Korean J Intern Med.  2018 Jan;33(1):176-184. 10.3904/kjim.2016.119.

Clinical value of procalcitonin for suspected nosocomial bloodstream infection

Affiliations
  • 1Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea. psy99ch@hanmail.net
  • 2Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.

Abstract

BACKGROUND/AIMS
Procalcitonin (PCT) may prove to be a useful marker to exclude or predict bloodstream infection (BSI). However, the ability of PCT levels to differentiate BSI from non-BSI episodes has not been evaluated in nosocomial BSI.
METHODS
We retrospectively reviewed the medical records of patients ≥ 18 years of age with suspected BSI that developed more than 48 hours after admission.
RESULTS
Of the 785 included patients, 105 (13.4%) had BSI episodes and 680 (86.6%) had non-BSI episodes. The median serum PCT level was elevated in patients with BSI as compared with those without BSI (0.65 ng/mL vs. 0.22 ng/mL, p = 0.001). The optimal PCT cut-off value of BSI was 0.27 ng/mL, with a corresponding sensitivity of 74.6% (95% confidence interval [CI], 66.4% to 81.7%) and a specificity of 56.5% (95% CI, 52.7% to 60.2%). The area under curve of PCT (0.692) was significantly larger than that of C-reactive protein (CRP; 0.526) or white blood cell (WBC) count (0.518). However, at the optimal cut-off value, PCT failed to predict BSI in 28 of 105 cases (26.7%). The PCT level was significantly higher in patients with an eGFR < 60 mL/min/1.73 m² than in those with an eGFR ≥ 60 mL/min/1.73 m² (0.68 vs. 0.17, p = 0.01).
CONCLUSIONS
PCT was more useful for predicting nosocomial BSI than CRP or WBC count. However, the diagnostic accuracy of predicting BSI remains inadequate. Thus, PCT is not recommended as a single diagnostic tool to avoid taking blood cultures in the nosocomial setting.

Keyword

Procalcitonin; Nosocomial bloodstream infection; Renal function
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