Diagnostic value of procalcitonin for bacterial infection in elderly patients in the emergency department

Chih Cheng Lai, Shey Ying Chen, Cheng Yi Wang, Jen Yu Wang, Chan Ping Su, Chun Hsing Liao, Che Kim Tan, Yu Tsung Huang, Hen I. Lin, Po Ren Hsueh

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

OBJECTIVES: To evaluate the diagnostic performance of procalcitonin (PCT) in elderly patients with bacterial infection in the emergency department (ED). DESIGN: Prospective. SETTING: ED of a tertiary care hospital. PARTICIPANTS: Elderly patients with systemic inflammatory response syndrome (SIRS) enrolled from September 2004 through August 2005. MEASUREMENTS: A serum sample for the measurement of PCT, two sets of blood cultures, and other cultures of relevant specimens from infection sites were collected in the ED. Two independent experts blinded to the PCT results classified the patients into bacterial infection and nonbacterial infection groups. RESULTS: Of the 262 patients with SIRS enrolled, 204 were classified as having bacterial infection and 48 as having bacteremia. PCT levels were significantly higher in patients with bacteremia than in those without. The area under the receiver operating characteristic curve for identification of bacteremia according to PCT was 0.817 for the old-old group (≥75), significantly higher than 0.639 for the young-old group (65-74); P=.02). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of PCT for bacteremia in patients aged 75 and older were 96.0%, 68.3%, 33.8%, and 98.8%, respectively, with a PCT cutoff value of 0.38 ng/mL. CONCLUSION: PCT is sensitive for diagnosing bacteremia in elderly patients with SIRS at ED admission but is helpful in excluding bacteremia only in those aged 75 and older. PCT is not an independent predictor of local infections in these patients.

Original languageEnglish
Pages (from-to)518-522
Number of pages5
JournalJournal of the American Geriatrics Society
Volume58
Issue number3
DOIs
Publication statusPublished - Mar 1 2010
Externally publishedYes

Fingerprint

Calcitonin
Bacterial Infections
Hospital Emergency Service
Bacteremia
Systemic Inflammatory Response Syndrome
Infection
Tertiary Healthcare
Tertiary Care Centers
ROC Curve
Sensitivity and Specificity
Serum

Keywords

  • Bacteremia
  • Bacterial infection
  • Elderly
  • Procalcitonin
  • Systemic inflammatory response syndrome

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Diagnostic value of procalcitonin for bacterial infection in elderly patients in the emergency department. / Lai, Chih Cheng; Chen, Shey Ying; Wang, Cheng Yi; Wang, Jen Yu; Su, Chan Ping; Liao, Chun Hsing; Tan, Che Kim; Huang, Yu Tsung; Lin, Hen I.; Hsueh, Po Ren.

In: Journal of the American Geriatrics Society, Vol. 58, No. 3, 01.03.2010, p. 518-522.

Research output: Contribution to journalArticle

Lai, Chih Cheng ; Chen, Shey Ying ; Wang, Cheng Yi ; Wang, Jen Yu ; Su, Chan Ping ; Liao, Chun Hsing ; Tan, Che Kim ; Huang, Yu Tsung ; Lin, Hen I. ; Hsueh, Po Ren. / Diagnostic value of procalcitonin for bacterial infection in elderly patients in the emergency department. In: Journal of the American Geriatrics Society. 2010 ; Vol. 58, No. 3. pp. 518-522.
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abstract = "OBJECTIVES: To evaluate the diagnostic performance of procalcitonin (PCT) in elderly patients with bacterial infection in the emergency department (ED). DESIGN: Prospective. SETTING: ED of a tertiary care hospital. PARTICIPANTS: Elderly patients with systemic inflammatory response syndrome (SIRS) enrolled from September 2004 through August 2005. MEASUREMENTS: A serum sample for the measurement of PCT, two sets of blood cultures, and other cultures of relevant specimens from infection sites were collected in the ED. Two independent experts blinded to the PCT results classified the patients into bacterial infection and nonbacterial infection groups. RESULTS: Of the 262 patients with SIRS enrolled, 204 were classified as having bacterial infection and 48 as having bacteremia. PCT levels were significantly higher in patients with bacteremia than in those without. The area under the receiver operating characteristic curve for identification of bacteremia according to PCT was 0.817 for the old-old group (≥75), significantly higher than 0.639 for the young-old group (65-74); P=.02). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of PCT for bacteremia in patients aged 75 and older were 96.0{\%}, 68.3{\%}, 33.8{\%}, and 98.8{\%}, respectively, with a PCT cutoff value of 0.38 ng/mL. CONCLUSION: PCT is sensitive for diagnosing bacteremia in elderly patients with SIRS at ED admission but is helpful in excluding bacteremia only in those aged 75 and older. PCT is not an independent predictor of local infections in these patients.",
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AU - Lai, Chih Cheng

