Procalcitonin

Bacterial/ Viral

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No Fasting Required

Details

Procalcitonin is a peptide precursor of the hormone calcitonin, normally produced in the thyroid

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Procalcitonin Test Information Guide

Why is it done?
- Test Purpose: Procalcitonin (PCT) is a biomarker used to detect and differentiate bacterial infections from viral infections or non-infectious causes of inflammation. It is a precursor of calcitonin produced by the body in response to bacterial endotoxins and inflammatory cytokines.
- Primary Indications: Diagnosing bacterial infections including sepsis, severe bacterial infections, and acute bacterial meningitis; Differentiating bacterial from viral respiratory tract infections; Assessing severity of infection and risk of complications; Guiding antibiotic therapy decisions and stewardship
- Typical Circumstances: Performed in emergency departments and intensive care units (ICUs) for critically ill patients; Used in hospital settings for patients with suspected sepsis or severe infections; Ordered for immunocompromised patients with fever; Monitored serially during hospitalization to track infection course and treatment response
Normal Range
- Reference Values: Normal/Healthy Adults: <0.05 ng/mL (or <50 pg/mL) Borderline: 0.05-0.5 ng/mL Elevated: >0.5 ng/mL
- Units of Measurement: Nanograms per milliliter (ng/mL) or picograms per milliliter (pg/mL)
- Clinical Interpretation: Normal (Negative): <0.05 ng/mL indicates low probability of bacterial infection or sepsis; typically seen in healthy individuals or those with viral infections Borderline (Low Probability): 0.05-0.5 ng/mL suggests possible early infection or non-specific inflammation; may require clinical correlation Elevated (High Probability): >0.5 ng/mL indicates probable bacterial infection; >2.0 ng/mL suggests significant risk of sepsis or severe infection
- What Normal vs Abnormal Means: Normal results make bacterial infection or sepsis unlikely; Abnormal results suggest bacterial infection is present and warrants antibiotic therapy; Serial measurements showing decreasing values indicate good treatment response
Interpretation
- Low Values (<0.05 ng/mL): Indicates absence of significant bacterial infection; Supports viral etiology of symptoms; Suggests low risk of sepsis; May support discontinuation of antibiotics in appropriate clinical context
- Intermediate Values (0.05-0.5 ng/mL): Indicates gray zone requiring clinical judgment; May represent early bacterial infection, localized infection, or significant viral infection; Requires correlation with clinical presentation and other biomarkers; Serial measurements helpful in determining clinical significance
- Elevated Values (0.5-2.0 ng/mL): Indicates probable bacterial infection; Supports initiation or continuation of antibiotic therapy; Suggests moderate risk of systemic infection; Warrants close clinical monitoring and follow-up testing
- High Values (>2.0 ng/mL): Strongly indicates sepsis or severe bacterial infection; Associated with high mortality risk; Requires aggressive antimicrobial therapy and ICU-level care; Indicates need for source control measures; Serial monitoring essential for assessing treatment response
- Factors Affecting Readings: Recent surgery or major trauma may elevate PCT; Severe viral infections can cause modest elevations; Certain malignancies (medullary thyroid carcinoma, small cell lung cancer) may elevate baseline PCT; Autoimmune diseases may show borderline elevations; Time of sample collection relative to symptom onset affects results; Peak levels typically occur 24-48 hours after infection onset
- Clinical Significance of Result Patterns: Rising trend: Suggests worsening infection or inadequate treatment response; Declining trend: Indicates good treatment response and improving clinical condition; Persistently elevated: May indicate ongoing infection, inadequate source control, or development of resistant organism; Serial measurements more valuable than single values for monitoring
Associated Organs
- Primary Organ Systems Involved: Immune system: PCT production is triggered by endotoxins and inflammatory cytokines (TNF-α, IL-6); Neuroendocrine system: Released from thyroid C-cells and other neuroendocrine cells; Circulatory system: Reflects systemic inflammatory response and endothelial dysfunction; Affected organ systems depend on infection site and severity
- Common Infections Associated with Elevation: Sepsis and septic shock; Pneumonia (community-acquired, hospital-acquired, ventilator-associated); Acute bacterial meningitis; Endocarditis; Urinary tract infections with bacteremia; Intra-abdominal infections (appendicitis, peritonitis, pancreatitis); Wound infections and post-surgical infections; Catheter-related bloodstream infections
- Diseases Helped by This Test: Sepsis diagnosis and risk stratification; Acute bacterial meningitis; Bacterial endocarditis; Severe acute respiratory infections; Intra-abdominal infections; Diabetic complications with infection; Immunocompromised patient infections; Post-operative infections; Chronic obstructive pulmonary disease (COPD) exacerbations with bacterial component
- Complications Associated with Abnormal Results: Septic shock with multi-organ failure; Acute respiratory distress syndrome (ARDS); Disseminated intravascular coagulation (DIC); Acute kidney injury; Hepatic dysfunction; Myocardial depression; Hypotension requiring vasopressor support; Death if untreated or inadequately managed
Follow-up Tests
- Additional Tests Based on Results: Blood cultures: To identify specific bacterial organism and guide antibiotic selection; Complete Blood Count (CBC): Assess white blood cell count and left shift indicating bacterial infection; Lactate level: Marker of tissue hypoperfusion and sepsis severity; C-reactive protein (CRP): Additional inflammatory marker for monitoring; Liver and kidney function tests: Assess organ involvement and sepsis severity; Coagulation studies (PT/INR, PTT): Screen for DIC in severe infections
- Further Investigations: Imaging studies (chest X-ray, CT abdomen/pelvis, ultrasound): Identify source of infection; Lumbar puncture and cerebrospinal fluid analysis: If meningitis suspected; Echocardiography: If endocarditis suspected; Urinalysis and urine culture: If urinary source suspected; Wound cultures: If localized infection present
- Monitoring Frequency: Critically ill patients: Repeat PCT at 12-24 hour intervals; Daily monitoring in ICU settings; Serial measurements every 24-48 hours after initial diagnosis; Continued monitoring until clinical improvement and normalization of values; May reduce frequency once clinically stable and antibiotic course established
- Related Complementary Tests: SOFA (Sequential Organ Failure Assessment) score: Calculates sepsis severity; qSOFA score: Rapid bedside assessment of sepsis risk; Presepsin: Another bacterial infection biomarker; Serum amyloid A (SAA): Additional acute phase reactant; Cytokine measurements (IL-6, TNF-α): Research settings; Endotoxin levels: Direct measurement of bacterial endotoxin
Fasting Required?
- Fasting Status: No - Fasting is NOT required for procalcitonin testing
- Special Instructions: No fasting period required; Patient can eat and drink normally before the test; Food intake does not affect PCT results; Hydration status does not significantly affect test accuracy; Test can be performed at any time of day
- Medications to Avoid: No medications need to be held before the test; Antibiotics should not be stopped prior to testing; Current medications do not interfere with PCT results; Continue all regular medications as prescribed
- Patient Preparation Requirements: No special preparation needed; Patient should notify phlebotomist of any recent procedures or surgeries (within 48 hours) for result interpretation; Inform healthcare provider of any recent hospitalizations or immunosuppressive conditions; Sample collection is typically via standard peripheral venipuncture; Test can be performed regardless of clinical status (sitting, lying down, ambulatory)

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