Serum procalcitonin is a sensitive and specific marker in the. Use of serum procalcitonin to detect bacterial infection in patients with autoimmune diseases. Procalcitonin to guide duration of antimicrobial therapy and intensive care units. Pdf the role of procalcitonin as a biomarker in sepsis.
Pct is a member of the calcitonin ct superfamily of peptides. In the absence of systemic inflammation, procalcitonin synthesis is mainly restricted to the neuroendocrine cells of the thyroid. Procalcitonin is a calcitonin propeptide synthesized by c cells of the thyroid gland and released from leukocytes of the peripheral blood taskin et al. Pct lia thermo fisher, hennigsdorf, germany, a manual luminometric. Multiple trials have explored the safety and efficacy of using pct as a biomarker to guide decisions about starting or stopping antibiotic therapy in a wide variety of situations, and pct assays have recently been approved by the federal drug administration fda in the us for use in.
Nov 15, 20 in one trial, procalcitonin was used only in adults with artis who were judged by their physicians to require antibiotics, and thus the probability of empiric antibiotics in the usual care arm 97 % and of an elevated procalcitonin level 9. Procalcitonin testing was associated with lower 30day mortality 286 deaths3336 patients with procalcitonin testing 8. In healthy persons procalcitonin levels are indetectably low. Diagnostic value of procalcitonin in wellappearing young. These other tissues lack the ability to cleave pct to its mature form, calcitonin. Our objective was to assess its performance in diagnosing serious bacterial infections and specifically invasive bacterial infections ibis in wellappearing. This test measures the level of procalcitonin in the blood. The large biosynthetic molecule splits intracellularly to generate the hormone, and they named it as procalcitonin. A masters project submitted in partial fulfillment of the requirements for the degree of. Procalcitonin is a precursor of calcitonin that is supported by grant 1002341b0028my3nsc from the. Tang et al, 2007 procalcitonin represents a good biological diagnostic marker for sepsis, severe sepsis, or septic shock, dicult diagnoses in critically ill patients. Allisons study 1981 in rna isolated from human medullary carcinoma demonstrated the synthesis of calcitonin as a precursor protein molecule in human. Use of serum procalcitonin to detect bacterial infection in.
Therefore, procalcitonin levels remain undetectable. Crp and procalcitonin showed limited value in discriminating between the three target infections due to widely overlapping distributions, but diagnostic accuracy was higher for discriminating pjp from cap or tuberculosis. Pct is expressed by neuroendocrine cells c cells of the thyroid, pulmonary and pancreatic tissues and successively enzymatically cleaved into immature calcitonin, katacalcin, and an n. It is becoming a frequent complication in hospitalized patients. Procalcitonin, sepsis, antibiotic therapy, diagnostic marker. Design diagnostic study performed between 2007 and 2010. There is a plausible explanation for this evidence. In vitro studies have found that parenchymal cells of tissues, including adipocytes, secrete procalcitonin in response to stimulation by activated macrophages. This favorable association was similar for distinct types of respiratory infections ie, communityacquired pneumonia, exacerbation of. Diagnosis of systemic secondary infection postsurgery, and in severe trauma, burns, and. Proposed algorithms for use of procalcitonin pct values to determine antibiotic treatment of infections.
