II. Indication

  1. Marker of Bacterial Infection and Sepsis

III. Physiology

  1. Peptide produced in the Thyroid, lung and Intestine
  2. Calcitonin precursor (involved in Calcium Homeostasis)
  3. Remains at low levels when well
  4. Increases in inflammatory states, rising within 4 hours of infection onset and peaking at 12 to 48 hours
    1. Postulated to increase markedly, and selectively in Bacterial Infection
    2. Postulated to allow for monitoring treatment response due to Procalcitonin short Half-Life
  5. Contrast with Interferon gamma, which increases in Viral Infections and decreases Procalcitonin

IV. Interpretation

  1. Procalcitonin level <0.05: Normal
  2. Procalcitonin level <0.25: Bacterial Sepsis unlikely
  3. Vijayan (2017) J Intensive Care 5:51 +PMID: 28794881 [PubMed]

V. Efficacy: Adults

  1. Mediocre efficacy in Sepsis diagnosis
    1. Test Sensitivity: 77%
    2. Test Specificity: 79%
    3. Wacker (2013) Lancet Infect Dis 13(5): 426-35 +PMID: 23375419 [PubMed]
  2. Low efficacy in Bacterial Pneumonia diagnosis
    1. Test Sensitivity: 55%
    2. Test Specificity: 76%
    3. Maisel (2012) Eur J Heart Fail 14(3): 278-86 +PMID: 22302662 [PubMed]
  3. Worse outcomes in ICU when Procalcitonin was used to direct antibiotic management
    1. Bouadma (2010) Lancet 375(9713): 463-74 +PMID: 20097417 [PubMed]
  4. May allow shortening of antibiotic course in Sepsis and respiratory infections without adversely affecting outcomes
    1. Elnajdy (2022) Infect Dis 54(6):387-402 +PMID: 35175169 [PubMed]

VI. Efficacy: Children

VII. References

  1. Orman, Herbert, Spiegel in Herbert (2016) EM:Rap 16(10):12-3
  2. Morgenstern in Swadron (2022) EM:Rap 22(9): 4-6
  3. Dolatabadi (2015) Niger Med J 56(1):17-22 +PMID:25657488 [PubMed]

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Related Studies

Ontology: procalcitonin (C0072027)

Concepts Amino Acid, Peptide, or Protein (T116) , Biologically Active Substance (T123)
MSH C029100
SnomedCT 418752001
LNC LP31682-5, MTHU015794
English calcitonin precursor polyprotein, Calcitonin, pro-, pro calcitonin, procalcitonin, Procalcitonin, Calcitonin precursor polyprotein, Procalcitonin (substance)
Spanish procalcitonina (sustancia), procalcitonina