this sample. Conclusion: In this sample, PCT on presentation was higher in those with ACS compared to VOC, but this difference did not achieve statistical significance. Further study in a larger population would be useful to evaluate this finding. Disclosures No relevant conflicts of interest to declare.

Utility of Procalcitonin in the Early Diagnosis of Patients with Sickle Cell Disease Presenting with Fever

Background: Patients with sickle cell disease (SCD) are at increased risk of developing bacterial infections as a result of functional asplenia. Fever, a common symptom in SCD often occurs with other sickle cell related conditions and viral infections. This poses a diagnostic challenge and early use of empiric antibiotics is recommended while awaiting cultures. The widespread administration of antibiotics to all patients with SCD with fever can result in problems such as antibiotic resistance and increased medical costs. An early and reliable biomarker is therefore needed to help distinguish between bacterial and non-bacterial causes for fever in SCD. Procalcitonin (PCT) has been shown to be elevated in bacterial but not viral infections. In SCD, few studies have looked at the role of PCT in predicting bacterial infections. Unal et al reported vaso-occlusive crisis (VOC) with or without fever did not increase PCT levels in relation to patients with no crisis and no fever. However, Rincón-López et al reported a PCT &amp;lt; 0.6ng/mL had a negative predictive value of 97.2% and potentially could be used to identify bacterial infection early. Methods: We retrospectively studied 122 patients with SCD who presented to the emergency department with fever from 2015-2019. Inclusion criteria were defined as patients with SCD, 17 years and older and PCT measurement on presentation to the emergency department. Exclusion criteria were defined as patients with SCD and fever who had received empiric antibiotics prior to labs being drawn in the emergency department. The cohort was divided into groups of patients with Confirmed Bacterial Infection (CBI, n=18), Suspected Bacterial Infection (SBI, n=6), Viral Infections (n=10) and Vaso-Occlusive Crises (VOC, n=88) only. CBI was defined as a positive bacterial culture (blood, body fluid, urine, respiratory or cerebrospinal fluid) or C.difficile toxin assay. Viral infections were defined as a negative bacterial culture in the presence of a virus found on PCR obtained with nasopharyngeal swab. Characteristics including genotype, age, gender, complete blood count, PCT, creatinine, total bilirubin, hydroxyurea use and length of stay were examined. Data was analyzed between the groups using descriptive statistics and accounting for unequal variances, with p-value set at 0.05 for significance. Results: Demographics and clinical characteristics are summarized in Table 1 (Figure). The mean age was 34.6 years with predominantly males (64.8%). Almost two-thirds were on hydroxyurea (62.3%). The most common genotype was HbSS (70.5%) followed by HbSC (26.2%) and HbSβ (3.3%). The mean PCT for patients with CBI was 8.99 ng/mL (range, 0.03-78.36) as compared to 0.31 ng/mL (range, 0.02-6.82) in the VOC group. The most common organisms detected were E.coli, C.difficile, Pseudomonas, Staphylococcus and Enterobacter. There was a significant difference between median PCT for patients with CBI and those with VOC (p=0.036) and between patients with CBI and viral infections (p= 0.045). Using a PCT of &amp;gt;0.5ng/mL resulted in 81% Sensitivity and 85% Specificity for CBI. Conclusion: In patients with SCD presenting with fever, PCT on presentation was significantly higher in those with CBI compared to VOC only or Viral Infection. Disclosures No relevant conflicts of interest to declare.

Prospective Observational Study to Determine Kinetics of Procalcitonin in Hospitalized Children Receiving Antibiotic Therapy for Non-Critical Acute Bacterial Infections.

IntroductionThe kinetics of procalcitonin in pediatric patients with non-critical acute bacterial infections receiving appropriate antibiotic therapy are not well described.MethodsWe performed a single-center, prospective observational pilot study of children admitted to a tertiary care children’s hospital who were receiving antibiotics for treatment of a non-critical acute bacterial infection, and we prospectively measured serial procalcitonin levels daily for 4 days during hospitalization.ResultsAmong the 46 children with baseline procalcitonin levels enrolled in the study, procalcitonin kinetics followed a half-life of approximately 24 h in most patients. Procalcitonin declined faster than C-reactive protein over the first 48 h of appropriate antibiotic treatment. There was variation in biomarker levels among participants with the same infection type, especially in participants with bacteremia, musculoskeletal infection and skin/soft tissue infection.ConclusionUtility of procalcitonin as a biomarker to follow every 24–48 h in non-critically ill children receiving antibiotic therapy for bacterial infections as an objective measure of clinical improvement is promising.

Utility of procalcitonin in amedical intensive care unit in Croatia.

