Prospective evaluation of procalcitonin in sepsis in the Illawarra area of Australia: PEPSIA study.

INTRODUCTION

Procalcitonin (PCT) is a precursor of the hormone calcitonin and has been proposed as a marker of infection in critically ill patients. We evaluated the role of procalcitonin in the early detection of sepsis in an Australian intensive care-high dependency unit (ICU/HDU).

METHODS

This prospective observational study enrolled 204 consecutive patients admitted to the ICU/HDU of Wollongong Hospital, NSW, over a 3-month period, October to December 2001. Of the 204, 172 (84%) were included in the final analysis. Patient demographic data, serum PCT levels and the vital signs required to score the criteria for systemic inflammatory response syndrome (SIRS) and sepsis were recorded daily until the patient left the ICU. Cultures were obtained when clinically indicated.

RESULTS

PCT measurement appears a useful screening test for sepsis with a cut-off value > 0.85 ng/dL. At levels >10 ng/dL, its diagnostic accuracy improves significantly. PCT level was able to discriminate between sepsis and nonsepsis, and between septic shock and non-septic shock. However, it failed to discriminate well between bacterial and non-bacterial SIRS with a 95% CI for area under the receiver operating characteristic curve of 0.59-0.76.

CONCLUSIONS

The use of PCT as a screening test (PCT >0.85ng/dL) in conjunction with traditional criteria is of value in the early diagnosis of bacterial sepsis in suspected cases in the ICU. PCT appears to be a reliable diagnostic test for bacterial sepsis at levels > 10 ng/dL.