Procalcitonin: a valuable indicator of infection in a medical ICU?

Abstract

Objective: To assess the use of procalcitonin (PCT) for the diagnosis of infection in a medical ICU.

Design: Prospective, observational study.

Patients: Seventy-seven infected patients and 24 patients with systemic inflammatory response syndrome (SIRS) due to other causes. Seventy-five patients could be classified into sepsis (n=24), severe sepsis (n=27) and septic shock (n=24), and 20 SIRS patients remained free from infection during the study. Plasma PCT and C-reactive protein (CRP) levels were evaluated within 48 h of admission (day 0), at day 2 and day 4.

Results: As compared with SIRS, PCT and CRP levels at day 0 were higher in infected patients, regardless of the severity of sepsis (25.2±54.2 ng/ml vs 4.8±8.7 ng/ml; 159±92 mg/l vs 71±58 mg/l, respectively). At cut-off values of 2 ng/ml (PCT) and 100 mg/l (CRP), sensitivity and specificity were 65% and 70% (PCT), 74% and 74% (CRP). PCT and CRP levels were significantly more elevated in septic shock (38.5±59.1 ng/ml and 173±98 mg/l) than in SIRS (3.8±6.9 ng/ml and 70±48 mg/l), sepsis (1.3±2.7 ng/ml and 98±76 mg/l) and severe sepsis (9.1±18. 2 ng/ml and 145±70 mg/l) (all p=0.005). CRP, but not PCT, levels were more elevated in severe sepsis than in SIRS (p<0.0001). Higher PCT levels in the patients with four dysfunctional organs and higher PCT and CRP levels in non-survivors may only reflect the marked inflammatory response to septic shock.

Conclusion: In this study, PCT and CRP had poor sensitivity and specificity for the diagnosis of infection. PCT did not clearly discriminate SIRS from sepsis or severe sepsis.