title: Procalcitonin in early rule-in/rule-out of sepsis in SIRS patients admitted to a medical ward.
abstract: BACKGROUND
  A relevant amount of patients with clinical suspect of sepsis is admitted and treated in medical wards (MW). These patients have a better prognosis but are older and with more comorbidities compared to those admitted to intensive care units (ICU). Procalcitonin (PCT) is extensively used in emergency departments for the diagnosis of sepsis, but its accuracy in the setting of a MW has not been thoroughly investigated. Predicted low PCT levels also call for the comparison of immunomagnetic-chemiluminescent (L-PCT) and time-resolved amplified cryptate emission (TRACE, K-PCT) technologies, in PCT determination.
  
  
  METHODS
  In 80 patients with systemic inflammatory response syndrome (SIRS) diagnostic criteria and suspect of sepsis newly admitted to a MW, PCT was determined with L- and K-PCT method.
  
  
  RESULTS
  Sixty patients were diagnosed as sepsis (20 microbiologically and 40 clinically proven) and 20 with non-infective SIRS. The sepsis group had significantly higher levels of both PCTs, with no differences between the clinically and microbiologically proven subgroups. The areas under ROC curves for L- and K-PCT were 0.72 and 0.78 (p<0.001 for each), respectively. Based on MW customized cut-off values of 0.150 (L-PCT) and 0.143 ng/mL (K-PCT), overall accuracies were 66.8 (95% CI 58.7-78.9) and 78.2% (69.8-87.2), respectively, compared to the 55% (44.2-66) of 0.5 ng/mL canonical cut-off. Neither PCT-L nor -K held prognostic value on survival.
  
  
  CONCLUSIONS
  In MW patients, customized PCT cut-off levels provide better accuracy than customary levels adopted from ICU, and TRACE technology seems to offer a wider analysis range.
authors.forename: Nicola
authors.initials: N
authors.lastname: Fiotti
authors.forename: Filippo
authors.initials: F
authors.lastname: Mearelli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ruscio
authors.forename: Nicola
authors.initials: N
authors.lastname: Altamura
authors.forename: Pierandrea
authors.initials: P
authors.lastname: Vinci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fernandes
authors.forename: Margherita
authors.initials: M
authors.lastname: De Nardo
authors.forename: Jacopo
authors.initials: J
authors.lastname: Lombardi
authors.forename: Lorenza
authors.initials: L
authors.lastname: Mamolo
authors.forename: Enrico
authors.initials: E
authors.lastname: Chendi
authors.forename: Andrea
authors.initials: A
authors.lastname: Breglia
authors.forename: Alberto
authors.initials: A
authors.lastname: Peretti
authors.forename: Daniele
authors.initials: D
authors.lastname: Peric
authors.forename: Daniele
authors.initials: D
authors.lastname: Orso
authors.forename: Giulia
authors.initials: G
authors.lastname: Pivetti
authors.forename: Gianni
authors.initials: G
authors.lastname: Biolo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D005260:Female; D006801:Humans; D008297:Male; D010343:Patient Admission; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D018805:Sepsis / Q000097:blood* / Q000175:diagnosis* / Q000628:therapy; D013997:Time Factors
chemical_list: C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide