The Diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in preterm premature rupture of the membranes with respect of highvaginal swab as gold standard

Objective: To determine the diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in Preterm premature rupture of the membranes (PPROM) with respect of high vaginal swab as gold standard Methods: A cross-sectional study was conducted at Liaquat National Hospital, Karachi, from February to August 2017. The blood sample of women with PPROM were collected to measure procalcitonin level. PCT1 and PCT2 were run along with the sample for the accuracy of the results. Sensitivity, specificity, PPV, NPV, and diagnostic accuracy of procalcitonin were calculated taking HVS C/S as gold standard. Results: Out of total 150 women, mean age was 28.78±4.79 years. Mean gestational age was 30.79±3.07 weeks. Mean procalcitonin level was 0.13±0.24 ng/ml. Intra-amniotic infection was diagnosed in 48.7% cases through procalcitonin levels and 51.3% through HVS culture and sensitivity. Sensitivity, Specificity, PPV (Positive predictive value), NPV (Negative predictive value) and accuracy were 87%, 91.8%, 91.78%, 87%, and 89.3% respectively. For females with gestational age ≤32 weeks, sensitivity, specificity, and diagnostic accuracy were 83.9%, 90.4%, and 87.03% respectively. For females with gestational age >32 weeks, sensitivity, specificity, and diagnostic accuracy were 95.2%, 92.5%, and 95.23% respectively. Conclusion: Diagnostic accuracy of maternal blood procalcitonin levels were found satisfactory in detection of early intra-amniotic infection in PPROM. doi: https://doi.org/10.12669/pjms.38.1.4436 How to cite this:Farooqui R, Siddiqui QA. Diagnostic accuracy of procalcitonin in maternal plasma to detect early intra-amniotic infection in preterm premature rupture of the membranes with respect of high vaginal swab as gold standard. Pak J Med Sci. 2022;38(1):---------. doi: https://doi.org/10.12669/pjms.38.1.4436 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

325. Empiric Antibiotics for COVID-19 and the Utility of Procalcitonin

Background Bacterial coinfection in COVID-19 is infrequent, yet empiric antibiotic use is common. The objectives of this study were to investigate the effect of empiric antibiotics on time to resolution of COVID-19 pneumonia, elucidate the impact of COVID-19 on procalcitonin levels, and determine the incidence of respiratory bacterial coinfection. Methods This was a retrospective study of adult patients hospitalized with COVID-19 between June 1, 2020 and September 30, 2020. Patients were included if they had at least one procalcitonin level. They were excluded if admitted to an intensive care unit within 24 hours of presentation or received antibiotics for an indication besides pneumonia. Patients were stratified into 4 groups based on procalcitonin level and receipt of antibiotics. The primary outcome was time to clinical resolution of pneumonia. A key secondary outcome was incidence of confirmed respiratory bacterial coinfection. Results A total of 199 patients were included. Patients with a procalcitonin greater than 0.25 ng/mL who received antibiotics had a longer median time to clinical resolution of pneumonia, 8 days (95% CI, 4 to 11 days) vs. 3 or 4 days in other groups (P< 0.001). Additionally, this same group required greater baseline oxygen supplementation, had more comorbidities, and increased mortality compared to all other groups. Median time to clinical resolution of pneumonia was also longer in patients who received antibiotics compared to those who did not (5 vs. 4 days, P=0.017) and in those with a procalcitonin greater than 0.25 ng/mL compared to those with PCT less than or equal to 0.25 ng/mL (7 vs. 4 days, P< 0.001). Renal dysfunction was more prevalent in patients with an elevated procalcitonin (45% vs. 17.5%). The overall incidence of confirmed respiratory bacterial coinfection was 1.5%. Conclusion Irrespective of procalcitonin level, empiric antibiotics were not associated with a shorter time to resolution of COVID-19 pneumonia in non-critically ill patients. Elevated procalcitonin is likely a reflection of the severity of COVID-19 disease and baseline renal function rather than bacterial infection. Additionally, the overall incidence of confirmed bacterial coinfection in non-critically ill patients hospitalized with COVID-19 was low. Disclosures Kiya D. Mohadjer, PharmD, BCPS, BCIDP, Eli Lilly and Company (Shareholder)Gilead Sciences (Shareholder)

