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Procalcitonin as a potent marker of bacterial infection in febrile Afro-Caribbean patients at the emergency department.

Limper M, de Kruif MD, Ajubi NE, van Zanten AP, Brandjes DP, Duits AJ, van Gorp EC - Eur. J. Clin. Microbiol. Infect. Dis. (2011)

Bottom Line: Prospective, blinded PCT measurements were performed in patients with a microbiologically or serologically confirmed diagnosis or a strongly suspected diagnosis on clinical grounds.C-reactive protein (CRP) levels were shown to be less accurate when comparing the same groups.These results may improve diagnostics and eventually decrease antibiotic prescriptions in resource-limited settings.

View Article: PubMed Central - PubMed

Affiliation: Immunology Laboratory Department, Red Cross Blood Bank Foundation, Pater Euwensweg 36, Willemstad, Curaçao, Netherlands Antilles. maarten.limper@slz.nl

ABSTRACT
Procalcitonin (PCT) has been shown to be of additional value in the work-up of a febrile patient. This study is the first to investigate the additional value of PCT in an Afro-Caribbean febrile population at the emergency department (ED) of a general hospital. Febrile patients were included at the ED. Prospective, blinded PCT measurements were performed in patients with a microbiologically or serologically confirmed diagnosis or a strongly suspected diagnosis on clinical grounds. PCT analysis was performed in 93 patients. PCT levels differentiated well between confirmed bacterial and confirmed viral infection (area under the curve [AUC] of 0.82, sensitivity 85%, specificity 69%, cut-off 0.24 ng/mL), between confirmed bacterial infection and non-infectious fever (AUC of 0.84, sensitivity 90%, specificity 71%, cut-off 0.21 ng/mL) and between all bacterial infections (confirmed and suspected) and non-infectious fever (AUC of 0.80, sensitivity 85%, specificity 71%, cut-off 0.21 ng/mL). C-reactive protein (CRP) levels were shown to be less accurate when comparing the same groups. This is the first study showing that, in a non-Caucasian febrile population at the ED, PCT is a more valuable marker of bacterial infection than CRP. These results may improve diagnostics and eventually decrease antibiotic prescriptions in resource-limited settings.

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Related in: MedlinePlus

ROC curve showing the diagnostic value of CRP, leukocytes and PCT for the differentiation between confirmed bacterial infection and non-infectious fever. AUC PCT 0.84 (sensitivity 90%/specificity 71% at cut-off 0.21 ng/mL); CRP 0.65 (89%/43% at 0.85 mg %); leukocytes 0.48 (18%/100% at 28.0 giga/L), respectively
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Fig3: ROC curve showing the diagnostic value of CRP, leukocytes and PCT for the differentiation between confirmed bacterial infection and non-infectious fever. AUC PCT 0.84 (sensitivity 90%/specificity 71% at cut-off 0.21 ng/mL); CRP 0.65 (89%/43% at 0.85 mg %); leukocytes 0.48 (18%/100% at 28.0 giga/L), respectively

Mentions: PCT levels differentiated well between infectious and non-infectious fever (AUC of 0.76, sensitivity 78%, specificity 71%, cut-off 0.21 ng/mL; Fig. 2), between confirmed bacterial and confirmed viral infection (AUC of 0.82, sensitivity 85%, specificity 69%, cut-off 0.24 ng/mL), between confirmed bacterial infection and non-infectious fever (AUC of 0.84, sensitivity 90%, specificity 71%, cut-off 0.21 ng/mL) and between all bacterial infections (confirmed and suspected) and non-infectious fever (AUC of 0.80, sensitivity 85%, specificity 71%, cut-off 0.21 ng/mL; Fig. 3). CRP levels were shown to be less accurate when comparing the same groups (AUC of 0.69, sensitivity 71%, specificity 75%, cut-off 8.3 mg %; AUC of 0.65, sensitivity 89%, specificity 43%, cut-off 8.5 mg %; AUC of 0.64, sensitivity 90%, specificity 43%, cut-off 8.5 mg %, respectively).Fig. 2


Procalcitonin as a potent marker of bacterial infection in febrile Afro-Caribbean patients at the emergency department.

