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Procalcitonin‐reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients
Author(s) -
Svaldi M.,
Hirber J.,
Lanthaler A.I.,
Mayr O.,
Faes S.,
Peer E.,
Mitterer M.
Publication year - 2001
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1046/j.1365-2141.2001.03083.x
Subject(s) - procalcitonin , sepsis , medicine , gastroenterology , white blood cell , septic shock , systemic inflammatory response syndrome , bacteremia , immunology , antibiotics , biology , microbiology and biotechnology
Procalcitonin (PCT) has proven to be a very sensitive marker of sepsis for non‐leucopenic patients. Little is known about its relevance in immunosuppressed and leucopenic adults. Four hundred and seventy‐five PCT determinations were carried out in 73 haematological patients: on 221 occasions the white blood cell (WBC) count was < 1·0 × 10 9 /l and on 239 occasions it was > 1·0 × 10 9 /l leucocytes. Patients were classified as: non‐systemic infected controls ( n = 280), patients with bacteraemia ( n = 32), sepsis ( n = 30), severe sepsis ( n = 3), septic shock ( n = 3) and systemic inflammatory response syndrome (SIRS) ( n = 62). When the WBC count was > 1·0 × 10 9 /l, gram‐negative bacteria induced higher PCT levels (median 9·4 ng/ml) than gram‐positives (median 1·4 ng/ml). In cases with a WBC < 1·0 × 10 9 /l, PCT levels were similar for gram‐negative and gram‐positive bacteria (1·1 ng/ml versus 0·85 ng/ml). Regardless of the leucocyte count, the median PCT level in bacteraemia cases always remained < 0·5 ng/ml. In heavily leucopenic situations, PCT levels were never > 2 ng/ml even in the sepsis and severe sepsis/septic shock groups, whereas a WBC count > 1·0 × 10 9 /l resulted in median PCT values of 4·1 ng/ml and 45 ng/ml respectively. The positive predictive value for sepsis (cut‐off 2 ng/ml) was 93% in cases of WBC count > 1·0 × 10 9 /l, but only 66% in leucopenic conditions. The negative predictive value (cut‐off 0·5 ng/ml) was 90% when the WBC count was > 1·0 × 10 9 /l and 63% in leucopenic conditions. Procalcitonin is an excellent sepsis marker with a high positive‐ and negative‐predictive value in patients with WBC count > 1·0 × 10 9 /l, but it does not work satisfactorily below this leucocyte count.