Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study.
Purpose. To investigate whether absolute value of procalcitonin (PCT) or the change (delta-PCT) is better indicator of infection in intensive care patients. Materials and Methods. Post hoc analysis of a prospective observational study. Patients with suspected new-onset infection were included in whom PCT, C-reactive protein (CRP), temperature, and leukocyte (WBC) values were measured on inclusion (t 0) and data were also available from the previous day (t -1). Based on clinical and microbiological data, patients were grouped post hoc into infection- (I-) and noninfection- (NI-) groups. Results. Of the 114 patients, 85 (75%) had proven infection. PCT levels were similar at t -1: I-group (median [interquartile range]): 1.04 [0.40-3.57] versus NI-group: 0.53 [0.16-1.68], p = 0.444. By t 0 PCT levels were significantly higher in the I-group: 4.62 [1.91-12.62] versus 1.12 [0.30-1.66], p = 0.018. The area under the curve to predict infection for absolute values of PCT was 0.64 [95% CI = 0.52-0.76], p = 0.022; for percentage change: 0.77 [0.66-0.87], p < 0.001; and for delta-PCT: 0.85 [0.78-0.92], p < 0.001. The optimal cut-off value for delta-PCT to indicate infection was 0.76 ng/mL (sensitivity 80 [70-88]%, specificity 86 [68-96]%). Neither absolute values nor changes in CRP, temperature, or WBC could predict infection. Conclusions. Our results suggest that delta-PCT values are superior to absolute values in indicating infection in intensive care patients. This trial is registered with ClinicalTrials.gov identifier: NCT02311816.
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Domonkos
0000-0002-6128-0718
D
Trásy
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Krisztián
0000-0002-6863-075X
K
Tánczos
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Márton
0000-0003-4534-9006
M
Németh
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Péter
P
Hankovszky
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
András
0000-0002-8320-1515
A
Lovas
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
András
0000-0002-7716-2353
A
Mikor
Faculty of Medicine, Division of Infectious Diseases, First Department of Internal Medicine, University of Szeged, Szeged, Hungary.
Edit
E
Hajdú
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Angelika
0000-0003-3535-5103
A
Osztroluczki
Faculty of Medicine, Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
János
0000-0001-6523-800X
J
Fazakas
Faculty of Medicine, Department of Anaesthesiology and Intensive Therapy, University of Szeged, 6 Semmelweis Street, Szeged 6725, Hungary.
Zsolt
0000-0002-1468-4058
Z
Molnár
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein; D002116:Calcitonin / Q000097:blood*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood* / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020033:Protein Isoforms; D012372:ROC Curve; D012680:Sensitivity and Specificity
D015415:Biomarkers; D020033:Protein Isoforms; D002116:Calcitonin; D002097:C-Reactive Protein