Liana Ysabelle J.

Casusi December 13, 2022

CP Research
DIAGNOSTIC VALUE OF SERUM PROCALCITONIN IN PREDICTING
MICROBIOLOGICAL CULTURE RESULTS FOR PATIENTS WITH
SUSPECTED BLOODSTREAM INFECTION

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 Introduction

Background of the Study

Sepsis is a significant cause of morbidity worldwide, with an estimated 48.9 million cases
recorded worldwide in 2017.

Mortality from the disease is also noteworthy, accounting for 19.7% of all global deaths.

Only 30% of septic patients demonstrate bloodstream infection (BSI), or the presence of
viable pathogenic organisms in blood, and this is associated with high death rates.

The current standard of diagnosis is microbiological culture, however, with the average
waiting time of at least 24 to 48 hours for the results, a more rapid but sensitive and specific
biomarker is needed.
 Introduction

Background of the Study

This delay has prompted initiatives for investigation of quicker assays and markers to
detect bloodstream infection at an earlier time.

One test being studied- Procalcitonin (PCT) is a clinical chemistry assay that can be easily
measured using a patient’s serum, and results are available, with a recommended
turnaround time of one to two hours.

This study intends to determine the diagnostic value of procalcitonin (PCT) in predicting
microbiological culture results in adult patients with suspected bloodstream infection.
 Introduction

Review of Related Literature

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host

response to infection.

It is a common cause of morbidity and mortality, with an estimated incidence 48.9 million
cases recorded worldwide in 2017, and 11 million sepsis-related deaths reported,
representing 19.7% of all global deaths.

Delayed diagnosis and inadequate antimicrobial therapy are associated with higher
mortality, and is especially true, because early detection and appropriate treatment of
patients with sepsis is essential.
 Introduction

Review of Related Literature

The spectrum of sepsis is broad and heterogenous, but it has been documented that
bacteremia is present in approximately 30% of patients diagnosed with sepsis.

Despite the burden of disease, local epidemiological studies remain scarce. A study
conducted in Africa and Asia revealed the median prevalence of bacteremia or bloodstream
infection (BSI) to be 12.5%, with Salmonella enterica (34.8%), Streptococcus pneumoniae
(13.2%), and Escherichia coli (8.8%) as the most frequent organisms isolated

International guidelines recommend that blood cultures be obtained prior to initiating

antimicrobial therapy if cultures can be obtained in a timely manner. However, the
risk/benefit ratio favors rapid administration of antimicrobials if it is not logistically possible
to obtain cultures promptly.
 Introduction

Review of Related Literature

Aside from blood culture, other markers have emerged for screening bacterial infections
due to the need for rapid diagnosis and management.

These include procalcitonin (PCT), neutrophil-lymphocyte count ratio, C-reactive protein

(CRP), and lactate which were shown to improve and aid diagnosis of sepsis.

Among these, the most reliable predictor of bloodstream infection was procalcitonin.

Procalcitonin is the precursor of calcitonin, produced by the C cells of the thyroid gland,
and the neuroendocrine cells of the lungs or intestines. It is produced in response to
microbial toxins of inflammatory mediators such as interleukins and tumor necrosis factor
(TNF).
 Introduction

Review of Related Literature

Blood PCT concentrations >0.5 ng/mL are considered positive.

Recent studies revealed that PCT was useful for ruling out the presence of bacteremia, with
a sensitivity of as high as 76% and specificity of 72% when a cutoff value of 0.5 ng/mL was
used for diagnosing a bloodstream infection.

Its positive predictive values remain conflicting, with some publications demonstrating as
low as 17 to 20% and up to 69%, while its negative predictive value was 98%.
 Introduction

General Objective

To determine the diagnostic value of procalcitonin in predicting the microbiological

culture results in adult patients with suspected bloodstream infection.

SPECIFIC OBJECTIVES
1. To determine the specificity, sensitivity, positive and negative predictive value of
serum procalcitonin levels in patients with Gram-positive and Gram-negative blood
culture results.

2. To determine the association of procalcitonin levels with the most common isolated
organisms in our locale.
 Introduction

Significance of the Study

Procalcitonin (PCT), a measurable substance in serum, rises in response to microbial

toxins and is detectable as early as 3 to 4 hours following an infection.

Being a more readily accessible test that has the potential to predict bloodstream
infection, this study will aid clinicians in prompt recognition of the disease and
initiation of empiric therapy.

It may also be helpful in predicting the probability of a negative blood culture, hence,
excluding low-risk patients who may not benefit from empiric antimicrobial therapy.

Finally, this study will contribute to medical research by providing new insight in the
field of microbiology and new uses for immunochemistry tests.
Conceptual Framework
 Methodology

Research Design
This was a one (1) year cross-sectional study that will determined the correlation of
serum procalcitonin levels and blood culture results in adult patients with suspected
bloodstream infection (BSI) from March 2020 to February 2021.

Sample Size
 Methodology

Data Collection

This was a secondary data gathering done by the researcher using an abstraction form,
through the Laboratory Information System.

Using the abstraction form, demographic data including patient’s age, sex, diagnosis,
serum procalctionin values, and bacterial culture results were collected.

From these data, the researcher identified patients suspected of having bloodstream
infection reflected in the Laboratory Information System as those who have
concomitant results for procalcitonin assay and blood culture drawn not more than 24
hours apart,
 Methodology

Algorithm of the Study

Results and Discussion
Results and Discussion
Results and Discussion
 Results and Discussion

Discussion
The ability to include or exclude suspected sepsis is vital for adequate and early
initiation of therapy in patients. This study investigated the diagnostic value of serum
procalcitionin in predicting microbiological culture results for patients with suspected
bloodstream infection.

Published studies on the diagnostic value of procalcitionin showed as high as 97.56%

sensitivity, 95.83% specificity, 98.76% positive predictive value, and 92% negative
predictive value.

In this study, the sensitivity of procalcitonin in determining the presence of sepsis is

comparable, at 77.14%. On the other hand, its specificity was lower, at 51%. This can
be interpreted as the test being a fairly reliable screening tool for bloodstream
infections.
 Results and Discussion

Discussion
Furthermore, the positive predictive and negative predictive values (18.51% and
94.04%, respectively) show that a normal procalcitonin level can be used to rule out
the diagnosis of sepsis in the acute setting.

The most common isolate in our locale was Staphylococcus aureus, a Gram-positive
bacteria,

Comparing Gram negative from Gram positive isolates showed that the cut-off of 0.5
ng/mL was more sensitive in predicting blood culture positivity for Gram negative
organisms (90.48%).
 Conclusion and Recommendations

This study has demonstrated the potential of procalcitonin as a test that can help
predict the presence of bloodstream infection, as well as its utility in categorizing an
isolate as possibly Gram-negative when elevated.

Despite procalcitonin being an accessible and relatively rapid test that can potentially
help predict the presence of bloodstream infection, or whether an isolate is Gram-
negative vs. Gram-positive, the lack of standardization on cut-offs and contrasting
evidence can still present challenges.

More extensive research with focus on setting internationally-accepted cut-offs, and

more local studies are recommended to be able to tailor-fit diagnostics to the specific
needs of this institution. Regular hospital-wide multi-disciplinary conferences on this
topic may also help steer the goals as a whole unit.
Liana Ysabelle J. Casusi December 13, 2022

Thank you!

The End