4.3 Reference materials No reference material is currently available. To exclude sepsis and systemic inflammation, a concentration of ≤0.2 ng/mL is a useful reference range. Serum procalcitonin (PCT) levels rapidly increase in patients with invasive bacterial disease. PCT levels increase faster than do C-reactive protein levels. Furthermore, a rapid decrease in the PCT level is supporting evidence that the source of the bacterial infection is responding to clinical management. Procalcitonin level between .5 - 2 µg/L can indicate the possibility of a systemic infection. 7-12 However, while conclusions from meta-analyses appear to support the association of higher procalcitonin levels with worse clinical outcomes in patients with sepsis, 13,14 the overriding theme across a review of meta-analyses shows only moderate sensitivity … Procalcitonin (PCT) is a widely applied biomarker in the diagnosis of infection, and considering the presence of pre‐existing inflammation in CKD patients, the PCT level could be high in such a population; however, no reference value for PCT in CKD patients has been available to date. If infection symptoms are severe but the procalcitonin level is low, the cause is more likely viral. The level of procalcitonin in the blood can increase significantly in systemic bacterial infections and sepsis.This test measures the level of procalcitonin in the blood. Uses of Procalcitonin Test The PCT test is conducted to detect severe sepsis infection, bacterial infections like pneumonia & meningitis or to detect urinary tract infections in children. Serum procalcitonin (PCT) levels are of interest as a biomarker in patients with respiratory tract infections for several reasons. In conclusion, a serum PCT level over the 95th percentile on the reference curve for preterm infants and a combination of PCT and CRP levels with WBC count and/or IgM levels for term infants provided sufficient diagnostic accuracy. Normal levels vary by laboratory but are very low in the healthy patient. Learn more about laboratory tests, reference ranges, and understanding results. Procalcitonin is a helpful biomarker for early diagnosis of sepsis in critically ill patients. Low risk for progression to severe systemic infection sev r p i ). Low PCT levels do not automatically exclude the presence of bacterial infection. A Procalcitonin level less than .5 µg/L may be a reason to suspect that there is an infection. Low concentrations may suggest a local infection that has not yet spread to the whole of the body and become systemic or a systemic infection that is less than six hours old. Moderate to high risk of sepsis: 2 µg/L and 10 µg/L. Serum procalcitonin (PCT) is a 116-amino acid peptide with a low molecular weight of about 13 kDa. The serum PCT level in healthy individuals is under 0.3 ng/ml. In the life-threatening septic condition due to severe bacterial infection, the serum PCT level exceeds 0.5 ng/ml [ 1 ]. In 185 patients with community acquired pneumonia (CAP), higher PCT levels were observed in the more severe cases; those with PCT>0.5 ng/mL had higher mortality 33. If you are being treated for an infection, decreasing or low procalcitonin levels can show that your treatment is working. Plasma levels of PCT in healthy individuals are quite low (<0.1 ng/mL). Procalcitonin (PCT) was first reported as a precursor of calcitonin in 1975 [].In 1991, PCT production by medullary carcinoma of the thyroid was described [].Elevated PCT levels in burn patients with pneumonia was reported in 1992 [].The first article to suggest that PCT levels might discriminate viral from bacterial infection was published in 1993 []. Procalcitonin levels were checked daily, and clinicians were advised to stop antibiotics when levels were ≤0.5 ng/mL or if the level decreased by ≥80 percent from peak. Procalcitonin is the peptide precursor to calcitonin. The clinical setting (eg, emergency room, ICU, post-operative or trauma patients) The site and extent of the infection (eg, RTI, meningitis, abdominal infection) Co-morbidities (eg, immunosuppression) Severe liver dysfunction has been shown to influence PCT levels. Detection of Bacterial Infection Based on Age-Specific Percentile-Based Reference Curve for Serum Procalcitonin Level in Preterm Infants. Fukuzumi N, Osawa K, Sato I, Iwatani S, Ohnuma K, Imanishi T, Iijima K, Saegusa J, Morioka I. The optimal cut-off values ranges of Procalcitonin (PCT) are variable and dependent on. Typically the levels of procalcitonin in the blood remain below 0.5 ng/mL in cases of acute organ rejection, which has been stated previously to be well below the 1 μg/mL typically seen in bacterial infection. Most patients with bacterial meningitis will have ProCT levels of more than 10 times this level. Procalcitonin levels of 2-10 µg/L indicate that sepsis is a likely cause and 10 µg/L or greater indicates a very high possibility of severe sepsis. 