Procalcitonin helps to discriminate between septic and non-septic underlying disease at admission in ICU

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Introduction

Differentiation between acute bacterial infection from other types of inflammation is often difficult in ICU. Procalcitonin (PCT) was reported to be a new potential specific marker for infection. The aim of this study was to assess, at the admission, a PCT cutoff of infection in ICU patients.

Methods

In a prospective study, we studied all patients admitted to our ICU between January 1999 and July 1999. PCT was measured at admission (J0) and on second day (J2). Patients were grouped according to Bones classification (SIRS, sepsis, severe sepsis, septic shock, SDMV). Statistical analysis was performed using SYSTAT (GENDEL).

Results

377 consecutive patients (234 males and 143 females, mean age 60.3± 16.9 years, mean IGS II 34.12± 17.3) were admitted to ICU. Mortality rate was 26%, mean length of ICU stay was 7.14± 8.1 days. At admission and J2, mean PCT for all of them was 16.4± 57 ng/ml and 27.1± 100 ng/ml. According to Bones classification, mean PCT was: without SIRS=1.74 ng/ml (n=213), SIRS= 1.51 ng/ml (n=33), sepsis=14.48 ng/ml (n=43), severe sepsis=35.56 ng/ml (n=41), septic shock= 70.85 ng/ml (n=30), SDMV=94.95 ng/ml (n=13). The PCT cut off of infection (Bones ≥ sepsis) is shown in the Table.

Table 1

Discussion

At admission to ICU, PCT seems to be an interesting marker of early diagnosis of infection when the level is higher than 1.5 ng/ml. On the second day, a PCT level of 3 ng/ml seems to be more effective for diagnosis of infection than 1.5 ng/ml.