EXTENDED REPORT

Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes?

I Delévaux¹, M André¹, M Colombier², E Albuisson³, F Meylheuc¹, R-J Bégue², J-C Piette⁴, O Aumaître¹

¹ Department of Internal Medicine, Gabriel Montpied Hospital, groupe hospitalier Saint-Jacques, BP 69, 63003 Clermont-Ferrand Cedex 1, France
² Laboratory of Hormonology, Gabriel Montpied Hospital, groupe hospitalier Saint-Jacques, BP 69, 63003 Clermont-Ferrand Cedex 1, France
³ Laboratory of Biostatistic, Gabriel Montpied Hospital, groupe hospitalier Saint-Jacques, BP 69, 63003 Clermont-Ferrand Cedex 1, France
⁴ Department of Internal Medicine, Pitié-Salpêtriére Hospital, 47–83 boulevard de l’Hôpital, 75651 Paris Cedex 13, France

Correspondence to:
Correspondence to:
Professor O Aumaître, Department of Internal Medicine, Gabriel Montpied Hospital, groupe hospitalier Saint-Jacques, BP 69, 63003 Clermont-Ferrand Cedex 1, France;
oaumaitre{at}chu-clermontferrand.fr

Objective: To study the levels of procalcitonin (PCT) in various inflammatory states seen in an internal medicine department and to evaluate the possible discriminative role of PCT in differentiating bacterial infection from other inflammatory processes.

Methods: PCT, C reactive protein (CRP), and white blood cell count (WBC) were measured in patients admitted to the department for fever or biological inflammatory syndrome, or both. The serum of 173 consecutive patients was analysed according to the aetiological diagnosis. The patients were divided into two groups: group I (n=60) with documented bacterial or fungal infection; group II (n=113) with abacterial inflammatory disease.

Results: PCT levels were >0.5 ng/ml in 39/60 (65%) patients in group I. In group II, three patients with a viral infection had slightly increased PCT levels (0.7, 0.8, and 1.1 ng/ml) as did two others, one with crystal arthritis and the other with vasculitis (0.7 ng/ml in both cases). All other patients in group II had PCT levels <0.5 ng/ml. In this study a value of PCT >0.5 ng/ml was taken as the marker of bacterial infection (sensitivity 65%, specificity 96%). PCT values were more discriminative than WBC and CRP in distinguishing a bacterial infection from another inflammatory process.

Conclusion: PCT levels only rose significantly during bacterial infections. In this study PCT levels >1.2 ng/ml were always evidence of bacterial infection and the cue for starting antibiotic treatment.

Keywords: procalcitonin; C reactive protein; abacterial inflammatory processes

Abbreviations: CI, confidence interval; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; PCT, procalcitonin; ROC, receiver operating characteristic; TNF, tumour necrosis factor ; WBC, white blood cell count

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Chen, D-Y, Chen, Y-M, Ho, W-L, Chen, H-H, Shen, G-H, Lan, J-L (2009). Diagnostic value of procalcitonin for differentiation between bacterial infection and non-infectious inflammation in febrile patients with active adult-onset Still's disease. Ann Rheum Dis 68: 1074-1075 [Full Text]  
• Schmidt, J., Duhaut, P., Bourgeois, A.M., Salle, V., Smail, A., Chatelain, D., Betsou, F., Maziere, J.C., Ducroix, J.P., members of the Groupe de Recherche sur l'Arterite, (2009). Procalcitonin at the onset of giant cell arteritis and polymyalgia rheumatica: the GRACG prospective study. Rheumatology (Oxford) 48: 158-159 [Abstract] [Full Text]  
• Linssen, C. F M, Bekers, O., Drent, M., Jacobs, J. A (2008). C-reactive protein and procalcitonin concentrations in bronchoalveolar lavage fluid as a predictor of ventilator-associated pneumonia. Ann Clin Biochem 45: 293-298 [Abstract] [Full Text]  
• Viget, N, Vernier-Massouille, G, Salmon-Ceron, D, Yazdanpanah, Y, Colombel, J-F (2008). Opportunistic infections in patients with inflammatory bowel disease: prevention and diagnosis. Gut 57: 549-558 [Abstract] [Full Text]  
• Suresh, E (2006). Diagnostic approach to patients with suspected vasculitis.. Postgrad. Med. J. 82: 483-488 [Abstract] [Full Text]