Limper M, de Kruif MD, Ajubi NE, van Zanten AP, Brandjes DP, Duits AJ, van Gorp EC - Eur. J. Clin. Microbiol. Infect. Dis. (2011)

ROC curve showing the diagnostic value of CRP, leukocytes and PCT for the differentiation between confirmed bacterial infection and non-infectious fever. AUC PCT 0.84 (sensitivity 90%/specificity 71% at cut-off 0.21 ng/mL); CRP 0.65 (89%/43% at 0.85 mg %); leukocytes 0.48 (18%/100% at 28.0 giga/L), respectively
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Related In: Results  -  Collection

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Fig3: ROC curve showing the diagnostic value of CRP, leukocytes and PCT for the differentiation between confirmed bacterial infection and non-infectious fever. AUC PCT 0.84 (sensitivity 90%/specificity 71% at cut-off 0.21 ng/mL); CRP 0.65 (89%/43% at 0.85 mg %); leukocytes 0.48 (18%/100% at 28.0 giga/L), respectively
Mentions: PCT levels differentiated well between infectious and non-infectious fever (AUC of 0.76, sensitivity 78%, specificity 71%, cut-off 0.21 ng/mL; Fig. 2), between confirmed bacterial and confirmed viral infection (AUC of 0.82, sensitivity 85%, specificity 69%, cut-off 0.24 ng/mL), between confirmed bacterial infection and non-infectious fever (AUC of 0.84, sensitivity 90%, specificity 71%, cut-off 0.21 ng/mL) and between all bacterial infections (confirmed and suspected) and non-infectious fever (AUC of 0.80, sensitivity 85%, specificity 71%, cut-off 0.21 ng/mL; Fig. 3). CRP levels were shown to be less accurate when comparing the same groups (AUC of 0.69, sensitivity 71%, specificity 75%, cut-off 8.3 mg %; AUC of 0.65, sensitivity 89%, specificity 43%, cut-off 8.5 mg %; AUC of 0.64, sensitivity 90%, specificity 43%, cut-off 8.5 mg %, respectively).Fig. 2

Bottom Line: Prospective, blinded PCT measurements were performed in patients with a microbiologically or serologically confirmed diagnosis or a strongly suspected diagnosis on clinical grounds.C-reactive protein (CRP) levels were shown to be less accurate when comparing the same groups.These results may improve diagnostics and eventually decrease antibiotic prescriptions in resource-limited settings.

View Article: PubMed Central - PubMed

Affiliation: Immunology Laboratory Department, Red Cross Blood Bank Foundation, Pater Euwensweg 36, Willemstad, Curaçao, Netherlands Antilles. maarten.limper@slz.nl

ABSTRACT
Procalcitonin (PCT) has been shown to be of additional value in the work-up of a febrile patient. This study is the first to investigate the additional value of PCT in an Afro-Caribbean febrile population at the emergency department (ED) of a general hospital. Febrile patients were included at the ED. Prospective, blinded PCT measurements were performed in patients with a microbiologically or serologically confirmed diagnosis or a strongly suspected diagnosis on clinical grounds. PCT analysis was performed in 93 patients. PCT levels differentiated well between confirmed bacterial and confirmed viral infection (area under the curve [AUC] of 0.82, sensitivity 85%, specificity 69%, cut-off 0.24 ng/mL), between confirmed bacterial infection and non-infectious fever (AUC of 0.84, sensitivity 90%, specificity 71%, cut-off 0.21 ng/mL) and between all bacterial infections (confirmed and suspected) and non-infectious fever (AUC of 0.80, sensitivity 85%, specificity 71%, cut-off 0.21 ng/mL). C-reactive protein (CRP) levels were shown to be less accurate when comparing the same groups. This is the first study showing that, in a non-Caucasian febrile population at the ED, PCT is a more valuable marker of bacterial infection than CRP. These results may improve diagnostics and eventually decrease antibiotic prescriptions in resource-limited settings.

Show MeSH
Related in: MedlinePlus