ArticlePeerJ2017
Diagnostic value of serum procalcitonin, lactate, and high-sensitivity C-reactive protein for predicting bacteremia in adult patients in the emergency department.
Article in PeerJ, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 46 citations in OpenAlex.
- Accuracy of procalcitonin for diagnosing sepsis in adult patients admitted to the emergency department: a systematic review and meta-analysis.Systematic reviews · 2024Pooled it
- Effect of preoperative prophylactic antibiotic use on postoperative infection after percutaneous nephrolithotomy in patients with negative urine culture: a single-center randomized controlled trial.World journal of urology · 2023Trial
- Intuitive Risk Equation for Post-Transplant Bloodstream Infection Prediction: A Symbolic Regression Approach.Biomedicines · 2026Article
- Early Peri-Admission Lactate-to-Albumin (LAR), C-Reactive Protein-to-Albumin (CAR), and Procalcitonin-to-Albumin (PAR) Ratios and ICU Mortality in a Tertiary Cardiac ICU.Journal of clinical medicine · 2026Article
- Sepsis Biomarkers: Advancements and Clinical Applications-A Narrative Review.International journal of molecular sciences · 2024Review
- Clinical evaluation of droplet digital PCR in the early identification of suspected sepsis patients in the emergency department: a prospective observational study.Frontiers in cellular and infection microbiology · 2024Observational
- The Value of Peripheral Blood Leukocyte Parameters in the Early Diagnosis and Clinical Prognosis of Sepsis.International journal of analytical chemistry · 2023Article
- Routine laboratory biomarkers used to predict Gram-positive or Gram-negative bacteria involved in bloodstream infections.Scientific reports · 2022Article
- Machine Learning Approach to Predicting Absence of Serious Bacterial Infection at PICU Admission.Hospital pediatrics · 2022Article
- Combination of Prehospital NT-proBNP with qSOFA and NEWS to Predict Sepsis and Sepsis-Related Mortality.Disease markers · 2022Article
- Diagnostic Value and Prognostic Significance of Procalcitonin Combined with C-Reactive Protein in Patients with Bacterial Bloodstream Infection.Computational and mathematical methods in medicine · 2022Article
- Early prediction of blood stream infection in a prospectively collected cohort.BMC infectious diseases · 2021Article
- Clinical Outcome Predictive Value of Procalcitonin in Patients Suspected with Infection in the Emergency Department.Emergency medicine international · 2021Article
- The Development and Validation of a Machine Learning Model to Predict Bacteremia and Fungemia in Hospitalized Patients Using Electronic Health Record Data.Critical care medicine · 2020Article
- Blood cultures of adult patients discharged from the emergency department-is the safety net reliable?European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2020Article
- Procalcitonin: A promising tool or just another overhyped test?International journal of medical sciences · 2020Review
- Using local clinical and microbiological data to develop an institution specific carbapenem-sparing strategy in sepsis: a nested case-control study.Antimicrobial resistance and infection control · 2019Article
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Corrections and comments
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Authors and funding
5 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundFew studies compared the diagnostic value of procalcitonin with a combination of other tests including lactate and high-sensitivity C-reactive protein in the prediction of pathogenic bacteremia in emergency department adult patients.
methodsWe performed a retrospective study assessing the differences in performances of procalcitonin at a cutoff of 0.5 ng/mL, lactate at a cutoff of 19.8 mg/dL, high-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL and their combinations for predicting bacteremia in emergency department adult patients. Sensitivity, specificity, overall accuracy, positive-test and negative-test likelihood, and diagnostic odds ratio with 95% confidence interval for each test combination were calculated for comparison. The receiver operating characteristic curve for every single test were compared using DeLong's method. We also performed a sensitivity analysis in two expanded patient cohorts to assess the discriminative ability of procalcitonin or test combination.
resultsA total of 886 patients formed the initial patient cohort. The area under the receiver operating characteristic curve for discriminating positive blood culture was: procalcitonin = 0.72 (95% CI [0.69-0.75]) with a derived optimal cutoff at 3.9 ng/mL; lactate 0.69 (0.66-0.72) with an optimal cutoff at 17.9 mg/dL; high-sensitivity C-reactive protein 0.56 (0.53-0.59) with an optimal cutoff of 13 mg/dL; with pairwise comparisons showing statistically significant better performance of either procalcitonin or lactate outperforming high-sensitivity C-reactive protein. To predict positive blood cultures, the diagnostic odds ratio for procalcitonin was 3.64 (95% CI [2.46-5.51]), lactate 2.93 (2.09-4.14), and high-sensitivity C-reactive protein 0.91 (0.55-1.55; DISCUSSIONS: For adult emergency patients, procalcitonin has an acceptable discriminative ability for bacterial blood culture and a better discriminative ability for gram-negative bacteremia when compared with lactate and high-sensitivity C-reactive protein. High-sensitivity C-reactive protein at a cutoff of 0.8 mg/dL performed poorly for the prediction of positive bacterial culture.
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