Serum procalcitonin in lower respiratory tract infections. Procalcitonin is not found in the serum of healthy individuals. Procalcitoninguided diagnosis and antibiotic stewardship revisited. In one trial, procalcitonin was used only in adults with artis who were judged by their physicians to require antibiotics, and thus the probability of empiric antibiotics in the usual care arm 97 % and of an elevated procalcitonin level 9. Plasma procalcitonin and risk of type 2 diabetes in the. The first study to investigate the usefulness of pct in patients with infection was published in 1993 and showed that serum concentrations of pct correlated with the severity of microbial infection 9, 10. June 2011, using the same inclusion and exclusion criteria. Normal values and clinical cutoffs of procalcitonin ref1,2. Proct is processed to an nterminal 57 amino acid peptide ct 32amino acids and a 21amino acid cterminal peptide, catacalcin ccp1. Under normal conditions, procalcitonin is a glycopeptide of 116 amino acids produced by c cells of the thyroid gland, and it is a calcitonin precursor with a molecular weight of kd 3, 4. Early and differential diagnosis of sepsis is needed critically to avoid unnecessary usage of antimicrobial agents and for proper antibiotic treatments. Procalcitonin is not listed as a mesh term, so we initially searched for procalcitonin as a text word with no language restriction and then combined procalcitonin with keywords for different autoimmune diseases. Procalcitonin is a socalled acute phase reactant, rising in response to tissue inflammation and injury. Procalcitonin for reduced antibiotic exposure in the critical care setting.
Reference individuals without bacterial infection usually have pct levels form of pneumonia p0. Procalcitonin pct is a peptide precursor of the hormone calcitonin, the latter being involved with calcium homeostasis. Although the overall number of covid19 patients with increased procalcitonin values seems limited, as highlighted in a recent article, the results of this concise metaanalysis of the literature would suggest that serial procalcitonin measurement may play a role for predicting evolution towards a more severe form of disease. Outside the thyroid, pct is secreted by the lungs, intestines and other tissues in increasing amounts in response to bacterial endotoxin in. Procalcitonin for diagnosis of infection and guide to antibiotic.
Reference values in sepsis brahms pct procalcitonin. Feb 28, 20 significance of serum procalcitonin in sepsis 1. Procalcitonin for diagnosis of infection and guide to. One of the advantages of procalcitonin is that it is. The role of procalcitonin as a biomarker in sepsis. It consists of 116 amino acids with a molecular weight of kd 6, 7, and under normal circumstances, is produced in the ccells of the thyroid gland. It arises once preprocalcitonin is cleaved by endopeptidase.
Procalcitonin pct is the 116 amino acid precursor of the hormone calcitonin, produced by the c cells of the thyroid. We then limited the sample to patients who had been treated at hospitals that contributed data in both the 2009 to 2011 and 20 to 2014 periods. The level of procalcitonin in the blood can increase significantly in systemic bacterial infections and sepsis. Procalcitonin algorithms for antibiotic therapy decisions.
Up to 50% of antimicrobial use in the inpatient setting is unneeded or inappropriate. Procalcitonin proct is a 116amino acid precursor of calcitonin ct. Normally it is produced by the c cells of the thyroid gland. Procalcitonin pct is an amino acid precursor of calcitonin, which under normal circumstances is produced by. The study of procalcitonin is evolving, and the approach to procalcitonin use varies among institutions and experts. Sepsis is a condition with high morbidity and mortality in which clinical diagnostic criteria lack sensitivity and specificity.
Rapid diagnosis of sepsis and early initiation of antibiotic and goaldirected therapies have demonstrated a reduction in mortality. Pharmacistdriven procalcitonin protocol chi franciscan. A case study in the trial design process for approval of a new diagnostic test for lower respiratory tract infections, clinical infectious diseases 524. Participants had their history taken, underwent physical examination and measurement of c reactive protein crp and. Use of procalcitonin in patients with various degrees of. Procalcitonin to guide antibiotic therapy in the icu. Adult procalcitonin pct testing guidelines background procalcitonin pct is an amino acid precursor of calcitonin, which under normal circumstances is produced by thyroid ccells in bacterial infections, pct is produced by different body tissues resulting in increased pct levels in the blood. Procalcitonin at ucla ucla antimicrobial stewardship program. As a consequence, unnecessary and prolonged exposure to antimicrobial agents adversely affect patient outcomes, while inappropriate antibiotic therapy increases antibiotic resistance. Apr 30, 20 objectives to quantify the diagnostic accuracy of selected inflammatory markers in addition to symptoms and signs for predicting pneumonia and to derive a diagnostic tool.
