Extra-pulmonary applications of procalcitonin: an updated literature review

ABSTRACT

Introduction

Procalcitonin (PCT) is a biomarker with established performance in the differentiation between bacterial and viral infections, predominantly in pulmonary infections, as well as the diagnosis and prognosis of bacterial sepsis. However, the role of PCT in extra-pulmonary infections is not well described.

Areas Covered

We reviewed the role of PCT in commonly experienced extra-pulmonary infections including meningitis, diabetic foot infection, prosthetic joint infection, osteomyelitis, and skin and soft tissue infection. PubMed and Medline online libraries were searched, from 2013 till 2022, for relevant articles.

Expert Opinion

For meningitis, PCT could distinguish bacterial from viral meningitis. PCT distinguished septic arthritis from different inflammatory states but had variable performance in discriminating septic arthritis from crystal arthropathy. For periprosthetic joint infections, results were inconclusive. PCT had a potential role in diagnosis of more complex infections such as osteomyelitis and diabetic foot infections, but further studies are needed for a definitive cutoff. In skin and soft tissue infections, PCT performance was variable requiring further investigation to define cutoff for the discrimination of cellulitis from necrotizing fasciitis. We find that PCT performed best for meningitis and helps in the reduction of unnecessary antibiotic treatment, but has variable outcomes with other extra-pulmonary infections.

KEYWORDS:

• Procalcitonin
• biomarker
• infection
• outcomes
• meningitis

Article highlights

• PCT can be used as an adjunctive diagnostic tool in extra-pulmonary infections.

• PCT performed well for differentiating viral from bacterial meningitis, but demonstrates variable performance in periprosthetic infection, native joint inflammation, osteomyelitis, SSTI and lower extremity ulceration, where further studies are warranted.

Declaration of interest

M.K. Mansour is the recipient of an unrestricted research fund from Thermo Fisher Scientific for the clinical trial, ProSAVE (NCT04158804). The authors have no other 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 apart from those disclosed.

Reviewer disclosures

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

Supplementary material

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Additional information

Funding

This work was supported, in part, by the National Institutes of Health, NIAID RO1 AI132638 to M.K. Mansour.