title: Utility of procalcitonin as an early diagnostic marker of bacteremia in patients with acute fever.
abstract: OBJECTIVE
  Procalcitonin (PCT) is a current, frequently used marker for severe bacterial infection. The aim of this study was to assess the ability of PCT levels to differentiate bacteremic from nonbacteremic patients with fever. We assessed whether PCT level could be used to accurately rule out a diagnosis of bacteremia.
  
  
  METHODS
  Serum samples and blood culture were obtained from patients with fever between August 2008 and April 2009. PCT was analyzed using a VIDAS® B.R.A.H.M.S PCT assay. We reviewed the final diagnosis and patient histories, including clinical presentation and antibiotic treatment.
  
  
  RESULTS
  A total of 300 patients with fevers were enrolled in this study: 58 with bacteremia (positive blood culture) (group I); 137 with local infection (group II); 90 with other diseases (group III); and 15 with fevers of unknown origin (group IV). PCT levels were significantly higher in patients with bacteremia than in those with non-bacteremia (11.9 ± 25.1 and 2.5 ± 14.7 ng/mL, respectively, p < 0.001). The sensitivity and specificity were 74.2% and 70.1%, respectively, at a cut-off value of 0.5 ng/mL. A serum PCT level of < 0.4 ng/mL accurately rules out diagnosis of bacteremia.
  
  
  CONCLUSIONS
  In febrile patients, elevated PCT may help predict bacteremia; furthermore, low PCT levels were helpful for ruling out bacteremia as a diagnosis. Therefore, PCT assessment could help physicians limit the number of prescriptions for antibiotics.
authors.affiliation: Department of Laboratory Medicine, Kyung Hee University Hospital at Gandong, Kyung Hee University School of Medicine, 1 Heogi-dong, Dongdaemun-gu, Seoul 130-702, Korea.
authors.forename: Myeong Hee
authors.initials: MH
authors.lastname: Kim
authors.forename: Gayoung
authors.initials: G
authors.lastname: Lim
authors.forename: So Young
authors.initials: SY
authors.lastname: Kang
authors.forename: Woo-In
authors.initials: WI
authors.lastname: Lee
authors.forename: Jin-Tae
authors.initials: JT
authors.lastname: Suh
authors.forename: Hee Joo
authors.initials: HJ
authors.lastname: Lee
mesh_terms: D016470:Bacteremia / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D042241:Early Diagnosis; D005260:Female; D005334:Fever / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D005335:Fever of Unknown Origin / Q000097:blood / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood*; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide