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procalcitonin in serum (Vidas Brahms PCT Assay)

Clinical significance: 1) appears to be a marker for bacterial infection - detection of serious bacterial infections in children presenting with fever without source [6] - not useful for determining when to start antibiotic use in ICU patients [5] - sensitivity for sepsis upon hospital admission is 68% - positive predictive value is 23% [17] 2) assessing bacterial vs viral meningitis [2] 3) assessing bacterial pneumonia vs viral etiology of lower respiratory tract infection [3] 4) assessing bacterial pneumonia vs heart failure [7] 5) FDA-approved Vidas Brahms PCT Assay for guidance in starting or stopping antibiotics for community-acquired pneumonia & for stopping antibiotics in sepsis [9] 6) high levels (>10 ng/mL) in patients with community- acquired pneumonia associated with need for intensive care but clinical relevance uncertain [8] 7) procalcitonin in serum may help guide treatment decisions, reduce antibiotic use & improve survival in patients with lower respiratory tract infections [10] 8) low serum procalcitonin may identify patients hospitalized with COPD exacerbation for which antibiotic therapy > 24 hours does not reduce readmission rates [14] 9) use to guide treatment for lower respiratory tract infections does not appear to reduce antibiotic prescriptions [13] 10) not recommended by the Infectious Diseases Society of America to guide initiation of antimicrobial therapy in community-acquired pneumonia [16] 10) may be useful for managing antibiotic cessation in ICU patients [12] 11) may be increased in lung small-cell-carcinoma 12) increased in medullary thyroid carcinoma see Algorithm for procalcitonin-guided management [4] insufficient evidence to recommend routine adoption (NICE) Reference interval: - > 0.5 ng/mL predicts bacterial vs aseptic meningitis - > 0.1 ng/mL predicts bacterial pneumonia vs heart failure - initiation or continuation of antibiotics is encouraged for serum procalcitonin levels > 0.25-0.5 ug/L [3] Increases: - bacterial infection - bacterial meningitis - bacterial pneumonia - small cell carcinoma of the lung - medullary thyroid carcinoma Procedure: - functional assay sensitivity of 0.06 ug/L - assay time of < 20 minutes Notes: - it is unclear how the assay for serum calcitonin used in the diagnosis of medullary thyroid carcinoma differs from that of serum procalcitonin

Related

calcitonin in serum calcitonin; contains: katacalcin; calcitonin carboxyl-terminal peptide; CCP; PDN-21 (CALC, CALC1)

General

special chemistry test

References

  1. Journal Watch 24(7):56, 2004 Christ-Crain M et al, Lancet 363:600, 2004 PMID: 14987884
  2. Dubos F et al, Serum procalcitonin and other biologic markers to distinguish between bacterial and aseptic meningitis J Pediatr 2006, 149:71 PMID: 16860131
  3. Schuetz P et al Effect of Procalcitonin-Based Guidelines vs Standard Guidelines on Antibiotic Use in Lower Respiratory Tract Infections. The ProHOSP Randomized Controlled Trial. JAMA. 2009;302(10):1059-1066. PMID: 19738090 http://jama.ama-assn.org/cgi/content/full/302/10/1059?home - Yealy DM and Fine MJ Measurement of Serum Procalcitonin A Step Closer to Tailored Care for Respiratory Infections? JAMA. 2009;302(10):1115-1116 PMID: 19738100 http://jama.ama-assn.org/cgi/content/short/302/10/1115?home
  4. Schuetz P et al Algorithm for procalcitonin-guided management (PDF) http://jama.ama-assn.org/cgi/data/302/10/1059/DC1/1
  5. Layios N et al. Procalcitonin usefulness for the initiation of antibiotic treatment in intensive care unit patients. Crit Care Med 2012 Aug; 40:2304. PMID: 22809906
  6. Yo CH et al. Comparison of the test characteristics of procalcitonin to C-reactive protein and leukocytosis for the detection of serious bacterial infections in children presenting with fever without source: A systematic review and meta-analysis. Ann Emerg Med 2012 Nov; 60:591. PMID: 22921165
  7. Alba GA, Truong QA, Gaggin HK et al Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea. Am J Med. 2016 Jan;129(1):96-104.e7 PMID: 26169892
  8. Self WH et al. Procalcitonin as an early marker of the need for invasive respiratory or vasopressor support in adults with community- acquired pneumonia. Chest 2016 Apr 21
  9. FDA News Release. February 23, 2017 FDA clears test to help manage antibiotic treatment for lower respiratory tract infections and sepsis. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm543160.htm
  10. Schuetz P, Wirz Y, Sager R et al Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. The Lancet Infectious Diseases. Oct 13, 2017 PMID: 29037960 http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30592-3/fulltext - Fontela PS, Papenburg J Procalcitonin and antibiotic use: imperfect, yet effective. The Lancet Infectious Diseases. Oct 13, 2017 PMID: 29037959 http://thelancet.com/journals/laninf/article/PIIS1473-3099(17)30593-5/fulltext
  11. Schuetz P, Wirz Y, Sager R et al Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev. 2017 Oct 13;10:CD007498 PMID: 29025194
  12. Lam SW, Bauer SR, Fowler R, Duggal A. Systematic review and meta-analysis of procalcitonin-guidance versus usual care for antimicrobial management in critically ill patients: Focus on subgroups based on antibiotic initiation, cessation, or mixed strategies. Crit Care Med 2018 Jan 2; PMID: 29293146
  13. Huang DT, Yealy DM, Filbin MR et al Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med. May 20, 2018. PMID: 29781385 Free Article https://www.nejm.org/doi/full/10.1056/NEJMoa1802670
  14. Bremmer DN, Moffa MA, Ma K et al. Acute exacerbations of chronic obstructive pulmonary disease with a low procalcitonin concentration: Impact of antibiotic therapy. Clin Infect Dis. 2019 Feb 15;68(5):725-730 PMID: 29982350 https://academic.oup.com/cid/article-abstract/68/5/725/5047438?redirectedFrom=fulltext
  15. O'Riordan F, Shiely F, Byrne S et al. An investigation of the effects of procalcitonin testing on antimicrobial prescribing in respiratory tract infections in an Irish university hospital setting: A feasibility study. J Antimicrob Chemother 2019 Nov 1; 74:3352 PMID: 31325313 https://academic.oup.com/jac/article/74/11/3352/5536342.
  16. Sakoulas G Clarifying Procalcitonin's Influence on Antimicrobial Use for Respiratory Tract Infections NEJM Journal Watch. Dec 13, 2019 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
  17. Lawandi A, Oshiro M, Warner S et al. Reliability of admission procalcitonin testing for capturing bacteremia across the sepsis spectrum: Real-world utilization and performance characteristics, 65 U.S. hospitals, 2008-2017. Crit Care Med 2023 Jul 3; [e-pub]. PMID: 37395622 https://journals.lww.com/ccmjournal/Abstract/9900/Reliability_of_Admission_Procalcitonin_Testing_for.181.aspx

Component-of

inflammatory markers (iAGE)