Serum procalcitonin as a biomarker of sepsis

Background: The overlap of clinical presentation between sepsis and SIRS has presented diagnostic difficulty in these two close common scenarios. Blood culture remains the gold standard for detection of specific micro-organism, the non-availability of culture report early and difficulty in culture of many organisms is a challenge in differentiation of sepsis from its mimickers. Keeping this background, a simple tool is needed to guide sepsis management while awaiting the culture report. Therefore, the present study is conducted to determine the procalcitonin level in the setting suspicious of sepsis and to differentiate it from SIRS. The objective of the study was to determine Serum procalcitonin level as a biomarker of early diagnosis of sepsis and also to differentiate sepsis from severe inflammatory response syndrome.Methods: Cross sectional study on 79 patients aged above 18 years with suspected sepsis admitted in medicine ward. Serum procalcitonin levels were measured and analysed to look for any association with sepsis.Results: Culture was positive in 41 patients and 38 patients were procalcitonin positive. The sensitivity, specificity, positive predictive value and negative predictive values of serum procalcitonin were found as 96.68%, 94.74%, 95% and 92.30% respectively.Conclusions: There was a significant association between serum procalcitonin and culture positivity. Procalcitonin levels was found to have high sensitivity and high positive predictive value which may aid in the early diagnosis and guide initiation of anti-microbial therapy in sepsis.

Sputum procalcitonin – a potential biomarker in stable bronchiectasis

Introduction/AimSputum procalcitonin has been demonstrated to be elevated in exacerbations of bronchiectasis. The primary aim was to investigate whether sputum procalcitonin levels were higher in patients with stable bronchiectasis compared with healthy-controls. We also assessed differences in procalcitonin levels in spontaneously expectorated and induced sputum samples and their repeatability one week later.MethodsParticipants included were aged over 18 years and had either radiologically confirmed bronchiectasis or were healthy-controls. Patients with bronchiectasis were clinically stable for at least six weeks and had both spontaneous and induced sputum collected at visit one and again, seven days later. Only induced sputum samples were collected from healthy-controls during visit one. Sputum procalcitonin concentrations in sputum were measured.ResultsThirty patients with bronchiectasis and 15 healthy-controls were enrolled in this observational study. In the pooled data from visit 1 and 2, the geometric mean procalcitonin level in induced sputum was significantly higher in the bronchiectasis group than in the healthy-control group (1.5 ng·mL−1 [95%CI 1.0–2.1] versus 0.4 ng·mL−1 [95%CI 0.2–0.9], mean ratio: 3.6 [95% CI 1.5–8.6], p=0.006). Mean procalcitonin level was higher in spontaneous sputum than in induced sputum at visit 1 (1.8 ng·mL−1 [95%CI 1.2–2.7] versus 1.1 ng·mL−1 [95%CI 0.7–1.8]) and visit 2 (1.5 ng·mL−1 [95%CI 1.0–2.5] versus 1.2 ng·mL−1 [95%CI 0.8–1.6], p-value=0.001). Repeating spontaneous and induced sputum procalcitonin levels one week later produced similar concentrations (p-value=0.29; intraclass correlation co-efficient (ICC)=0.76 and p-value=0.72; ICC=0.70 respectively).ConclusionSputum procalcitonin is increased in patients with stable bronchiectasis and has potential as a biomarker of airway inflammation and infection in bronchiectasis.

Procalcitonin Level Can be a Useful Indicator of When Antibiotics Should be Stepped up in Children with Cancer and Fever without Source

Objective: To assess whether procalcitonin (PCT) levels can be a reliable indicator of when it is unnecessary to step up antibiotics in children with cancer and fever without source (FWS). Material and Methods: The medical records of children with hematologic-oncologic malignancies aged 3 months-15 years who had FWS ≥4 days and were admitted to Songklanagarind Hospital from December 2016 to February 2019 were reviewed. Results: FWS was identified in 89 patients. PCT levels were tested in 43 patients; 21 and 22 patients had low PCT (PCT <0.5 nanograms per milliliter (ng/mL)) and high PCT (PCT ≥0.5 ng/mL) levels, respectively. The baseline characteristics of the patients including age, sex, risk of serious bacterial infection, and duration of antibiotic(s) among the 3 groups (low-PCT, high-PCT and PCT-not-tested) were not significantly different. The proportions of patients who had had their antibiotics stepped up after 4 days with conventional treatment were 65.0%, 90.9%, and 95.7% and who were stepped up to carbapenem were 38.1%, 68.2%, and 73.9% in the low-PCT, high-PCT, and PCT-not-tested groups, respectively, significantly lowest in the low-PCT group. High PCT levels were associated with sepsis with sensitivity, specificity, positive predictive value, and negative predictive value of 87.5%, 57.1%, 31.8%, and 95.2%, respectively. Conclusion: We suggest that cancer children who have FWS without sepsis and low PCT levels do not need to have their antibiotics stepped up; however, as the sample size of this study was quite small, further studies are needed to confirm our findings and conclusion.