AU - Chen, Shey Ying

AU - Wang, Cheng Yi

AU - Wang, Jen Yu

AU - Su, Chan Ping

AU - Liao, Chun Hsing

AU - Tan, Che Kim

AU - Huang, Yu Tsung

AU - Lin, Hen I.

AU - Hsueh, Po Ren

PY - 2010/3/1

Y1 - 2010/3/1

N2 - OBJECTIVES: To evaluate the diagnostic performance of procalcitonin (PCT) in elderly patients with bacterial infection in the emergency department (ED). DESIGN: Prospective. SETTING: ED of a tertiary care hospital. PARTICIPANTS: Elderly patients with systemic inflammatory response syndrome (SIRS) enrolled from September 2004 through August 2005. MEASUREMENTS: A serum sample for the measurement of PCT, two sets of blood cultures, and other cultures of relevant specimens from infection sites were collected in the ED. Two independent experts blinded to the PCT results classified the patients into bacterial infection and nonbacterial infection groups. RESULTS: Of the 262 patients with SIRS enrolled, 204 were classified as having bacterial infection and 48 as having bacteremia. PCT levels were significantly higher in patients with bacteremia than in those without. The area under the receiver operating characteristic curve for identification of bacteremia according to PCT was 0.817 for the old-old group (≥75), significantly higher than 0.639 for the young-old group (65-74); P=.02). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of PCT for bacteremia in patients aged 75 and older were 96.0%, 68.3%, 33.8%, and 98.8%, respectively, with a PCT cutoff value of 0.38 ng/mL. CONCLUSION: PCT is sensitive for diagnosing bacteremia in elderly patients with SIRS at ED admission but is helpful in excluding bacteremia only in those aged 75 and older. PCT is not an independent predictor of local infections in these patients.

AB - OBJECTIVES: To evaluate the diagnostic performance of procalcitonin (PCT) in elderly patients with bacterial infection in the emergency department (ED). DESIGN: Prospective. SETTING: ED of a tertiary care hospital. PARTICIPANTS: Elderly patients with systemic inflammatory response syndrome (SIRS) enrolled from September 2004 through August 2005. MEASUREMENTS: A serum sample for the measurement of PCT, two sets of blood cultures, and other cultures of relevant specimens from infection sites were collected in the ED. Two independent experts blinded to the PCT results classified the patients into bacterial infection and nonbacterial infection groups. RESULTS: Of the 262 patients with SIRS enrolled, 204 were classified as having bacterial infection and 48 as having bacteremia. PCT levels were significantly higher in patients with bacteremia than in those without. The area under the receiver operating characteristic curve for identification of bacteremia according to PCT was 0.817 for the old-old group (≥75), significantly higher than 0.639 for the young-old group (65-74); P=.02). The diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of PCT for bacteremia in patients aged 75 and older were 96.0%, 68.3%, 33.8%, and 98.8%, respectively, with a PCT cutoff value of 0.38 ng/mL. CONCLUSION: PCT is sensitive for diagnosing bacteremia in elderly patients with SIRS at ED admission but is helpful in excluding bacteremia only in those aged 75 and older. PCT is not an independent predictor of local infections in these patients.

KW - Bacteremia

KW - Bacterial infection

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KW - Procalcitonin

KW - Systemic inflammatory response syndrome

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