The utility of procalcitonin in the diagnosis of severe sepsis
a validation study
DOI:
https://doi.org/10.59736/IJP.23.04.1009Keywords:
Biomarker, Blood Culture, Procalcitonin, SepsisAbstract
Background: One of the main causes of morbidity and death is still severe sepsis, particularly in environments with minimal resources when prompt detection is difficult. Early identification of sepsis may be possible with procalcitonin (PCT), a biomarker that is raised in bacterial infections. By contrasting serum PCT with blood culture data, this study sought to assess the diagnostic accuracy of serum PCT in detecting severe sepsis.
Methods: Over the course of six months, from December 1, 2023, to May 1, 2024, this cross-sectional validation study was carried out in the Department of Medicine at Khyber Teaching Hospital in Peshawar. Non-probability consecutive sampling was used to recruit 111 patients with severe sepsis, ages 18 to 60. Blood cultures and serum PCT levels were taken at presentation. All data analysis was performed using SPSS version 25. Patients were determined true positive if both “PCT” (positive procalcitonin) and blood culture were positive; false positive if “PCT” was positive while blood culture was negative; true negative if both “PCT” and blood culture test was negative; and false negative if “PCT” was negative while blood culture was positive.
Results: Of the 111 patients, 60.4% were male; the mean age was 42.6 years, the sensitivity of procalcitonin was 87.3%, specificity was 75.0%, positive predictive value was 82.1%, negative predictive value was 81.8%, and overall diagnostic accuracy was 82.0%. There was a statistically significant association between procalcitonin and blood cultures (p = 0.0001).
Conclusion: Serum procalcitonin is a valuable diagnostic tool in the early identification of severe sepsis. Procalcitonin's high sensitivity and strong predictive values lends to a recommendation for the incorporation of serum procalcitonin into clinical practice guidelines for rapid treatment of sepsis.
References
Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-resistant sepsis: a critical healthcare challenge. Antibiotics. 2024;13(1):46.
Jacobi J. The pathophysiology of sepsis—2021 update: part 2, organ dysfunction and assessment. Am J Health Syst Pharm. 2022;79(6):424–36.
Pohanka M. Diagnoses based on C-reactive protein point-of-care tests. Biosensors. 2022;12(5):344.
Kiriakopoulos A, Giannakis P, Menenakos E. Calcitonin: current concepts and differential diagnosis. Ther Adv Endocrinol Metab. 2022; 13:20420188221099344.
Li Y, Min L, Zhang X. Usefulness of procalcitonin, C-reactive protein, and white blood cell levels in the differential diagnosis of acute bacterial, viral, and mycoplasmal respiratory tract infections in children. BMC Pulm Med. 2021; 21:1–8.
Mayne ES, George JA, Louw S. Assessing biomarkers in viral infection. In: Application of Omic Techniques to Identify New Biomarkers and Drug Targets for COVID-19. 2023. p. 159–73.
Leroux P, De Ruffi S, Ramont L, Gornet M, Giordano Orsini G, Losset X, et al. Clinical outcome predictive value of procalcitonin in patients suspected with infection in the emergency department. Emerg Med Int. 2021; 2021:2344212.
Zaki HA, Bensliman S, Bashir K, Iftikhar H, Fayed MH, Salem W, et al. Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis. Syst Rev. 2024;13(1):37.
Covino M, Manno A, De Matteis G, Taddei E, Carbone L, Piccioni A, et al. Prognostic role of serum procalcitonin measurement in adult patients admitted to the emergency department with fever. Antibiotics. 2021;10(7):788.
Park DW, Choi JY, Kim CJ, Kim JH, Kim HB, Lee DG. Implementation of procalcitonin in antibiotic stewardship: derivation of a consensus algorithm for procalcitonin use in clinical practice. Infect Chemother. 2022;54(4):621.
Zhang GM, Guo XX. Combining procalcitonin with C-reactive protein is better than separate testing for patients with bacteriuria in the intensive care unit: a retrospective study. Eur J Med Res. 2024;29(1):441.
Chuang CL, Yeh HT, Niu KY, Chen CB, Seak CJ, Yen CC. Diagnostic performances of procalcitonin and C-reactive protein for sepsis: a systematic review and meta-analysis. Eur J Emerg Med. 2025;32(4):248–58.
Suo S, Luo L, Song Y, Huang H, Chen X, Liu C. Early diagnosis and prediction of death risk in patients with sepsis by combined detection of serum PCT, BNP, lactic acid, and APACHE II score. Contrast Media Mol Imaging. 2022; 2022:8522842.
Alsabri M, Abdul AA, Zhang S, Tsoi V, Pyala R, Shubietah A, et al. Empowering pediatric emergency settings: strategies for improved sepsis care in resource-limited environments. Curr Emerg Hosp Med Rep. 2024;12(3):110–23.
Unar A, Bertolino L, Patauner F, Gallo R, Durante-Mangoni E. Decoding sepsis-induced disseminated intravascular coagulation: a comprehensive review of existing and emerging therapies. J Clin Med. 2023;12(19):6128.
Angus DC, Van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369(9):840–51.
Vijayan AL, Vanimaya N, Ravindran S, Saikant R, Lakshmi S, Kartik R. Procalcitonin: a promising diagnostic marker for sepsis and antibiotic therapy. J Intensive Care. 2017; 5:1–7.
Rodgers O, Mills C, Watson C, Waterfield T. Role of diagnostic tests for sepsis in children: a review. Arch Dis Child. 2024;109(10):786–93.
Reinhart K, Karzai W, Hartog-Schier C. Procalcitonin (PCT) and its role in the diagnosis of sepsis. Sepsis. 1998; 2:157–61.
Xiao H, Zhang H, Wang G, Wang Y, Tan Z, Sun X, et al. Comparison among presepsin, procalcitonin, and C-reactive protein in predicting blood culture positivity and pathogen in sepsis patients. Shock. 2023.
Wang X, Jing M, Li L, Xu Q. The prognostic value of procalcitonin clearance and procalcitonin-to-albumin ratio in sepsis patients. Clin Lab. 2023;69(3).
Lee YC, Yeh HT, Lu SW, Tsai YC, Tsai YC, Yen CC. Diagnostic accuracy of procalcitonin in adult non-neutropenic cancer patients with suspected infection: a systematic review and meta-analysis. BMC Infect Dis. 2024;24(1):278.
Omar J, Ahmad N, Che-Soh N, Wan-Azman W, Yaacob N, Abdul-Ghani N, et al. Serum procalcitonin: is there a role as an early biomarker in infected diabetic foot ulcer patients? Malays Orthop J. 2023;17(2):62.
Goyal M, Mascarenhas D, Rr P, Haribalakrishna A. Diagnostic accuracy of point-of-care testing of C-reactive protein, interleukin-6, and procalcitonin in neonates with clinically suspected sepsis: a prospective observational study. Med Princ Pract. 2024;33(3):291–8.
Bhat A, Alsadhan N, Alsadhan N, Alnowaiser D, Gattoo I, Hussain M, et al. Procalcitonin and C-reactive protein as early diagnostic markers of sepsis or septic shock in children presenting with fever to the pediatric emergency department at a tertiary hospital in Riyadh, Saudi Arabia. Int J Emerg Med. 2025;18(1):1–13.
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