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Open Access Highly Accessed Research article

Diagnostic accuracy of procalcitonin in critically ill immunocompromised patients

Nicolas Bele1, Michael Darmon123, Isaline Coquet1, Jean-Paul Feugeas4, Stéphane Legriel1, Nadir Adaoui4, Benoît Schlemmer1 and Élie Azoulay1*

Author Affiliations

1 AP-HP, Hôpital Saint-Louis, Medical ICU Department, 75010 Paris, France; University Paris-7 Paris-Diderot, UFR de Médecine, 75010 Paris, France

2 Medical-Surgical Intensive Care Unit, Saint-Etienne university hospital, and Jean Monnet University, Avenue Albert Raymond, Saint-Etienne, 42270, France

3 Thrombosis Research Group, EA 3065, Saint-Etienne University Hospital and Saint-Etienne Medical School, Avenue Albert Raymond, Saint-Etienne, 42270, France

4 AP-HP, Hôpital Saint-Louis, Biochemistry Department, 75010 Paris, France; University Paris-7 Paris-Diderot, UFR de Médecine, 75010 Paris, France

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BMC Infectious Diseases 2011, 11:224  doi:10.1186/1471-2334-11-224

Published: 24 August 2011

Abstract

Background

Recognizing infection is crucial in immunocompromised patients with organ dysfunction. Our objective was to assess the diagnostic accuracy of procalcitonin (PCT) in critically ill immunocompromised patients.

Methods

This prospective, observational study included patients with suspected sepsis. Patients were classified into one of three diagnostic groups: no infection, bacterial sepsis, and nonbacterial sepsis.

Results

We included 119 patients with a median age of 54 years (interquartile range [IQR], 42-68 years). The general severity (SAPSII) and organ dysfunction (LOD) scores on day 1 were 45 (35-62.7) and 4 (2-6), respectively, and overall hospital mortality was 32.8%. Causes of immunodepression were hematological disorders (64 patients, 53.8%), HIV infection (31 patients, 26%), and solid cancers (26 patients, 21.8%). Bacterial sepsis was diagnosed in 58 patients and nonbacterial infections in nine patients (7.6%); 52 patients (43.7%) had no infection. PCT concentrations on the first ICU day were higher in the group with bacterial sepsis (4.42 [1.60-22.14] vs. 0.26 [0.09-1.26] ng/ml in patients without bacterial infection, P < 0.0001). PCT concentrations on day 1 that were > 0.5 ng/ml had 100% sensitivity but only 63% specificity for diagnosing bacterial sepsis. The area under the receiver operating characteristic (ROC) curve was 0.851 (0.78-0.92). In multivariate analyses, PCT concentrations > 0.5 ng/ml on day 1 independently predicted bacterial sepsis (odds ratio, 8.6; 95% confidence interval, 2.53-29.3; P = 0.0006). PCT concentrations were not significantly correlated with hospital mortality.

Conclusion

Despite limited specificity in critically ill immunocompromised patients, PCT concentrations may help to rule out bacterial infection.

Keywords:
bacterial infection; neutropenia; HIV infection; immune deficiency; bone marrow transplantation; Sensitivity and Specificity.