Procalcitonin as a Marker for the Detection of Bacteremia and Sepsis in the Emergency Department

Rapid diagnosis of bloodstream infections (BSIs) in the emergency department (ED) is challenging, with turnaround times exceeding the timeline for rapid diagnosis. We studied the usefulness of procalcitonin as a marker of BSI in 367 adults admitted to our ED with symptoms of systemic infection. Seru...

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Bibliographic Details
Published in:American journal of clinical pathology 2011-02, Vol.135 (2), p.182-189
Main Authors: RIEDEL, Stefan, MELENDEZ, Johan H, AN, Amanda T, ROSENBAUM, Janet E, ZENILMAN, Jonathan M
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Bacteremia - blood
Bacteremia - diagnosis
Bacterial diseases
Bacterial sepsis
Biological and medical sciences
Biomarkers - blood
Calcitonin - blood
Calcitonin Gene-Related Peptide
Emergency Service, Hospital
Human bacterial diseases
Humans
Infectious diseases
Inflammation - blood
Inflammation - diagnosis
Investigative techniques, diagnostic techniques (general aspects)
Medical sciences
Middle Aged
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Predictive Value of Tests
Protein Precursors - blood
Retrospective Studies
Sensitivity and Specificity
Sepsis - blood
Sepsis - diagnosis
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Summary:Rapid diagnosis of bloodstream infections (BSIs) in the emergency department (ED) is challenging, with turnaround times exceeding the timeline for rapid diagnosis. We studied the usefulness of procalcitonin as a marker of BSI in 367 adults admitted to our ED with symptoms of systemic infection. Serum samples obtained at the same time as blood cultures were available from 295 patients. Procalcitonin levels were compared with blood culture results and other clinical data obtained during the ED visit. Procalcitonin levels of less than 0.1 ng/mL were considered negative; all other levels were considered positive. In 16 patients, there was evidence of BSI by blood culture, and 12 (75%) of 16 patients had a procalcitonin level of more than 0.1 ng/mL. In 186 (63.1%) of 295 samples, procalcitonin values were less than 0.1 ng/mL, and all were culture negative. With a calculated threshold of 0.1475 ng/mL for procalcitonin, sensitivity and specificity for the procalcitonin assay were 75% and 79%, respectively. The positive predictive value was 17% and the negative predictive value 98% compared with blood cultures. Procalcitonin is a useful marker to rule out sepsis and systemic inflammation in the ED.
ISSN:0002-9173
1943-7722
DOI:10.1309/ajcp1mfyinqlecv2