Procalcitonin (PCT) level is helpful in the diagnosis of bacterial infections. Patients (Pts) with ventricular assist devices (VAD), tandem heart (TH), extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP) and orthotropic heart transplant (OHT) present with systemic inflammatory response syndrome (SIRS) mimicking bacterial infections. We sought to evaluate PCT in these pts.
A retrospective review in a 680 bed tertiary care hospital between 2013 and 2015. Pts with elevated WBC, temperature >100.4, and any positive (+) culture were considered as having an infectious process. Data was collected for demographics, cultures and all radiologic tests. PCT levels of > 0.5ng/mL was considered positive. Chi square test was used for statistical analysis.
Fifty four pts had a total of 140 PCT. VAD 20 (37%), OHT 17(31.5%), IABP 10(18.5%), ECMO 4 (7.4%) TH 3(5.6%) Sixteen (29.6%) pts had 1 PCT, 18 (33.3%) 2 PCT, 10 (18.5%), 3 PCT and 10 (18.5%) > 4. Men 45 (85.3%) mean age 58 years (range 23 -84).
Of 140 PCTs, 56 (40%) were from VAD, 55 (39%) OHT, 17 (12%) IABP, 6 (4%) had ECMO or TH. Positive cultures from blood, sputum, urine or wound were found in 107 (76%), 77(72%) of them had a (+) PCT. Of pts with (-) cultures, 24 (73%) had a (+) PCT.
VAD pts had 52 blood cultures (bld cx), of which 12 (23%) were (+). Of 56 PCT 34(60.7%) had a positive PCT. OHT pts had 52 bld cx, 8 (15.3%) were (+), 42/52 (80.7%) had a (+) PCT. Pts with IABP had 16 bld cx, 3 (18.7%) were (+), 10 (62.5%) had a (+) PCT.
Of total 23 (+) bld cx, 8 (35%) had a (-) PCT level with 65% (+) predictive value. Of the 108 (78%) (-) bld cx, only 6 had (+) PCT with 94% (-) predictive value (p=<0.001). There was no significant correlation between (+) bld cx and PCT (p=0.366).
Overall, pts with a creatinine ≥3mg/dl (p<0.001) and those with increased WBC count ≥11000 µl had a higher rate of (+) PCT (p=0.005).
Pneumonia diagnosed in 9 (17%), 6 (67%) had a (+) PCT.
In our pts with cardiac devices there was no significant relationship between PCT and (+) bld cx. Pts with (+) respiratory or wound cultures were significantly more likely to have a (+) PCT. Patients with (-) bld cx were more likely to have a (-) PCT. The highest correlation with PCT was noted with increased WBC count and creatinine.
S. Nagarakanti, None
M. Divita, None