Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections
Abstract Objective During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the pu...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12621 |
| _version_ | 1818255340150456320 |
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| author | Kaoutar Azijli Tanca C. Minderhoud Carlijn J. deGans Arthur W.E. Lieveld Prabath W.B. Nanayakkara |
| author_facet | Kaoutar Azijli Tanca C. Minderhoud Carlijn J. deGans Arthur W.E. Lieveld Prabath W.B. Nanayakkara |
| author_sort | Kaoutar Azijli |
| collection | DOAJ |
| description | Abstract Objective During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin. Methods This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included. Results A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80–0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 μg/L had a sensitivity of 100% (95% CI 63.1–100) and specificity of 81.2% (95% CI 75.1–86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 μg/L showed a sensitivity of 87.2% (95% CI 72.6–95.7) and specificity of 64.1 % (95% CI 58.3–69.6). Conclusion In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 μg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low. |
| first_indexed | 2024-12-12T17:10:18Z |
| format | Article |
| id | doaj.art-0b8abc84835443eb8af82351334f5637 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-12-12T17:10:18Z |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-0b8abc84835443eb8af82351334f56372022-12-22T00:17:53ZengWileyJournal of the American College of Emergency Physicians Open2688-11522022-06-0133n/an/a10.1002/emp2.12621Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infectionsKaoutar Azijli0Tanca C. Minderhoud1Carlijn J. deGans2Arthur W.E. Lieveld3Prabath W.B. Nanayakkara4Department of Emergency Medicine Amsterdam Public Health Research Institute Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsDepartment of General and Acute Internal Medicine Amsterdam Public Health Research Institute Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsDepartment of Emergency Medicine Amsterdam Public Health Research Institute Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsDepartment of General and Acute Internal Medicine Amsterdam Public Health Research Institute Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsDepartment of General and Acute Internal Medicine Amsterdam Public Health Research Institute Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The NetherlandsAbstract Objective During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin. Methods This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included. Results A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80–0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 μg/L had a sensitivity of 100% (95% CI 63.1–100) and specificity of 81.2% (95% CI 75.1–86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 μg/L showed a sensitivity of 87.2% (95% CI 72.6–95.7) and specificity of 64.1 % (95% CI 58.3–69.6). Conclusion In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 μg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low.https://doi.org/10.1002/emp2.12621emergency departmentinfectionprocalcitoninviral infection |
| spellingShingle | Kaoutar Azijli Tanca C. Minderhoud Carlijn J. deGans Arthur W.E. Lieveld Prabath W.B. Nanayakkara Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections Journal of the American College of Emergency Physicians Open emergency department infection procalcitonin viral infection |
| title | Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections |
| title_full | Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections |
| title_fullStr | Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections |
| title_full_unstemmed | Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections |
| title_short | Optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections |
| title_sort | optimal use of procalcitonin to rule out bacteremia in patients with possible viral infections |
| topic | emergency department infection procalcitonin viral infection |
| url | https://doi.org/10.1002/emp2.12621 |
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