Predicting bacteremia by procalcitonin levels in patients evaluated for sepsis in the emergency department

Abstract

Evaluation of: Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM. Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am. J. Clin. Pathol. 135(2), 182–189 (2011).

In a recent report, Riedel et al. proposed a procalcitonin cutoff of 0.1 ng/ml to rule out bacteremia in adult patients presenting to the emergency department with systemic infections. Procalcitonin levels were higher in patients with true bacteremia than in patients with negative blood cultures or bacteremia due to possible contaminants. For prediction of bacteremia, a procalcitonin level of 0.1 ng/ml had an excellent negative predictive value of 96.3%, and a good sensitivity of 75%, specificity of 70.6% and area under the curve of 0.73, but poor positive predictive value of 12.8%. Based on the results in this study, we propose that a procalcitonin value of 0.1 ng/ml or less could be used to rule out bacteremia (NPV: 96.3%).

Keywords::

• adults
• bacteremia
• emergency department
• procalcitonin
• sepsis
• systemic inflammation

Financial & competing interests disclosure

Werner C Albrich and Beat Mueller received support from BRAHMS to attend meetings and fulfilled speaking engagements. Beat Mueller has served as a consultant to, and received research support from, BRAHMS (Thermo Fisher Scientific, Hennigsdorf, Germany). Beat Mueller received support from BioMérieux to attend meetings. 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.

No writing assistance was utilized in the production of this manuscript.