The objectives of this study were to show that pct is an accurate marker in differentiating acute osteomyelitis and septic arthritis from viral and non infective inflammatory bone and joint conditions. Procalcitonin should be included in diagnostic guidelines for sepsis and in clinical practice in intensive care units. Procalcitonin for diagnosis and management of sepsis. Conversely, overuse and misuse of antibiotics can result in adverse events and add to the increasing problem of antibiotic. Early and highly specific marker for severe bacterial infection. Anmc adult procalcitonin pct utilization guideline. We studied the usefulness of procalcitonin as a marker of bsi in 367 adults admitted to our ed with symptoms of systemic infection. Procalcitonin pct is a 116 amino acid precursor of calcitonin which under. It is a peptide of 116 amino acid with an approximate molecular weight of 14. Procalcitonin, a glycoprotein, is the propeptide of calcito nin devoid of hormonal activity. Procalcitonin serum, plasma 1 name and description of analyte 1. Procalcitonin testing to guide antibiotic therapy in acute.
Research article open access procalcitonin versus c. Procalcitonin pct is a peptide measurable in serum which becomes elevated in response to bacterial infection. Participants had their history taken, underwent physical examination and measurement of c reactive protein crp and procalcitonin in venous blood on the day they. Costeffectiveness of procalcitoninguided antibiotic. Procalcitonin a new indicator of the systemic response to. Procalcitonin pct is the precursor of the hormone calcitonin and is mainly produced by the thyroid. Procalcitonin pct conversion to gl, ngl, ngdl, ng100ml. Procalcitonin journal of intensive care biomed central. Its value among young, wellappearing infants, however, is not completely defined. Hospital procalcitonin testing and antibiotic treatment of. Procalcitonin guidance for reduction of antibiotic use in. Pdf on dec 1, 2011, adam d irwin and others published procalcitonin find, read and cite all the research you need on researchgate. Procalcitonin is a substance produced by many types of cells in the body, often in response to bacterial infections but also in response to tissue injury.
Procalcitonin pct is a 116 amino acid prohormone with a molecular weight of approximately 12. However, its accuracy in distinguishing intensive care unit icu patients with and without infection remains low owing to a lack of specificity and the time lapse between infection onset and the pct rise. Its synthesis is upregulated in bacterial infection and downregulated by viral infection. Consequently, with the increasing development of antibiotic resistance, interest has focused on the ability of this marker to not only diagnose infection but to tailor antibiotic. Our findings show limitations for crp and procalcitonin, particularly for discriminiation of tuberculosis form cap. Anmc adult procalcitonin pct utilization guidelineclinical. Sepsis is reported to be the most common cause of death in noncoronary intensive care unit icu.
The serum procalcitonin pct concentration reflects both the systemic response to bacterial infection and its severity. Adult procalcitonin pct testing guidelines suny downstate. Procalcitonin pct, a propeptide synthesized in the c cells of the thyroid, is a precursor of calcitonin. Early and reliable differentiation of infected and noninfected newborns is possible with pct determination directly after birth from cord blood when neonatal infection is suspected.
Costeffectiveness of procalcitoninguided antibiotic therapy. A growing body of evidence supports the use of procalcitonin pct to improve. Research article open access procalcitonin versus creactive. Sepsis is a global healthcare problem, characterized by whole body inflammation in response to microbial infection, which leads to organ dysfunction. A, an algorithm for lowacuity nonpneumonic infections ie, low risk in primary care and emergency department ed settings. Importantly, subacute forms of endocarditis or prostheticvalve. In patients with lower respiratory tract infections, procalcitonin can serve as a helpful adjunct to clinical judgment for guiding antibiotic therapy and resolving diagnostic uncertainty. Procalcitonin a way to a better antibiotic stewardship in the adult population. Use of serum procalcitonin to detect bacterial infection. Serum procalcitonin is a sensitive and specific marker in. Procalcitonin pct has been introduced in many european protocols for the management of febrile children. Multiple trials have explored the safety and efficacy of using pct as a biomarker to guide decisions about starting or stopping antibiotic therapy in a wide variety of situations, and pct assays have recently been approved by the federal drug administration.
