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KMID : 0385920130240060694
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Journal of the Korean Society of Emergency Medicine
2013 Volume.24 No. 6 p.694 ~ p.701
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The Correlation between Infection Probability Score and Procalcitonin in Emergency Department Patients
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Jo Gyu-Dong
Choi Pil-Cho
Han Sang-Kook
Shin Dong-Hyuk
Lee Hyun-Jung
Na Ji-Ung
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Abstract
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Purpose: Procalcitonin is a well-established biochemical marker for bacterial infection. We conducted this study to analyze the correlation between procalcitonin and Infection Probability Score (IPS), a recently introduced scoring system to predict bacterial infection in intensive care unit patients. The cutoff value of IPS corresponding to procalcitonin cutoff values was determined for procalcitonin-guided antibiotic therapy in emergency department (ED) patients.
Methods: A retrospective observation study was conducted on adult ED patients who simultaneously underwent an IPS-required blood test and procalcitonin treatment from January 1, 2012 to June 30, 2012. Based on their diagnosis at discharge, patients were grouped into a lower respiratory infection group or an “other” diagnosis group. The correlation between IPS and procalcitonin was analyzed by correlation and linear regression analysis. The IPS value corresponded to 0.25 ng/mL procalcitonin (in the lower respiratory infection group) and 0.5 ng/mL (in the other diagnosis group) as inferred by ROC curve analysis. A total of 722 cases (lower respiratory infection group: 258, other diagnosis group: 464) were included in the final analysis.
Results: In correlation analysis, the IPS showed a significant correlation with procalcitonin level in both groups (r=0.26, p<0.01, r=0.25, p<0.01, respectively). In ROC curve analysis, IPS 14 could predict procalcitonin≥0.25 μg/L in the lower respiratory infection group (area under curve: 0.783 [95% CI, 0.724-0.841], sensitivity: 77.8%, specificity: 72.3%). Also, IPS 14 could predict procalcitonin≥0.5 μg/L in the other diagnosis group (area under curve: 0.764 [95% CI, 0.717-0.810], sensitivity: 70.1%, specificity: 74.2%).
Conclusion: The IPS had a significant correlation with procalcitonin level and IPS≥14 corresponded to the procalcitonin cut-off value to predict bacterial infection in ED patients. Thus, IPS≥14 may be used to predict bacterial infection and can guide early anti-microbial therapy in ED patients when procalcitonin is not readily available.
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KEYWORD
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Bacterial infections, Procalcitonin, Predictive Value of Tests
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