Procalcitonin levels associate with severity of Clostridium difficile infection.

PloS one

PubMedID: 23505476

Rao K, Walk ST, Micic D, Chenoweth E, Deng L, Galecki AT, Jain R, Trivedi I, Yu M, Santhosh K, Ring C, Young VB, Huffnagle GB, Aronoff DM. Procalcitonin levels associate with severity of Clostridium difficile infection. PLoS ONE. 2013;8(3):e58265.
OBJECTIVE
Clostridium difficile infection (CDI) is a major cause of morbidity and biomarkers that predict severity of illness are needed. Procalcitonin (PCT), a serum biomarker with specificity for bacterial infections, has been little studied in CDI. We hypothesized that PCT associated with CDI severity.

DESIGN
Serum PCT levels were measured for 69 cases of CDI. Chart review was performed to evaluate the presence of severity markers and concurrent acute bacterial infection (CABI). We defined the binary variables clinical score as having fever (T >38°C), acute organ dysfunction (AOD), and/or WBC >15,000 cells/mm(3) and expanded score, which included the clinical score plus the following: ICU admission, no response to therapy, colectomy, and/or death.

RESULTS
In univariate analysis log10 PCT associated with clinical score (OR 3.13, 95% CI 1.69-5.81, P<.001) and expanded score (OR 3.33, 95% CI 1.77-6.23, P<.001). In a multivariable model including the covariates log10 PCT, enzyme immunoassay for toxin A/B, ribotype 027, age, weighted Charlson-Deyo comorbidity index, CABI, and extended care facility residence, log10 PCT associated with clinical score (OR 3.09, 95% CI 1.5-6.35, P?=?.002) and expanded score (OR 3.06, 95% CI 1.49-6.26, P?=?.002). PCT >0.2 ng/mL was 81% sensitive/73% specific for a positive clinical score and had a negative predictive value of 90%.

CONCLUSION
An elevated PCT level associated with the presence of CDI severity markers and CDI was unlikely to be severe with a serum PCT level below 0.2 ng/mL. The extent to which PCT changes during CDI therapy or predicts recurrent CDI remains to be quantified.