1316. Procalcitonin A Useful Marker For Early Detection Of Bacteremia In Elderly Population
Session: Poster Abstract Session: Biomarkers and Correlates of Protection
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • procalcitonin elderly.pdf (169.1 kB)
  • Background: Diagnosing bacterial infection in the elderly is often difficult given their atypical presentations and chronic colonization. Multiple biological markers have been studied to aid  in detecting bacterial infection. CRP has been studied in elderly, but  is of limited use due to low specificity. Procalcitonin (PCT) as an early marker for bacterial sepsis that has good sensitivity and specificity. To date it has performed better than other biologic markers. However, only two studies have examined its utility in elderly. 

    Methods: : We performed a retrospective, multicenter analysis involving 210 adult patients who had confirmed infection and a PCT obtained on admission. 120 patients were 65 years or older. They were further sub-divided with regard to the presence of bacteremia and APACHE II score

    Results: In the elderly population: 44/120 had bacteremia; 19/44 had septic shock, 3/44 had severe sepsis, 18/44 had sepsis, and 4/44 had SIRS criteria. Skin and soft tissue infection were the predominant source of infection. In the younger population, 42/90 had bacteremia; 10/42 had septic shock, 6/42 had severe sepsis, 22/42 had sepsis, and 4/42 had SIRS criteria. Pneumonia was the predominant source. The average PCT for the younger  population was 48.67 ng/ml compared to 41.45 ng/ml in the elderly, with a minimum of 0.41 and 0.31 respectively. PCT level significantly increased with APACHE II score in both age groups (p = 0.0001). In patients with focal infection, the mean PCT level was 10.49 ng/ml for the younger group compared to 9.32 ng/ml in the elderly. Level of PCT did not significantly change with APACHE II score(p = 0.10).  

     Our study concluded that PCT production correlated with APACHE II score in the setting of bacteremia in all age groups. However, it failed to show a similar response in focal infection. This is consistent with a previous study describing PCT as a useful marker in excluding bacteremia in elderly using the cutoff of 0.38 ng/ml. In our study the cutoff was 0.31ng/ml. Our study is the first to compare both the elderly and young populations with regard to PCT production when correlating with the severity of illness.

    Conclusion: Elderly patients produce PCT in the setting of bacteremia in a similar fashion as younger patients. It is useful in detecting bacteremia in elderly patients, but not for focal, non-systemic infections.

    Rasha Abdulmassih, MD1, Amy Attaway, MD1, Mazen Roumia, MD2, Thomas Flynn, MD3, Matthew V. Zaccheo, DO4 and Anita I. Charochak, DO5, (1)Internal Medicine, Western Michigan University School of Medicine., kalamazoo, MI, (2)Cardiovascular Disease, Geisinger Health System Program, Danville, PA, (3)Infectious Disease, Western Michigan University School of Medicine, Kalamazoo, MI, (4)Bronson Methodist Hospital, Kalamazoo, MI, (5)Borgess Medical Center, Kalamazoo, MI

    Disclosures:

    R. Abdulmassih, None

    A. Attaway, None

    M. Roumia, None

    T. Flynn, None

    M. V. Zaccheo, None

    A. I. Charochak, None

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