Yonsei Med J.  2011 Mar;52(2):276-281. 10.3349/ymj.2011.52.2.276.

Utility of Procalcitonin as an Early Diagnostic Marker of Bacteremia in Patients with Acute Fever

• Kim MH
• Lim G
• Kang SY
• Lee WI
• Suh JT
• Lee HJ

• KMID: 1779663
• DOI: http://doi.org/10.3349/ymj.2011.52.2.276

Abstract

PURPOSE
Procalcitonin (PCT) is a current, frequently used marker for severe bacterial infection. The aim of this study was to assess the ability of PCT levels to differentiate bacteremic from nonbacteremic patients with fever. We assessed whether PCT level could be used to accurately rule out a diagnosis of bacteremia.
MATERIALS AND METHODS
Serum samples and blood culture were obtained from patients with fever between August 2008 and April 2009. PCT was analyzed using a VIDAS(R) B.R.A.H.M.S PCT assay. We reviewed the final diagnosis and patient histories, including clinical presentation and antibiotic treatment.
RESULTS
A total of 300 patients with fevers were enrolled in this study: 58 with bacteremia (positive blood culture) (group I); 137 with local infection (group II); 90 with other diseases (group III); and 15 with fevers of unknown origin (group IV). PCT levels were significantly higher in patients with bacteremia than in those with non-bacteremia (11.9 +/- 25.1 and 2.5 +/- 14.7 ng/mL, respectively, p < 0.001). The sensitivity and specificity were 74.2% and 70.1%, respectively, at a cut-off value of 0.5 ng/mL. A serum PCT level of < 0.4 ng/mL accurately rules out diagnosis of bacteremia.
CONCLUSION
In febrile patients, elevated PCT may help predict bacteremia; furthermore, low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore, PCT assessment could help physicians limit the number of prescriptions for antibiotics.

Keyword

Bacteremia; procalcitonin; infection

MeSH Terms

Bacteremia/blood/*diagnosis
Biological Markers/blood
C-Reactive Protein/analysis
Calcitonin/*blood
Early Diagnosis
Female
Fever/blood/*diagnosis/etiology
Fever of Unknown Origin/blood/diagnosis/microbiology
Humans
Male
Middle Aged
Protein Precursors/*blood
Sensitivity and Specificity
Young Adult

Figure

• 

  Fig. 1 (A) Receiver operator characteristic curve demonstrating sensitivity as a function of one-specificity for discriminating patients with blood culture positivity based on procalcitonin (PCT) and C-reactive protein (CRP) levels. PCT and CRP had areas under the receiver operator characteristic curve of 0.753 and 0.696, respectively. (B) Receiver operator characteristic curve demonstrating sensitivity as a function of one-specificity for discriminating patients with bacteremia from patients with localized infection based on PCT and CRP. PCT and CRP had areas under the receiver operator characteristic curve of 0.769 and 0.746, respectively.

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