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Abstract
Background:
Bloodstream infection (BSI) is associated with a high mortality rate. Since the origin of infection is demonstrated in approximately 2/3rds of cases, early and established biomarkers are warranted. We evaluated the clinical performances of automated procalcitonin (PCT) and C-reactive protein (CRP) assays for the quantitative detection of BSI. Analytical performance of the VIDAS® B · R · A · H · M · S PCT assay (bioMérieux, France) was assessed and also compared with the semiquantitative PCT-Q test (B · R · A · H · M · S Aktiengesellschaft, Germany).
Methods:
We prospectively included consecutive patients divided into 3 groups at the Dong-A University Medical Center. Patients were categorized according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference (ACCP/SCCM), and also on the basis of catheter-associated bacteremia.
Results:
A total 77 patients were enrolled. All mean values of PCT and PCT-Q were consistent with the reference value. Measured PCT concentrations showed good linearity (r=0.983). The between-run, within-run, and total imprecisions were below 5%. The PCT levels in gram-negative bacteremia were significantly higher than those in gram-positive bacteremia. Furthermore, the PCT concentrations were significantly different among non-infection, bacteremia, sepsis, severe sepsis, and septic shock groups. Our study showed that PCT >0.3 ng/mL had 95.0% sensitivity and 97.3% specificity, whereas CRP >5.46 mg/dL had 85.0% sensitivity and 86.5% specificity for diagnosing sepsis.
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Fig. 1.
Flow diagram of the subjects included in this study.
Abbreviations: B/C, blood culture; ER, emergency room; SIRS, systemic inflammatory response syndrome.
Fig. 3.
Serum PCT level (A) and CRP level (B) in patients with no infection, bacteremia (catheter associated), sepsis, severe sepsis, and septic shock. Data are presented as box plots with median lines, 25- and 75-percentile boxes, and 10- and 90-percentile error bars. A log scale is used for the Y-axis in (A).
Abbreviations: PCT, procalcitonin; CRP, C-reactive protein.
Fig. 4.
The ROC curves of PCT (AUC, 0.982) and CRP (AUC, 0.871) for the diagnosis of sepsis.
Abbreviations: PCT, procalcitonin; CRP, C-reactive protein; AUC, area under the curve.
Table 1.
Comparison of procalcitonin measured using VIDAS® PCT and PCT-Q assays in 28 patients in groups I (N=12) and II (N=16)
| PCT-Q (ng/mL) | Total | ||||
|---|---|---|---|---|---|
| <0.5 | 0.5-2 | 2-10 | ≥10 | ||
| Agreement | 15 | 2 | 3 | 2 | 22 |
| Disagreement | 0 | 5∗ | 1† | 0 | 6 |
| Total | 15 | 7 | 4 | 2 | 28 |
Table 2.
Relationship of between PCT and CRP concentrations based on pathogens
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