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Procalcitonin
Aka: Procalcitonin, proCT
- Indication
- Marker of Bacterial Infection and Sepsis
- Physiology
- Peptide produced in the Thyroid, lung and intestin
- Calcitonin precursor (involved in Calcium Homeostasis)
- Remains at low levels when well
- Increases in inflammatory states, rising within 4 hours of infection onset and peaking at 12 to 48 hours
- Postulated to increase markedly in Bacterial Infection
- Postulated to allow for monitoring treatment response due to Procalcitonin short half-life
- Interpretation
- Procalcitonin level <0.05: Normal
- Procalcitonin level <0.25: Bacterial Sepsis unlikely
- Vijayan (2017) J Intensive Care 5:51 +PMID: 28794881 [PubMed]
- Efficacy: Adults
- Mediocre efficacy in Sepsis diagnosis
- Test Sensitivity: 77%
- Test Specificity: 79%
- Wacker (2013) Lancet Infect Dis 13(5): 426-35 +PMID: 23375419 [PubMed]
- Low efficacy in Pneumonia diagnosis
- Maisel (2013) Ear J Heart Fail 14(3): 278-86 +PMID: 22302662 [PubMed]
- Worse outcomes in ICU when Procalcitonin was used to direct antibiotic management
- Bouadma (2010) Lancet 375(9713): 463-74 +PMID: 20097417 [PubMed]
- Efficacy: Children
- See Serious Bacterial Infection in Children (Occult Bacteremia)
- Variable efficacy, although initial studies had very high accuracy in septic children
- Test Sensitivity: 26-55% for Bacterial Infection
- Test Specificity: 75 to 82% for Bacterial Infection
- Interpretation
- PCT <0.5 ng/ml has a Negative Predictive Value for serious Bacterial Infection of 90%
- PCT >0.6 (and WBC >19k, blasts >1.8k, Neutrophils >13k) suggests serious Bacterial Infection
- References
- Gendrel (1996) J Pediatr 128:570-3 [PubMed]
- Olaciregui (2009) Arch Dis Child 94(7): 501-5 +PMID:19158133 [PubMed]
- Mahajan (2014) Acad Emerg Med 21(2): 171-9 +PMID:24673673 [PubMed]
- References
- Orman, Herbert, Spiegel in Herbert (2016) EM:Rap 16(10):12-3
- Dolatabadi (2015) Niger Med J 56(1):17-22 +PMID:25657488 [PubMed]