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Does serum procalcitonin aid in the diagnosis of bloodstream infection regardless of whether patients exhibit the systemic inflammatory response syndrome?

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Abstract

Background

Physicians frequently rely on the systemic inflammatory response syndrome (SIRS) criteria to detect bloodstream infections (BSIs). We evaluated the diagnostic performance of procalcitonin (PCT) in detecting BSI in patients with and without SIRS.

Methods

We tested the association between BSI, serum PCT levels, contemporaneous SIRS scores and serum lactate using logistic regression in a dataset of 4279 patients. The diagnostic performance of these variables was assessed.

Results

In multivariate regression analysis, only log(PCT) was independently associated with BSI (p < 0.05). The mean area under the curve (AUC) of PCT in detecting BSI (0.683; 95% CI 0.65–0.71) was significantly higher than serum lactate (0.615; 95% CI 0.58–0.64) and the SIRS score (0.562; 95% CI 0.53–0.58). The AUC of PCT did not differ significantly by SIRS status. PCT of less than 0.1 ng/mL had a negative predictive value (NPV) of 97.4 and NPV of 96.2% for BSI in the SIRS-negative and SIRS-positive patients, respectively. A PCT of greater than 10 ng/mL had a LR of 6.22 for BSI in SIRS-negative patients. The probability of BSI increased exponentially with rising PCT levels regardless of SIRS status.

Conclusion

The performance of PCT for the diagnosis of BSI was not affected by SIRS status. Only PCT was independently associated with BSI, while the SIRS criterion and serum lactate were not. A low PCT value may be used to identify patients at a low risk for having BSI in both settings. An elevated PCT value even in a SIRS negative patient should prompt a careful search for BSI.

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Abbreviations

PCT:

Serum procalcitonin

SIRS:

Systemic inflammatory response syndrome

BSI:

Bloodstream infection

SD:

Standard deviation

OR:

Odds ratio

CI:

Confidence interval

NPV:

Negative predictive value

EMR:

Electronic medical record

HR:

Heart rate

RR:

Respiratory rate

WBC:

White blood cells

ROC:

Receiver operating characteristic

AUC:

Area under the curve

ICU:

Intensive care unit

LR:

Likelihood ratio

qSOFA:

Quick Sequential Organ Failure Assessment

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Acknowledgements

We would like to thank Dr. John Song, Dr. Anne-Marie Weber, Dr. Jonathon Kirsch and Dr. Robert Foley for critically reviewing the manuscript.

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, University of Minnesota, 420 Delaware Street, SE, MMC 741, Minneapolis, MN, 55455, USA

    Rashi Arora, James P. Campbell & Nishant Sahni

  2. Department of Health Informatics, Mayo Clinic, Rochester, MN, USA

    Gyorgy Simon

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  1. Rashi Arora
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  2. James P. Campbell
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  4. Nishant Sahni
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Correspondence to Nishant Sahni.

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Arora, R., Campbell, J.P., Simon, G. et al. Does serum procalcitonin aid in the diagnosis of bloodstream infection regardless of whether patients exhibit the systemic inflammatory response syndrome?. Infection 45, 291–298 (2017). https://doi.org/10.1007/s15010-016-0965-0

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