Published: 2016-12-29

Utility of procalcitonin as a diagnostic biomarker for bacterial infections and its comparison with C reactive protein and total leucocyte count

Mala V. Kaneria, Kunal K. Jakharia


Background: Distinguishing bacterial fever from other fevers is important for early treatment and the judicious use of antibiotics. This study aimed to evaluate the levels of procalcitonin (PCT) in febrile adults and compare it with C reactive protein (CRP) and total leukocyte count (TLC).

Methods: 70 patients were classified clinically according to severity of infection into mild (Group A 30), moderate (Group B 23) and severe (Group C 17). 30 healthy controls were taken (Group D). After a detailed clinical history, their blood collected aseptically was sent for complete hemogram, culture, biochemistry, PCT and CRP. PCT was measured by immunochromatographic method (Result Range: <0.5, 2, >2, >10ng/ml). CRP was measured by immunoturbidometry. Chisquare, ANOVA, Pearson’s Correlation were used.

Results: PCT was significantly elevated with higher degrees of infection (p value < 0.001). Sensitivity and specificity of PCT in Group 2 and 3 were both 100%. Group 1 had no rise in PCT proving that it is neither specific nor sensitive for mild infection. Mean CRP was significantly increased (p value <0.001) with severity of infection; sensitivity and specificity being 97.14% and 80%. TLC increased significantly (p value <0.001) with the severity of infection. However, it did not rise above the cut off, for mild infection.

Conclusions: PCT was highly sensitive and specific for moderate to severe infection and also determined prognosis. It could not identify mild local infection. CRP was sensitive for any grade of infection but not specific for bacterial fever. TLC was specific for moderate to severe infection though less sensitive.



Procalcitonin, C reactive protein, Total leucocyte count, Sepsis biomarker

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Nargis W, Ibrahim Md, Ahamed BU. Procalcitonin versus C-reactive protein: Usefulness as biomarker of sepsis in ICU patient. Int J Crit Illn Inj Sci. 2014;4(3):195-9.

Mitaka C. Clinical laboratory differentiation of infectious versus noninfectious systemic inflammatory response syndrome. Clin Chim Acta. 2005;351:17-29.

Ghorbani G. Procalcitonin Role in Differential Diagnosis of Infection Stages and Non Infection Inflammation. Pakistan Journal of Biological Sciences. 2009;12:393-6.

Assisot M, Gendrel D, Carsin H. High serum procalcitonin concentration in patients with sepsis and infection. Lancet. 1993;341:515-18.

Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375(9713):463-74.

Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care .J Antimicrob Chemother. 2011;66 Suppl 2:ii:33-40.

Reinhart K, Bauer M, Riedemann NC. New Approaches to Sepsis: Molecular Diagnostics and BiomarkersClin Microbiol Rev. 2012;25(4):609-34.

Kibe S, Adams K, Barlow G. Diagnostic and prognostic biomarkers of sepsis in critical care. J. Antimicrob. Chemother. 2011;66(suppl 2):ii33-40.

Galetto-Lacour A, Zamora SA, Gervaix A. Bedside procalcitonin and C-reactive protein tests in children with fever without localizing signs of infection seen in a referral centre. Pediatrics. 2003;112:1054-60.

Gramm HJ, Dollinger P, Beier W, 1995. Procalcitonin –ein neuer Marker der inflammatorischen Wirtsantwort. Longitudinal studien bei Patienten mit Sepsis und Peritonitis. Chir Gastroenterol. 1995;11(suppl 2):51-4.

Hergert M, Lestin HG. Procalcitonin with patients in sepsis and polytrauma. Clin Lab. 1998;44:659-70.

Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem. 2001;38:483-93.

Uzzan B, Cohen R, Nicolas P, Cucherat M, Perret GY. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 2006;34:1996-2003.

Tang BM, Eslick GD, Craig JC, McLean AS. Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis. 2007;7:210-7.

Rau BM, Kemppainen EA, Gumbs AA, Büchler MW, Wegscheider K, Bassi C, et al. Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT): a prospective international multicentre study. AnnSurg. 2007;245:74554.

Qu J, Lü X, Liu Y, Wang X. Evaluation of procalcitonin, C-reactive protein, interleukin-6 and serum amyloid A as diagnostic biomarkers of bacterial infection in febrile patients. Indian J Med Res. 2015;141(3):315-21.

Hatherill M, Tibby SM, Sykes K, Turner C, Murdoch IA. Diagnostic markers of infection: comparison of procalcitonin with C reactive protein and leucocyte count.Arch Dis Child. 1999;81(5):417-21.

Opatrná S, Klaboch J, Opatrný K Jr, Holubec L, Tomsů M, Sefrna F, et al. Procalcitonin levels in peritoneal dialysis patients. Perit Dial Int. 2005;25:470-2.

Shehabi Y, Seppelt I. Pro/con debate: is procalcitonin useful for guiding antibiotic decision making in critically ill patients? Crit Care. 2008;12:211-6.