Predictive Accuracy of Procalcitonin in Diagnosing Bacteraemia in Adult Patients in a Tertiary Hospital in Madurai, India

Abstract

BACKGROUND Bacteraemia is the presence of bacteria in the bloodstream that are alive and capable of reproducing. The incidence of bloodstream infections (BSI) either of the community-acquired origin or of hospital-acquired origin has dramatically increased. Identifying patients with high risk of bacteraemia in emergency department (ED) using predictive models is needed. The present study was conducted to evaluate the efficacy of procalcitonin as well as other biomarkers as diagnostic, predictive markers of bacteraemia in an adult patient population in India. METHODS A descriptive observational study was conducted at the ED of a tertiary care hospital in India. Fifteen years or older patients who were ready to give at least two samples of blood for blood culture were recruited. Data on demographic variables, predisposing conditions, clinical presentations, laboratory tests, and presumptive diagnosis was analysed using SPSS and P value of 0.05 was considered statistically significant. A logistic model was built using an iterative procedure which was later simplified into a coefficient-based scoring system. RESULTS Out of 78 patients, (66.67 %) from the emergency department and (33.33 %) from out-patient department (OPD) were enrolled. Among the study population, 40 (51.28 %) were with bacteraemia, and the remaining 38 (48.72 %) had no bacteraemia. There was no statistically significant difference in levels of procalcitonin, pulse rate, respiratory rate, systolic blood pressure, diastolic blood pressure, SPO2, total count, MCV, RDW, MPV, albumin, urea, creatinine between bacteraemia and no bacteraemia. (P value > 0.05). The mean procalcitonin was 33.02 ± 43.46. CONCLUSIONS Although, increased PCT levels can be useful as predictors of bacteremias in the emergency department, interpretation should be made carefully when deciding the prescription of antibiotics. KEYWORDS Procalcitonin, Bacteraemia, PCT levels