AimsTo investigate the clinical benefit of routine procalcitonin (PCT) measurement in the medical intensive care unit (ICU) of a tertiary referral hospital.MethodsAdult patients with suspected infections were included. White blood cells, C‑reactive protein (CRP), and PCT were measured.ResultsIn this study 129 patients of median age 64 years (interquartile range 39–89 years) were prospectively included. The Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were 21 ± 14 and 7 ± 6, respectively. Intensive care unit (ICU) mortality was 22.5%. Immunocompromised patients constituted 39.5%. A significant correlation was observed between PCT and APACHE II (Spearman’s rho 0.461, p < 0.01), PCT and SOFA (Spearman’s rho 0.494, p < 0.01) and PCT and CRP (Spearman’s rho 0.403, p < 0.01). Most patients (n = 83, 64.3%) received antibiotics before admission. No difference in PCT (1.56 ± 8 µg/L vs. 1.44 ± 13 µg/L, p = 0.6) was observed with respect to previous antibiotic therapy. Levels of PCT and CRP were significantly increased in patients with positive blood cultures, the infection caused by Gram-negative microorganism regardless of disease severity and pneumonia with complications. PCT did not differ among patients with positive vs negative urine culture (4.6 ± 16 µg/L vs. 1.76 ± 11.9 µg/L) or positive vs. negative endotracheal aspirate (1.93 ± 11.4 µg/L vs. 1.76 ± 1.11 µg/L). PCT-guided stewardship was applied in 36 patients (28%).ConclusionIncreased initial PCT levels might point to the development of more severe disease caused by Gram-negative bacteria, regardless of previous antibiotic treatment. The results pertain to immunocompetent and immunocompromised patients. Implementation of PCT-guided stewardship in those patients is possible and relies on experience as well as knowledge of reference change value for a marker within the specific setting.

The Utility of Procalcitonin in the Management of Kidney and Pancreas Transplant Recipients with Suspected Infection

The Utility of Procalcitonin in the Management of Kidney and Pancreas Transplant Recipients with Suspected Infection

Utility of Procalcitonin as a Biomarker for Sepsis in Children.

Sepsis is a complex process defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. It is associated with significant morbidity and mortality rates in both adults and children, and emphasis has been placed on its early recognition and prompt provision of antimicrobials. Owing to limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), significant research has been conducted to identify sepsis biomarkers. Ideally, a biomarker could reliably and rapidly distinguish bacterial infection from other, noninfectious causes of systemic inflammatory illness. In doing so, a sepsis biomarker could be used for earlier identification of sepsis, risk stratification/prognostication, and/or guidance of antibiotic decision-making. In this minireview, we review one of the most common clinically used sepsis biomarkers, procalcitonin, and its roles in sepsis management in these three areas. We highlight key findings in the adult literature but focus the bulk of this review on pediatric sepsis. The challenges and limitations of procalcitonin measurement in sepsis are also discussed.

Diagnostic utility of procalcitonin in children with infectious complications during chemotherapy-induced neutropenia: single center experience, literature review

Background. Infectious complications cause significant mortality in children with oncological diseases during chemotherapy-induced neutropenia. The absence of sensitive and specific signs and symptoms of infectious conditions as well as its microbiological identification, leads to inappropriate antibiotic exposure. The use of laboratory biomarkers (procalcitonin (PCT) and C-reactive protein (CRP)) may be helpful for differential diagnostics of inflammatory conditions and for rational antimicrobial therapy.Objective: to assess the current value of PCT as an additional marker for differentiating inflammatory conditions in children with chemotherapy-induced neutropenia.Materials and methods. We presented the analysis of infectious complications in pediatric patients with oncological and onco- / hematological diseases between 2017–2020 (54 patients from 2 mnths – 17 years). PCT and CRP with clinical and instrumental diagnostic data were used for differential diagnosis of fever and development of antimicrobial therapy decision rules. Literature review concerning the discussed theme from 2006–2018 was done.Results. Eighty-five infectious episodes in 36 months were registered, among them 42 in pts with onco- / hematological diseases and 43 – with solid tumors. In the group of bacterial infectious complications mean CRP and PCT values were significantly higher than in group of nonbacterial, moreover the discriminative value was higher for PCT. We revealed the correlation between severity of infectious complications and values of markers of acute-phase reactions. In case of non-severe bacterial complications and other types of infections significant difference was revealed only for PCT mean values.Conclusion. Specificity of PCT concentration in bacterial infections exceeds that of CRP, which confirms the hypothesis of advantages in using PCT as differential marker of inflammatory conditions in children with malignancies.