233. Procalcitonin Is More Sensitive Than Endotoxin for Screening of Bacteremia and ICU Admission
Session: Poster Abstract Session: Diagnostic Microbiology
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDweek2013ver3_KATO.pdf (3.8 MB)
  • Background: Although endotoxin (ENDO) is the conventional biomarker for assessing sepsis, procalcitonin (PCT) is gaining in popularity for this application. We assessed the sensitivity and specificity of these biomarkers for use in screening assays for severe infection.

    Methods: 69 bacteremic and 71 of abacteremic systemic infectious patients during June 2011 through March 2013 were included. Concurrent samples were evaluated for serum ENDO, PCT and blood cultures (two replicates) retrospectively.

    Results: Only 50 patients (36 with bacteremic and 14 with abacteremic infection) had detectable serum ENDO levels. ENDO was significantly higher in the bacteremia group (25.2 pg/mL, 7.3-43.1) than in the abacteremic infection and 0.60 pg/mL, 0.25-0.93; P < 0.001) group (mean, 95 % CI). Serum PCT level also differed between two groups (22.4 ng/mL, 15.5-29.2 and 8.1 ng/mL, 3.4-12.8; P < 0.001). ENDO was specifically high in patients with Gram-negative bacteremia (mean 34.1 pg/mL and 0.2 pg/mL) compared with PCT (mean 26.8 ng/mL and 10.3 ng/mL). According to receiver operator curve analysis, the AUC of PCT and ENDO for distinguish bacteremia was 0.76 (CI 0.68-0.84) and 0.68 (CI 0.60-0.77). PCT level of 2.49 ng/mL (sensitivity, 73.9%; specificity, 71.8%) and ENDO level of 0.55 pg/mL (sensitivity, 52.2%; specificity, 81.7%) were appropriate cut-off values to diagnose bacteremia in all infectious patients. In all 140 patients, patients who admitted to ICU (n = 57) had much higher PCT level than other patients (26.1 ng/mL, 17.2-35.1 and 7.58 ng/mL, 4.7-10.5; < 0.002), while ENDO level did not differ (13.31 pg/mL, 2.24-24.4 vs 12.3 pg/mL, 0.0-25.6; = 0.270).

    Conclusion: Although a high ENDO level (≥0.55 pg/mL) suggests bacteremia, especially for Gram-negative bacteremia, PCT (≥2.5 ng/mL) showed greater sensitivity in this regard and likely will be useful when screening for severe infection.

    Hideaki Kato, MD1,2, Ryoko Higa, MD2, Sei Samukawa, MD2, Atsuhisa Ueda, MD, MPH2, Takeshi Kaneko, MD, MPH1 and Yoshiaki Ishigatsubo, MD, MPH2, (1)Infection Control Department, Yokohama City Univ. Medical Center, Yokohama, Japan, (2)Department of Internal Medicine and Clinical Immunology, Yokohama City Univ., Yokohama, Japan

    Disclosures:

    H. Kato, None

    R. Higa, None

    S. Samukawa, None

    A. Ueda, None

    T. Kaneko, None

    Y. Ishigatsubo, None

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