2000 Mar-Apr. Procalcitonin levels correlate with the severity of pneumonia. This increase often correlates with the severity of the disease and with mortality. note however that normal Procalcitonin levels may be utilized to support decision-making regarding duration of antibiotics in LRTIs in patients who have not achieved clinical stability; PT levels ≤0.25 ng/mL or a >80% decrease in PCT level (from the highest PCT level) support antibiotic discontinuation IF a minimal standard duration has been completed. The reference value of PCT in adults and children older than 72 hours is 0.15 ng/mL or less. Reference Range: PCT< 0.05 UG/L for normal persons. Reference values … The procalcitonin levels in the sepsis-ICU-setting trials ranged from 4.5 to 12.0 ng/mL compared to 0.24–0.8 μg/L in the respiratory infection/pneumonia patients. Procalcitonin has been shown to increase with increasing degrees of sepsis and organ dysfunction34. PCT levels parallel the severity of the inflammatory insult or infection meaning those with more severe disease have higher levels. Routine use of procalcitonin is not an official recommendation of the IDSA as the assay is not readily available in all laboratories (Tunkel et al., 2004). A serum procalcitonin level >0.5 ng/ml had a PPV for bacterial meningitis of 100% and an NPV of 93%, while corresponding values for CSF procalcitonin were 100% and 74%, respectively. Procalcitonin level > or = 10.00 ng/mL: HIGH LIKELIHOOD OF SEVERE SEPSIS OR SEPTIC SHOCK. PCT is more sensitive than clinical assessment and routine laboratory markers of sepsis (such as leukocyte count and C-reactive protein) in detecting pancreatic infection [ 22 ]. Procalcitonin (PCT) is a widely used biomarker for the diagnosis of bacterial infections. The level of procalcitonin rises in response to a proinflammatory stimulus and is significantly increased in bacterial infections. have ProCT levels of more than 10 times this level. Measurements and results: PCT concentrations were moderately increased above the normal range in 32 % of patients after minor and aseptic surgery, in 59 % after cardiac and thoracic surgery, and in 95 % of patients after surgery of the intestine. To date, no clinical studies have compared the accuracy of serum procalcitonin (PCT) reference curves. Procalcitonin arises from endopeptidase-cleaved preprocalcitonin. Procalcitonin levels >10ng/ml are almost exclusively due to severe bacterial sepsis or septic shock. -Levels above 2.0 ng/mL are highly suggestive of systemic bacterial infection/sepsis or severe localized bacterial infection, such as severe pneumonia, meningitis, or peritonitis. This study investigated the clinical value of interleukin-6 (IL-6), pentraxin 3 (PTX3), and procalcitonin (PCT) in patients with sepsis and septic shock diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Furthermore, procalcitonin has some utility as a prognostic indicator with higher serum concentrations related to the risk of mortality. 4.2 Reference method There is currently no agreed reference method for procalcitonin. Serum levels of IL-6, PTX3, and PCT were measured in 142 enrolled subjects (51 with sepsis, 46 with septic shock, and 45 as … However, all automated and PoCT assays have been developed to, the results compared with, and the published reference ranges have been determined by, the LIA method. The procalcitonin results can also be used to determine if an infection is likely to be caused by bacteria or a virus. In bacterial infections, procalcitonin increases from concentrations in the picogram range (below the detection level of current procalcitonin assays) to plasma concentrations ranging from 1 to 1000 ng/mL. Severe sepsis: 10 µg/L or greater. Local bacterial Cinfection is possible. Infection . 28(2):68-73. Procalcitonin (PCT) is a widely applied biomarker in the diagnosis of infection, and considering the presence of pre-existing inflammation in CKD patients, the PCT level could be high in such a population; however, no reference value for PCT in CKD patients has been available to date. Procalcitonin (PCT) is a peptide measurable in serum which becomes elevated in response to bacterial infection. Low levels of procalcitonin in a seriously ill person indicates a low risk of sepsis and that they are unlikely to develop severe sepsis and/or septic shock, but a normal result does not exclude it. [Medline] . 