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. 2022 May 19;3(3):e12621.
doi: 10.1002/emp2.12621. eCollection 2022 Jun.

Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections

Kaoutar Azijli  1 , Tanca C Minderhoud  2 , Carlijn J de Gans  1   3 , Arthur W E Lieveld  2 , Prabath W B Nanayakkara  2
Affiliations

Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections

Kaoutar Azijli et al. J Am Coll Emerg Physicians Open. .

Abstract

Objective: During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin.

Methods: This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included.

Results: A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80-0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 μg/L had a sensitivity of 100% (95% CI 63.1-100) and specificity of 81.2% (95% CI 75.1-86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 μg/L showed a sensitivity of 87.2% (95% CI 72.6-95.7) and specificity of 64.1 % (95% CI 58.3-69.6).

Conclusion: In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 μg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low.

Keywords: emergency department; infection; procalcitonin; viral infection.

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Conflict of interest statement

None to declareKaoutar Azijli, Tanca C. Minderhoud, and Prabath W.B. Nanayakkara developed the research plan. Kaoutar Azijli, Tanca C. Minderhoud, Carlijn J. de Gans, and Carlijn J. de Gans designed the study. Carlijn J. de Gans, with the help of Kaoutar Azijli, Arthur W.E. Lievel, and Prabath W.B. Nanayakkara collected the data and created the database. The database was checked by Tanca C. Minderhoud. Carlijn J. de Gans, Tanca C. Minderhoud, and Kaoutar Azijli analyzed the data. Carlijn J. de Gans drafted a first version of the paper. Tanca C. Minderhoud and Kaoutar Azijli wrote the definite version of the paper. All authors critically appraised the paper, revised where appropriate and approved the final version of the manuscript. Tanca C. Minderhoud designed the visual abstract.

Figures

FIGURE 1
FIGURE 1
Diagram of flow of participants through the study
FIGURE 2
FIGURE 2
ROC curve of procalcitonin for the outcome of bacteremia, total group. Abbreviation: ROC, receiver operating characteristic
FIGURE 3
FIGURE 3
ROC curve of procalcitonin for the outcome of bacteremia, split by viral infection. Abbreviations: PCT, procalcitonin; ROC, receiver operating characteristic
See this image and copyright information in PMC

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