Delta Procalcitonin Is a Better Indicator of Infection Than Absolute Procalcitonin Values in Critically Ill Patients: A Prospective Observational Study

Abstract EN

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.