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. 2011 Aug 24:11:224.
doi: 10.1186/1471-2334-11-224.

Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

Nicolas Bele  1 , Michael Darmon, Isaline Coquet, Jean-Paul Feugeas, Stéphane Legriel, Nadir Adaoui, Benoît Schlemmer, Elie Azoulay
Affiliations

Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

Nicolas Bele et al. BMC Infect Dis. .

Abstract

Background: Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients.

Methods: This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis.

Results: We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P < 0.0001). PCT concentrations on day 1 that were > 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006). PCT concentrations were not significantly correlated with hospital mortality.

Conclusion: Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

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Figures

Figure 1
Figure 1
Patient flow chart.
Figure 2
Figure 2
Procalcitonin levels (ng/ml) in patients with bacterial infection and in the other patients on Day 1 and Day 3 (panel A) and in survivors and nonsurvivors (panel B).
Figure 3
Figure 3
ROC curve analysis of the performance of procalcitonin for diagnosing bacterial infection on the first day in the ICU.
See this image and copyright information in PMC

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