Procalcitonin as a diagnostic marker for infection in sickle cell disease

ABSTRACT

Background

Patients with sickle cell disease (SCD) are at increased risks of infection. Fever often occurs with vaso-occlusive crisis (VOC), posing a diagnostic challenge in SCD. Procalcitonin (PCT) is an infectious biomarker validated in the general population but with limited data on use in SCD.

Methods

We performed a retrospective single-center study (n = 145) with primary objective of assessing ability of PCT to differentiate infection from VOC in SCD presenting with fever. Subgroups included confirmed bacterial infection (CBI), suspected bacterial infection, viral infection, and VOC. A secondary objective examined the association of PCT with acute chest syndrome. Clinical characteristics and data were collected and analyzed to assess the diagnostic performance of PCT and associated variables.

Results

  Of the cohort, 16% had CBI and 8% had viral infection. PCT was able to discriminate CBI from viral infection [AUC = 0.89 (95%CI, 0.78–0.99)] and VOC [AUC = 0.87 (95%CI, 0.78–0.97)]. PCT had an association with ACS but poor diagnostic performance [AUC = 0.69 (95% CI, 0.54–0.84)].

Conclusion

PCT has utility in distinguishing confirmed bacterial infection from VOC or viral infection and is a promising biomarker when investigating fever in SCD.

KEYWORDS:

• Hemoglobinopathy
• infection
• procalcitonin
• sickle cell disease
• vaso-occlusive crisis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.