Infect Chemother.  2019 Sep;51(3):263-273. 10.3947/ic.2019.51.3.263.

Prognostic Value of Serum Procalcitonin level for the Diagnosis of Bacterial Infections in Critically-ill Patients

Affiliations
  • 1Faculty of Pharmacy, Siam University, Bangkok, Thailand.
  • 2Department of Medicine, Phyathai 2 International Hospital, Bangkok, Thailand.
  • 3Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand. preecha.mon@mahidol.ac.th
  • 4Clinical Pharmacy Unit, Division of Pharmacy, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Abstract

BACKGROUND
Procalcitonin (PCT) is a diagnostic biomarker for bacterial infections in critically-ill patients. However, the cut-off value of PCT for the diagnosis of bacterial infections is unclear and unreliable. This study aimed to determine the optimal cut-off value of PCT for the diagnosis of bacterial infections in critically-ill patients.
MATERIALS AND METHODS
We conducted a retrospective study involving 311 adult patients who had been admitted to the medical or surgical intensive care unit for more than 24 hours from 2013 to 2015. At least one blood test for PCT level was performed for all patients within the first 24 hours of suspecting an infection.
RESULTS
One hundred and fifty-seven patients had bacterial infections, while 154 did not. Patients with bacterial infections had a significantly higher median PCT level than those without bacterial infections (1.90 ng/mL vs. 0.16 ng/mL, P <0.001). The area under the receiver operating characteristic curve of PCT for discriminating between bacterial and non-bacterial infections was 0.874 (95% confidence interval: 0.834, 0.914; P <0.001). The optimal cut-off value of PCT for differentiating between fevers due to bacterial infections from those due to non-bacterial infections was 0.5 ng/mL, with a sensitivity of 84.7%, specificity of 79.9%, positive predictive value of 81.1%, and negative predictive value of 83.7%.
CONCLUSION
PCT was found to be an accurate biomarker for the diagnosis of bacterial infections among patients admitted to medical and surgical intensive care units. The optimal cut-off value of PCT for the diagnosis of bacterial infections was 0.5 ng/mL.

Keyword

Bacterial infections; Critical illness; Diagnosis; Procalcitonin

MeSH Terms

Adult
Bacterial Infections*
Critical Care
Critical Illness
Diagnosis*
Fever
Hematologic Tests
Humans
Retrospective Studies
ROC Curve
Sensitivity and Specificity
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