The potential role of procalcitonin in the emergency department management of febrile young adults during a sustained meningococcal epidemic.
OBJECTIVE
To prospectively investigate the diagnostic characteristics of procalcitonin as an aid in the diagnosis of meningococcal disease in febrile young adults presenting to the Waikato Hospital emergency department during a sustained meningococcal epidemic.


METHODS
The study population were emergency department patients aged 14-40 years presenting with either a temperature > or = 38.0 degrees C without an obvious focus of infection, or symptoms consistent with meningococcal disease. All had procalcitonin levels, N. meningitidis PCR, blood +/- CSF cultures.


RESULTS
One hundred and eighty-three patients presented with undifferentiated febrile illness over a 9 month study period. Nine were subsequently shown to have meningococcal disease. A positive procalcitonin (> or = 0.5 ng/mL) had a sensitivity of 100% (CI 66.4-100), specificity 89% (CI 83.1-93.1), negative predictive value 100% (CI 97.6-100) and positive predictive value 32% (CI 15.9-52.4) for meningococcal disease.


CONCLUSIONS
The finding of a procalcitonin level > or = 0.5 ng/mL in young adults with undifferentiated fever indicates an increased chance that the presenting illness may be meningococcal disease. In New Zealand's continuing meningococcal epidemic empirical antibiotics should be strongly considered in those with elevated procalcitonin levels in the hope of reducing meningococcal disease deaths due to delays in antibiotic administration.
Bugden
Simon A
SA
Departments of Emergency Medicine and Infectious Diseases, Waikato Hospital, Hamilton, New Zealand.
Coles
Clare
C
Mills
Graham D
GD
D000293:Adolescent; D000328:Adult; D015415:Biomarkers; D002116:Calcitonin / Q000097:blood* / Q000134:cerebrospinal fluid*; D015740:Calcitonin Gene-Related Peptide; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D006801:Humans; D008589:Meningococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D009520:New Zealand / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood* / Q000134:cerebrospinal fluid*; D012680:Sensitivity and Specificity
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide