Comparison between procalcitonin and C-reactive protein in predicting bacteremias and confounding factors: a case-control study
-
Hirokazu Nishikawa
,
Michinori Shirano
Abstract
Background:
The detection of infectious bacteria in blood culture samples is important for diagnosis and treatment, but this requires 1–2 days at least, and is not adequate as a rapid test. Therefore, we have investigated the diagnostic ability and the optimal cutoff value of procalcitonin (PCT) and C-reactive protein (CRP) for predicting the bacteremias using receiver operating characteristic (ROC) curves and relative cumulative frequency distribution (RCD) curves.
Methods:
A case-control study was performed in inpatients (852 subjects: 426 positive cultures and 426 negative cultures) from January 1 to December 31, 2014. We retrospectively investigated their blood culture and blood chemistry findings recorded in this period using electronic medical records.
Results:
Area under the ROC curve of PCT and CRP were 0.79 and 0.66, respectively. The optimal cutoff values were 0.5 μg/L with a sensitivity of 70% and specificity of 70% for PCT and 50.0 mg/L with a sensitivity of 63% and specificity of 65% for CRP. When the optimal cutoff value was treated as a reference, the odds ratio (OR) was 71.11 and the hazard ratio (HR) was 6.27 for PCT >2.0 μg/L, and the risk of blood culture positivity was markedly elevated. PCT levels were significantly higher in the population with Gram-negative rod (GNR) infections than in the population with Gram-positive coccal (GPC) infections.
Conclusions:
The elevation of CRP and PCT were significantly associated with bacteremias. PCT was superior to CRP as a diagnostic indicator for predicting bacteremias, for discriminating bacterial from nonbacterial infections, and for determining bacterial species.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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©2017 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorials
- Opportunities and drawbacks of nonstandard body fluid analysis
- How I first met Dr. Morton K. Schwartz
- Reviews
- Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids
- Quality control materials for pharmacogenomic testing in the clinic
- Modulating thrombotic diathesis in hereditary thrombophilia and antiphospholipid antibody syndrome: a role for circulating microparticles?
- Opinion Papers
- Advances in laboratory diagnosis of hereditary spherocytosis
- Analytical performance specifications for external quality assessment – definitions and descriptions
- Genetics and Molecular Diagnostics
- Differences between quantification of genotype 3 hepatitis C virus RNA by Versions 1.0 and 2.0 of the COBAS AmpliPrep/COBAS TaqMan HCV Test
- General Clinical Chemistry and Laboratory Medicine
- Estimating the intra- and inter-individual imprecision of manual pipetting
- Effect of multiple freeze-thaw cycles on selected biochemical serum components
- The effect of storage temperature fluctuations on the stability of biochemical analytes in blood serum
- Comparison of ex vivo stability of copeptin and vasopressin
- Physiologic changes of urinary proteome by caffeine and excessive water intake
- Assessment of autoantibodies to interferon-ω in patients with autoimmune polyendocrine syndrome type 1: using a new immunoprecipitation assay
- Reference Values and Biological Variations
- Within-day biological variation and hour-to-hour reference change values for hematological parameters
- Relationship between anti-Müllerian hormone and antral follicle count across the menstrual cycle using the Beckman Coulter Access assay in comparison with Gen II manual assay
- Cardiovascular Diseases
- Low-grade inflammation and tryptophan-kynurenine pathway activation are associated with adverse cardiac remodeling in primary hyperparathyroidism: the EPATH trial
- Infectious Diseases
- Comparison between procalcitonin and C-reactive protein in predicting bacteremias and confounding factors: a case-control study
- Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery
- Activation of the tryptophan/serotonin pathway is associated with severity and predicts outcomes in pneumonia: results of a long-term cohort study
- Letters to the Editor
- Incidental findings of monoclonal proteins from carbohydrate-deficient transferrin analysis using capillary electrophoresis
- IgD-λ myeloma with extensive free light-chain excretion: a diagnostic pitfall in the identification of monoclonal gammopathies
- 25-Hydroxyvitamin D threshold values should be age-specific
- Effect of dabigatran treatment at therapeutic levels on point-of-care international normalized ratio (INR)
- Alkaline phosphatase activity – pH impact on the measurement result
- Cyst hydatid and cancer: the myth continues
- Role of activated platelets in severe acne scarring and adaptive immunity activation
- Towards a random-access LC-MS/MS model for busulfan analysis
Articles in the same Issue
- Frontmatter
- Editorials
- Opportunities and drawbacks of nonstandard body fluid analysis
- How I first met Dr. Morton K. Schwartz
- Reviews
- Measurement of thyroglobulin, calcitonin, and PTH in FNA washout fluids
- Quality control materials for pharmacogenomic testing in the clinic
- Modulating thrombotic diathesis in hereditary thrombophilia and antiphospholipid antibody syndrome: a role for circulating microparticles?
- Opinion Papers
- Advances in laboratory diagnosis of hereditary spherocytosis
- Analytical performance specifications for external quality assessment – definitions and descriptions
- Genetics and Molecular Diagnostics
- Differences between quantification of genotype 3 hepatitis C virus RNA by Versions 1.0 and 2.0 of the COBAS AmpliPrep/COBAS TaqMan HCV Test
- General Clinical Chemistry and Laboratory Medicine
- Estimating the intra- and inter-individual imprecision of manual pipetting
- Effect of multiple freeze-thaw cycles on selected biochemical serum components
- The effect of storage temperature fluctuations on the stability of biochemical analytes in blood serum
- Comparison of ex vivo stability of copeptin and vasopressin
- Physiologic changes of urinary proteome by caffeine and excessive water intake
- Assessment of autoantibodies to interferon-ω in patients with autoimmune polyendocrine syndrome type 1: using a new immunoprecipitation assay
- Reference Values and Biological Variations
- Within-day biological variation and hour-to-hour reference change values for hematological parameters
- Relationship between anti-Müllerian hormone and antral follicle count across the menstrual cycle using the Beckman Coulter Access assay in comparison with Gen II manual assay
- Cardiovascular Diseases
- Low-grade inflammation and tryptophan-kynurenine pathway activation are associated with adverse cardiac remodeling in primary hyperparathyroidism: the EPATH trial
- Infectious Diseases
- Comparison between procalcitonin and C-reactive protein in predicting bacteremias and confounding factors: a case-control study
- Monitoring of procalcitonin but not interleukin-6 is useful for the early prediction of anastomotic leakage after colorectal surgery
- Activation of the tryptophan/serotonin pathway is associated with severity and predicts outcomes in pneumonia: results of a long-term cohort study
- Letters to the Editor
- Incidental findings of monoclonal proteins from carbohydrate-deficient transferrin analysis using capillary electrophoresis
- IgD-λ myeloma with extensive free light-chain excretion: a diagnostic pitfall in the identification of monoclonal gammopathies
- 25-Hydroxyvitamin D threshold values should be age-specific
- Effect of dabigatran treatment at therapeutic levels on point-of-care international normalized ratio (INR)
- Alkaline phosphatase activity – pH impact on the measurement result
- Cyst hydatid and cancer: the myth continues
- Role of activated platelets in severe acne scarring and adaptive immunity activation
- Towards a random-access LC-MS/MS model for busulfan analysis
