245. The Role of Procalcitonin in the Diagnosis of Bacterial Infections in Patients with Cardiac devices and Orthotopic Heart Transplant
Session: Poster Abstract Session: Diagnostics: Miscellaneous
Thursday, October 8, 2015
Room: Poster Hall
Background:

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.

Methods:

 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.

 Results:

 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.

 Conclusion:

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.

Melinda Brown, MD1, Eliahu Bishburg, MD, FIDSA1, Sandhya Nagarakanti, MD1 and Michael Divita, MD2, (1)Family Treatment Center, Newark Beth Israel Medical Center, Newark, NJ, (2)Internal Medicine, Newark Beth Israel Medical Center, Newark, NJ

Disclosures:

M. Brown, None

E. Bishburg, None

S. Nagarakanti, None

M. Divita, None

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