Procalcitonin a way to a better antibiotic stewardship. Indian journal of critical care medicine, year 2011 janmarch, volume 15, issue 1 p. Diagnosis of bacteremia and septicemia in adults and children including neonates diagnosis of renal involvement in urinary tract infection in children diagnosis of bacterial infection in neutropenic patients diagnosis, risk stratification, and monitoring of septic shock diagnosis of systemic secondary infection postsurgery, and in severe trauma, burns, and multiorgan failure. Rapid diagnosis of bloodstream infections bsis in the emergency department ed is challenging, with turnaround times exceeding the timeline for rapid diagnosis. Clinical utility and measurement of procalcitonin ncbi. Cynthia l fowler 2011 procalcitonin for triage of patients with respiratory tract symptoms. Procalcitonin pct is a precursor to calcitonin which is normally produced by the. A metaanalysis published in 2011 that included 8 studies and 3431 patients found that procalcitonin utilization was associated with a 31% decrease in antibiotic prescriptions and a decrease in antibiotic duration of 1. Introduction procalcitonin is a serum biomarker that helps distinguish bacterial infection from other causes of infection or inflammation. Procalcitonin pct levels may predict the severity of cap and may be used to guide antibiotic use in hospitalized patients. Procalcitonin pct is detected in the blood stream within 3 to 6 hours after an infectious challenge.
Hospital procalcitonin testing and antibiotic treatment of patients admitted for chronic obstructive pulmonary disease exacerbation peter k. Chronic lowgrade inflammation is a key feature of the pathophysiology of obesity, insulin resistance and type 2 diabetes. Procalcitonin in patients with severe coronavirus disease. Calcitonin is a 32 amino acid peptide hormone secreted by parafollicular cells also known as c cells of the thyroid gland in humans, and in many other animals in the ultimopharyngeal body. But in severe bacterial, fungal, parasitic infections with systemic manifestations, a significant rise in procalcitonin levels are seen. It has been used as a marker of severe inflammation ernst et al. The high molecular form of ict was subsequently termed procalcitonin pct. Mar 04, 2020 although the overall number of covid19 patients with increased procalcitonin values seems limited, as highlighted in a recent article, the results of this concise metaanalysis of the literature would suggest that serial procalcitonin measurement may play a role for predicting evolution towards a more severe form of disease. In this condition the production site is the extra thyroid tissues 14. Procalcitonin pct medical clinical policy bulletins aetna. Objectives to quantify the diagnostic accuracy of selected inflammatory markers in addition to symptoms and signs for predicting pneumonia and to derive a diagnostic tool. Henry welch, rodrigo hasbun, in handbook of clinical neurology, 2010. Procalcitonin as a marker for the detection of bacteremia and. A value 2011 procalcitonin for triage of patients with respiratory tract symptoms.
Sep 22, 2011 there are a number of limitations to using conventional diagnostic markers for patients with clinical suspicion of infection. Importance of procalcitonin level in serum for postmortem. Expression of this group of peptides is normally limited to thyroid c cells and, to a small extent, other neuroendocrine cells. Procalcitonin as an indicator of the inflammatory response to infectious diseases it is important to determine whether procalcitonin is a marker of bacterial, fungal, or parasitic infection, of the. Early and differential diagnosis of sepsis is needed critically to avoid unnecessary usage of antimicrobial agents and for proper antibiotic treatments through the screening of. Differential diagnosis of bacterial infection and inflammatory response in kidney disease using procalcitonin. Procalcitonin pct guidance nebraska medicine omaha, ne. Additionally, procalcitonin levels may correlate with the. S pct is an automated test for the determination of procalcitonin pct in human serum or plasma.