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PCT Level (pct + level)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Procalcitonin-reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients

BRITISH JOURNAL OF HAEMATOLOGY, Issue 1 2001
M. Svaldi
Procalcitonin (PCT) has proven to be a very sensitive marker of sepsis for non-leucopenic patients. Little is known about its relevance in immunosuppressed and leucopenic adults. Four hundred and seventy-five PCT determinations were carried out in 73 haematological patients: on 221 occasions the white blood cell (WBC) count was <,1·0 × 109/l and on 239 occasions it was >,1·0 × 109/l leucocytes. Patients were classified as: non-systemic infected controls (n = 280), patients with bacteraemia (n = 32), sepsis (n = 30), severe sepsis (n = 3), septic shock (n = 3) and systemic inflammatory response syndrome (SIRS) (n = 62). When the WBC count was >,1·0 × 109/l, gram-negative bacteria induced higher PCT levels (median 9·4 ng/ml) than gram-positives (median 1·4 ng/ml). In cases with a WBC <,1·0 × 109/l, PCT levels were similar for gram-negative and gram-positive bacteria (1·1 ng/ml versus 0·85 ng/ml). Regardless of the leucocyte count, the median PCT level in bacteraemia cases always remained <,0·5 ng/ml. In heavily leucopenic situations, PCT levels were never >,2 ng/ml even in the sepsis and severe sepsis/septic shock groups, whereas a WBC count >,1·0 × 109/l resulted in median PCT values of 4·1 ng/ml and 45 ng/ml respectively. The positive predictive value for sepsis (cut-off 2 ng/ml) was 93% in cases of WBC count >,1·0 × 109/l, but only 66% in leucopenic conditions. The negative predictive value (cut-off 0·5 ng/ml) was 90% when the WBC count was >,1·0 × 109/l and 63% in leucopenic conditions. Procalcitonin is an excellent sepsis marker with a high positive- and negative-predictive value in patients with WBC count >,1·0 × 109/l, but it does not work satisfactorily below this leucocyte count. [source]

The role of procalcitonin in a decision tree for prediction of bloodstream infection in febrile patients

CLINICAL MICROBIOLOGY AND INFECTION, Issue 12 2006
R. P. H. Peters
Abstract Bloodstream infection (BSI) in febrile patients is associated with high mortality. Clinical and laboratory variables, such as procalcitonin (PCT), may predict BSI and help decision-making concerning empirical treatment. This study compared two models for prediction of BSI, and evaluated the role of PCT vs. clinical variables, collected daily in 300 consecutive febrile inpatients, for 48 h after onset of fever. Multiple logistic regression (MLR) and classification and regression tree (CART) models were compared for discriminatory power and diagnostic performance. BSI was present in 17% of cases. MLR identified the presence of intravascular devices, nadir albumin and thrombocyte counts, and peak temperature, respiratory rate and leukocyte counts, but not PCT, as independent predictors of BSI. In contrast, a peak PCT level of >2.45 ng/mL was the principal discriminator in the decision tree based on CART. The latter was more accurate (94%) than the model based on MLR (72%; p <0.01). Hence, the presence of BSI in febrile patients is predicted more accurately and by different variables, e.g., PCT, in CART analysis, as compared with MLR models. This underlines the value of PCT plus CART analysis in the diagnosis of a febrile patient. [source]

Surgery for menorrhagia within English regions: variation in rates of endometrial ablation and hysterectomy

BJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2009
DA Cromwell
Objective, To examine variation between English regions in the use of surgery (endometrial ablation or hysterectomy) for the treatment of menorrhagia. Design, Analysis of Hospital Episodes Statistics (HES) data to produce rates of surgery for English Strategic Health Authorities (SHAs) and Primary Care Trusts (PCTs). Population, Women aged between 25 and 59 years who had endometrial ablation or hysterectomy for menorrhagia between April 2003 and March 2006 in English NHS hospitals. Methods, Multilevel Poisson regression was used to determine the level of systematic variation in the regional rates of surgery and their association with regional characteristics (deprivation, service provision and mix of surgical procedures). Main outcome measure, Age-standardised annual rates of surgery. Results, The English rate of surgery for menorrhagia was 143 procedures per 100 000 women. Surgical rates within SHAs ranged from 52 to 230 procedures per 100 000 women, while rates within PCTs ranged from 20 to 420 procedures per 100 000 women. While, 60% of all procedures were endometrial ablations, the proportion across SHAs varied, ranging from 46% to 75%. Surgery rates were associated with the regional characteristics, but only weakly, and risk adjustment reduced the amount of unexplained variation by <15% at both SHA and PCT levels. Conclusion, Regional differences in surgical rates for menorrhagia have persisted despite changes in practice and improved evidence, suggesting there is scope for improving the management of menorrhagia within England. [source]