Additional value of procalcitonin for diagnosis of infection in patients with fever at the emergency department.
OBJECTIVE
First, to determine whether procalcitonin (PCT) significantly adds diagnostic value in terms of sensitivity and specificity to a common set of markers of infection, including C-reactive protein (CRP), at the Emergency Department. Second, to create a simple scoring rule implementing PCT values. Third, to determine and compare associations of CRP and PCT with clinical outcomes.


METHODS
The additional diagnostic value of PCT was determined using multiple logistic regression analysis. A score was developed to help distinguish patients with a culture-proven bacterial infection from patients not needing antibiotic treatment using 16 potential clinical and laboratory variables. The prognostic value of CRP and PCT was determined using Spearman's correlation and logistic regression.


METHODS
Emergency Department of a 310-bed teaching hospital.


METHODS
Patients between 18 and 85 years old presenting with fever to the Emergency Department.


METHODS
None.


RESULTS
A total of 211 patients were studied (infection confirmed, n = 73; infection likely, n = 58; infection not excluded, n = 46; no infection, n = 34). CRP and chills were the strongest predictors for the diagnosis of bacterial infection. After addition of PCT to these parameters, model fit significantly improved (p = .003). The resulting scoring rule (score = 0.01 * CRP + 2 * chills + 1 * PCT) was characterized by an AUC value of 0.83 (sensitivity 79%; specificity of 71%), which was more accurate than physician judgment or SIRS (systemic inflammatory response syndrome). PCT levels were significantly associated with admission to a special care unit, duration of intravenous antibiotic use, total duration of antibiotic treatment, and length of hospital stay, whereas CRP was related only to the latter two variables.


CONCLUSIONS
These data suggest that PCT may be a valuable addition to currently used markers of infection for diagnosis of infection and prognosis in patients with fever at the Emergency Department.
de Kruif
Martijn D
MD
Department of Internal Medicine, Slotervaart Hospital, Amsterdam, The Netherlands. m.d.dekruif@amc.uva.nl
Limper
Maarten
M
Gerritsen
Herman
H
Spek
C Arnold
CA
Brandjes
Dees P M
DP
ten Cate
Hugo
H
Bossuyt
Patrick M
PM
Reitsma
Pieter H
PH
van Gorp
Eric C M
EC
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016009:Chi-Square Distribution; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012044:Regression Analysis; D018709:Statistics, Nonparametric
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide