Can the determination of serum procalcitonin be helpful in the differential diagnosis of an infection and an acute exacerbation in patients with a systemic autoimmune disease?

Authors: O. Šléglová 1;  H. Dejmková 1;  J. Uhrová 2
Authors‘ workplace: Revmatologickýústav Praha, 2Ústav klinické biochemie a laboratorní diagnostiky VFN, Praha 1
Published in: Čes. Revmatol., 18, 2010, No. 1, p. 4-11.
Category: Original Papers


To evaluate the usefulness of testing for serum procalcitonin (PCT) in the differential diagnosis of infectious complications and an acute disease exacerbation in patients with systemic autoimmune diseases. Methods: 125 patients with systemic autoimmune diseases who were admitted to the inpatient department for a suspected acute infection or an acute exacerbation of their disease were prospectively tested for PCT levels. Concurrently, levels of C-reactive protein (CRP), white blood cell counts (WBC), and C3 and C4 complement components were measured. The group of patients with an infection comprised two subgroups- with a systemic and localised infection. The control group included 87 patients with autoimmune diseases without any signs of deterioration and attending the outpatient clinics. Results: Serum PCT levels were significantly higher in patients with infections than in patients with an active systemic disease (PCT mean ± SEM 4.560 ± 1,513 vs. 0,254 ± 0,029, p < 0,001). Levels of CRP and white blood cell counts were also higher in patients with infections; the differences between C3 and C4 complement component values were not statistically significant. PCT serum levels were not elevated in any patient included in the control group, and they were not affected by the current corticosteroid or immunosuppressive treatment. The sensitivity of the PCT test for an infectious complication (cut-off value = 0.5 ng/ml) was 52.4%, specificity 94.0% and diagnostic accuracy 80.2%. The area under the ROC curve for PCT was 73.21%. Conclusion: Increased serum PCT levels demonstrate a good specificity for evidence of an infection in patients with systemic diseases. The sensitivity of PCT serum levels is lower, and it is therefore suitable to complement the assessment with another high-sensitivity indicator, such as CRP.

Key words:
procalcitonin, C-reactive protein, autoimmune disease, bacterial and mycotic infection, corticosteroids, immunosuppressive treatment


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