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Open Access Highly Accessed Research article

Diagnostic and prognostic value of procalcitonin among febrile critically ill patients with prolonged ICU stay

Iraklis Tsangaris1*, Diamantis Plachouras2, Dimitra Kavatha2, George Michael Gourgoulis2, Argirios Tsantes3, Petros Kopterides1, George Tsaknis1, Ioanna Dimopoulou1, Stylianos Orfanos1, Evangelos Giamarellos-Bourboulis2, Helen Giamarellou2 and Apostolos Armaganidis1

Author Affiliations

1 The 2nd Critical Care Department, Attikon University General Hospital, Medical School, University of Athens, 1 Rimini Str., 12462, Athens, Greece

2 The 4th Department of Internal Medicine, Attikon University General Hospital, Medical School, University of Athens, 1 Rimini Str., 12462, Athens, Greece

3 Laboratory of Haematology & Blood Bank Unit Attikon University General Hospital, Medical School, University of Athens, 1 Rimini Str., 12462, Athens, Greece

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BMC Infectious Diseases 2009, 9:213  doi:10.1186/1471-2334-9-213

Published: 22 December 2009

Abstract

Background

Procalcitonin (PCT) has been proposed as a diagnostic and prognostic sepsis marker, but has never been validated in febrile patients with prolonged ICU stay.

Methods

Patients were included in the study provided they were hospitalised in the ICU for > 10 days, were free of infection and presented a new episode of SIRS, with fever >38°C being obligatory. Fifty patients fulfilled the above criteria. PCT was measured daily during the ICU stay. The primary outcome was proven infection.

Results

Twenty-seven out of 50 patients were diagnosed with infection. Median PCT on the day of fever was 1.18 and 0.17 ng/ml for patients with and without proven infections (p < 0.001). The area under the curve for PCT was 0.85 (95% CI; 0.71-0.93), for CRP 0.65 (0.46-0.78) and for WBC 0.68 (0.49-0.81). A PCT level of 1 ng/mL yielded a negative predictive value of 72% for the presence of infection, while a PCT of 1.16 had a specificity of 100%. A two-fold increase of PCT between fever onset and the previous day was associated with proven infection (p 0.001) (OR = 8.55; 2.4-31.1), whereas a four-fold increase of PCT of any of the 6 preceding days was associated with a positive predictive value exceeding 69.65%. A PCT value less than 0.5 ng/ml on the third day after the advent of fever was associated with favorable survival (p 0.01).

Conclusion

The reported data support that serial serum PCT may be a valuable diagnostic and prognostic marker in febrile chronic critically ill patients.