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Procalcitonin
Procalcitonin is a biomarker that is more specific than others for bacterial infection. It rises rapidly within 6 hours of an insult and declines quickly with treatment. It is not impacted by anti-inflammatory states and correlates well with illness severity. Procalcitonin levels can be used to differentiate between bacterial and viral lung infections, diagnose and monitor sepsis and septic shock, monitor antibiotic treatment response, and diagnose secondary infections. Reference values are provided and recommendations include measuring PCT at initiation of suspected conditions and repeating every 2-3 days to guide antibiotic use along with culture and clinical data.
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Procalcitonin
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- 2. Advantages over other biomarkers •Specificity for bacterial infection • Rapidity of rise after an insult (6 hours) • Rapid decline with treatment (T1/2 -24 hours) • Excellent correlation with severity of illness • Lack of impact of anti-inflammatory and immunosuppressive states.
- 6. LIMITATIONS • Newborns • Massivestress-severe trauma, surgery, cardiac shock, burns • Treatment with agents stimulating cytokines(anti-lymphocyte globulins,alemtuzumab,platelet transfusion. • Prolonged cardiogenic shock or organ perfusion abnormalities • Vasculitis, Acute GVHD • Medullary thyroid and small cell lung cancer • ESRD/ haemodialysis.
- 7. Clinical use • Bacterialv/s viral LRTI • Diagnosis ,risk stratification and monitoring sepsis and septic shock • Monitoring response to antibiotic therapy • Diagnosis of systemic secondary infection post surgery, post organ transplant, and in severe burns, multiorgan failure. • Diagnosis of bacterial infection in neutropenic patients.
- 8. REFERENCE VALUES • Normal:< 0.1 ng/ml (infants> 72 hours-adults) • Suspected LRTI: • 0.1-0.5 ng/ml- low likelihood of bacterial infection • >0.25 ng/ml- increased chance of bacterial infection • Suspected sepsis: antibiotics in all unstable patients • 0.1-0.5 ng/ml- low likelihood of sepsis • >0.5 ng/ml -high likelihood of sepsis • >2.0 ng/ml-high risk of sepsis/septic shock
- 13. Recommendations: • PCT atinitiation of sepsis /septic shock/LRTI • Repeat every 2-3 days • Antibiotics according to PCT dynamics, culture data and patient specific clinical data.
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