title: Use of procalcitonin, C-reactive protein and white blood cell count to distinguish between lower limb erysipelas and deep vein thrombosis in the emergency department: A prospective observational study.
abstract: Early differentiation of erysipelas from deep vein thrombosis (DVT) based solely on clinical signs and symptoms is challenging. There is a lack of data regarding the usefulness of the inflammatory biomarkers procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) count in the diagnosis of localized cutaneous infections. Herein, we investigated the diagnostic value of inflammatory markers in a prospective at-risk patient population. This is an observational quality control study including consecutive patients presenting with a final diagnosis of either erysipelas or DVT. The association of PCT (μg/L) and CRP (mg/L) levels and WBC counts (g/L) with the primary outcome was assessed using logistic regression models with area under the receiver-operator curve. Forty-eight patients (erysipelas, n = 31; DVT, n = 17) were included. Compared with patients with DVT, those with erysipelas had significantly higher PCT concentrations. No significant differences in CRP concentrations and WBC counts were found between the two groups. At a PCT threshold of 0.1 μg/L or more, specificity and positive predictive values (PPV) for erysipelas were 82.4% and 85.7%, respectively, and increased to 100% and 100% at a threshold of more than 0.25 μg/L. Levels of PCT also correlated with the severity of erysipelas, with a stepwise increase according to systemic inflammatory response syndrome criteria. We found a high discriminatory value of PCT for differentiation between erysipelas and DVT, in contrast to other commonly used inflammatory biomarkers. Whether the use of PCT levels for early differentiation of erysipelas from DVT reduces unnecessary antibiotic exposure needs to be assessed in an interventional trial.
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Rast
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Demian
authors.initials: D
authors.lastname: Knobel
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Lukas
authors.initials: L
authors.lastname: Faessler
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutz
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Susan
authors.initials: S
authors.lastname: Felder
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Svenja
authors.initials: S
authors.lastname: Laukemann
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Deborah
authors.initials: D
authors.lastname: Steiner
authors.affiliation: University Clinic of Infectious Diseases, University Hospital Bern, Bern, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Haubitz
authors.affiliation: Division of Infectious Diseases, University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Fux
authors.affiliation: Department of Laboratory Medicine, Kantonsspital Aarau, Aarau , Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Huber
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: University Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood*; D003937:Diagnosis, Differential; D004886:Erysipelas / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis*
chemical_list: D015415:Biomarkers; D002116:Calcitonin; D002097:C-Reactive Protein
keywords: cellulitis; deep vein thrombosis; erysipelas; lower limb; procalcitonin