4.4 Interfering substances 3 The baseline levels of serum procalcitonin (PCT) have not been determined in patients with end-stage renal disease needing renal replacement therapy. With successful antibiotic therapy, ProCT levels should fall with a half-life to 24 to 35 hours. Values between 0.5 and 2.0 µg/L are equivocal and generally not helpful. Several studies suggest that markedly elevated procalcitonin levels are associated with more severe disease and worse outcomes. Cautions Severe trauma, major burns, multiorgan failure, or major surgery can cause procalcitonin (ProCT) elevations in the absence of sepsis. Compared with controls, the procalcitonin group had significantly lower median antibiotic exposure (7.5 versus 9.3 defined daily doses) and lower 28-day mortality (19.6 versus 25 percent). The recent stop antibiotics on procalcitonin guidance study (SAPS), the largest procalcitonin trial to date, demonstrated reduction in both antibiotic exposure and … Procalcitonin levels rise rapidly in response to a pro-inflammatory stimulus of bacterial origin and normally fall after successful treatment . There are few studies of PCT in pregnancy as the reference interval for pregnant women is unknown. It is produced by various organs and the liver is considered to be the most important site of production. Viral infections, however, will not lead to elevation. -Procalcitonin (ProCT) between 0.15 and 2.0 ng/mL do not exclude an infection, because localized infections (without systemic signs) may be associated with such low levels. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Febrile Children in the ED: In studies have found PCT values of >2.0 µg/L make a serious infection much more likely while values of <0.5 µg/L make a serious infection much less likely. Procalcitonin (PCT) is used to accurately diagnose bacterial sepsis and differentiate it from other conditions, which is now particularly important given the vulnerability to COVID-19 in pregnancy. Procalcitonin (PCT) Reference Ranges PCT <0.05 µg/L Healthy individuals Determination of normal values with a high sensitive assay revealed normal values to be below 0.05 µg/L. Procalcitonin is a substance produced by many types of cells in the body, often in response to bacterial infections but also in response to tissue injury. Clearly, the septic patients in the ICU setting were more toxic, and this is reflected in the higher procalcitonin levels. The higher the level, the more severe your infection may be. Clinical Utility of Procalcitonin (PCT) What is Procalcitonin (PCT)? Procalcitonin helps to differentiate bacterial from viral infections or other causes of systemic inflammation. The early detection of elevated PCT levels in patients with suspected bacterial infections enables a more targeted antibiotic treatment. As a cut-off for the diagnosis of sepsis, plasma levels of ≥0.5 ng/mL are interpreted as abnormal and suggest sepsis. The reference value of PCT in adults and children older than 72 hours is 0.15 ng/mL or … Reference individuals without bacterial infection usually have PCT levels Conclusion: This meta-analysis showed that an elevated serum CRP, PCT, D-dimer, and ferritin were associated with a poor outcome in COVID-19. Nevertheless, the results of the test must be interpreted carefully in the context of medical history, physical examination, and microbiological assessment. citonin levels of <0.5 µg/L or levels that decrease by ≥80% from peak can guide discontinuation once patients stabilize. Procalcitonin arises from endopeptidase-cleaved preprocalcitonin. With successful antibiotic therapy, ProCT levels should fall with a half-life to 24 to 35 hours. A ProCT level below 0.5 ng/mL makes bacterial meningitis very unlikely. Patients with a composite poor outcome had a higher serum ferritin with a standardized mean difference of 0.90 (0.64, 1.15), p< 0.0001; I2: 76%. Expected values Normal range: <0.05ng/mL Clinical cut-off: <0.50ng/mL represents a low risk of severe sepsis and/or septic shock >2.00ng/mL represents a high risk of severe sepsis and/or septic shock PCT is normally less than 0.05 ng/ml (equivalent to less than 0.05 ug/L) in healthy individuals. The purpose of the present study is to verify the reference range of PCT and parameters affecting its value in patients receiving chronic hemodialysis. Based on prior studies, the normal value for PCT was defined as <0.5 ng/ml, with a cut-point ≥0.5 ng/ml being indicative of bacterial sepsis . In the Procalcitonin level was measured using an immunofluorescent assay (PCT-sensitive Kryptor; Brahms Diagnostica, Germany) with a lowest detection limit of 0.04 ng/ml. PCT <0.5 µg/L Systemic infection (sepsis) is not (likely.
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