Procalcitonin Levels Associate with Severity of Clostridium difficile Infection

Krishna Rao, Seth T. Walk, Dejan Micic, Elizabeth Chenoweth, Lili Deng, Andrzej T. Galecki, Ruchika Jain, Itishree Trivedi, Marie Yu, Kavitha Santhosh, Cathrin Ring, Vincent B. Young, Gary B. Huffnagle, David M. Aronoff

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

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/mm3 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.

Original languageEnglish (US)
Article numbere58265
JournalPloS one
Volume8
Issue number3
DOIs
StatePublished - Mar 7 2013
Externally publishedYes

Fingerprint

Clostridium Infections
Clostridium difficile
Clostridium
Calcitonin
infection
Biomarkers
bacterial infections
Bacterial Infections
biomarkers
Serum
Intensive care units
therapeutics
Colectomy
fever
morbidity
leukocytes
Fever
death
Morbidity

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Rao, K., Walk, S. T., Micic, D., Chenoweth, E., Deng, L., Galecki, A. T., ... Aronoff, D. M. (2013). Procalcitonin Levels Associate with Severity of Clostridium difficile Infection. PloS one, 8(3), [e58265]. https://doi.org/10.1371/journal.pone.0058265

Procalcitonin Levels Associate with Severity of Clostridium difficile Infection. / Rao, Krishna; Walk, Seth T.; Micic, Dejan; Chenoweth, Elizabeth; Deng, Lili; Galecki, Andrzej T.; Jain, Ruchika; Trivedi, Itishree; Yu, Marie; Santhosh, Kavitha; Ring, Cathrin; Young, Vincent B.; Huffnagle, Gary B.; Aronoff, David M.

In: PloS one, Vol. 8, No. 3, e58265, 07.03.2013.

Research output: Contribution to journalReview article

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 2013, 'Procalcitonin Levels Associate with Severity of Clostridium difficile Infection', PloS one, vol. 8, no. 3, e58265. https://doi.org/10.1371/journal.pone.0058265
Rao K, Walk ST, Micic D, Chenoweth E, Deng L, Galecki AT et al. Procalcitonin Levels Associate with Severity of Clostridium difficile Infection. PloS one. 2013 Mar 7;8(3). e58265. https://doi.org/10.1371/journal.pone.0058265
Rao, Krishna ; Walk, Seth T. ; Micic, Dejan ; Chenoweth, Elizabeth ; Deng, Lili ; Galecki, Andrzej T. ; Jain, Ruchika ; Trivedi, Itishree ; Yu, Marie ; Santhosh, Kavitha ; Ring, Cathrin ; Young, Vincent B. ; Huffnagle, Gary B. ; Aronoff, David M. / Procalcitonin Levels Associate with Severity of Clostridium difficile Infection. In: PloS one. 2013 ; Vol. 8, No. 3.
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abstract = "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/mm3 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.",
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AU - Rao, Krishna

AU - Walk, Seth T.

AU - Micic, Dejan

AU - Chenoweth, Elizabeth

AU - Deng, Lili

AU - Galecki, Andrzej T.

AU - Jain, Ruchika

AU - Trivedi, Itishree

AU - Yu, Marie

AU - Santhosh, Kavitha

AU - Ring, Cathrin

AU - Young, Vincent B.

AU - Huffnagle, Gary B.

AU - Aronoff, David M.

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N2 - 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/mm3 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.

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