CICM SAQ 2010.1 Q23

Question

Critically evaluate the role of Procalcitonin (PCT) as a biomarker in the diagnosis and management of sepsis.

Answer

Answer and interpretation

Diagnosis

  • PCT is synthesized physiologically by thyroid C cells but in sepsis has extrathyroidal origin from the inflamed/infected tissue
  • The biochemical and clinical profile well described
  • It is easy to perform (Blood test), not too expensive and provides a quick answer in about 30 minutes. Blood cultures can take up to 24 hours.
  • PCT is no gold standard for infection. There number of reports of PCT elevation in non-septic SIRS, immediately after surgery and trauma.
  • Data from meta-analyisis are conflicting, some suggesting it is superior to CRP, whilst others have concluded it is a weak biomarker in critical illness.
  • PCT is not elevated in viral infection, autoimmune disorders and immunocompromised patients – hence empiric therapy still the way in these
  • patients.
  • PCT does not tell you the site of infection/inflammation. History, clinical examination and other investigations like CT scan can.
  • PCT is a biomarker and cannot replace good history taking, systematic clinical examination, appropriate investigations for the source of sepsis.

Management

  • Few prospective randomised studies using PCT as a guide to antibiotic therapy have shown that prescription rate and the cost of antibiotics was reduced significantly with similar outcomes compared to the conventional approach
  • Mention of the recent Lancet paper (Jan2010 – ProRata study) and its conclusions is worthy of extra credit
Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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