Adult Procalcitonin (PCT) Educational Guidance

Criteria & Principles

In-house procalcitonin is now available to order at DUHS

What is procalcitonin?

• PCT is a 116 amino acid precursor of calcitonin and normally produced by the thyroid C-cells
• Under normal circumstances, serum concentrations of PCT are undetectable (< 0.05 mcg/mL)
• However, PCT may be produced in large quantities by extra-thyroid tissues (liver, pancreas, kidney, lung, intestine, etc.) & leukocytes in response to bacterial infection

Role for PCT in Adults at DUHS

1. Initiating or discontinuing antibiotics in suspected bacterial lower respiratory tract infections
2. Discontinuing antibiotics in patients with sepsis syndrome

LRTI Initial Antibiotic Use & PCT Assessment

LRTI PCT Follow-up & Assessment

Sepsis PCT Assessment & Evaluation

Diagnosis-Specific Information

PCT orderable

Laboratory turnaround time

• STAT: within 60 minutes from receipt of specimen in lab
• ROUTINE: within 4 hours from receipt of specimen in lab 

PCT Limitations

• As with any test, PCT has limitations for use
• Various disease states/drugs may cause elevated PCT in the absence of bacterial infection
• Interpret with caution. PCT use should be an adjunct to clinical decision

 

References

1. VIDAS® B·R·A·H·M·S PCT™ Package Insert. February 2017.
2. Christ-Crain and Muller. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007;30:556-73.
3. Kibe S, et al. Diagnostic and prognostic biomarkers of sepsis in critical care. J Antimicrob Chemother 2011;66(S2):33-40.
4. Schuetz P, et al. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Medicine 2011;9:107.
5. Grace E, Turner RM. Use of Procalcitonin in Patients With Various Degrees of Chronic Kidney Disease Including Renal Replacement Therapy. Clin Infect Dis 2014;59:1761-7.
6. Laifer G, Wasner M, Sendi P, et al. Dynamics of serum procalcitonin in patients after major neurosurgery. Clin Microbiol Infect 2005;11(8):679-681.
7. Bouaicha S, Blatter S, Moor BK, et al. Early Serum Procalcitonin Level after Primary Total Hip Replacement. Mediators of Inflammation 2013; 1-4.
8. Maier M, Wutzler S, Lehnert M, et al. Serum procalcitonin levels in patients with multiple injuries including visceral trauma. J Trauma 2009; 66(1):243-9.
9. Pihusch M, Pihusch R, Fraunberger P, et al. Evaluation of C-reactive protein, interleukin-6, and procalcitonin levels in allogeneic hematopoietic stem cell recipients. Eur J Haematol 2006;76:93-101.
10. Geppert A, Steiner A, Delle-Karth G, Heinz G, Huber K. Usefulness of procalcitonin for diagnosing complicating sepsis in patients with cardiogenic shock. Intensive Care Med 2003;29(8):1384-9.
11. Smith SE, Muir J, Kalabalik-Hoganson J. Procalcitonin in special patient populations: Guidance for antimicrobial therapy. Am J Health Syst Pharm 2020;77(10):745-758.
12. Saeed K, Gonzalez del Castillo J, Backous C, et al. Hot topics on procalcitonin use in clinical practice, can it help antibiotic stewardship? Int J Antimicrob Agents 2019;54(6):686-696.
13. Masia M, Gutierrez F, Padilla S, et al. Clinical characterisation of pneumonia caused by atypical pathogens combining classic and novel predictors. Clin Microbiol Infect 2017;13:153-161.
14. Schuetz P, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections. JAMA 2009;302:1059-66.
15. Huang DT et al. Procalcitonin-guided use of antibiotics for lower respiratory tract infections. N Engl J Med 2018 Jul 19;379(3):236-249.
16. Schuetz P et al. Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis. Lancet Infect Dis 2018;18:95-107.
17. Iankova I et al. Efficacy and Safety of Procalcitonin Guidance in Patients With Suspected or Confirmed Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med 2018; 46:691–698.
18. Lam SW et al. Systematic Review and Meta-Analysis of Procalcitonin-Guidance Versus Usual Care for Antimicrobial Management in Critically Ill Patients: Focus on Subgroups Based on Antibiotic Initiation, Cessation, or Mixed Strategies. Crit Care Med 2018; 46:684–690.
19. Fabre V, et al. The role of procalcitonin results in antibiotic decision-making in coronavirus diseases 2019 (COVID-19). Infect Control Hosp Epidemiol 2021;1-6.