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Procalcitonin and infection in elderly patients
Fabien Stucker1, François Herrmann, Jean-Daniel Graf
1Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland.
Journal of the American Geriatrics Society
|August 5, 2005
Summary
Procalcitonin (PCT) shows low sensitivity for detecting infection in elderly patients, with C-reactive protein (CRP) and sepsis being more reliable indicators. PCT may help identify severely ill older adults but not differentiate infection from non-infection.
Area of Science:
- Geriatric Medicine
- Infectious Disease Diagnostics
- Biomarker Research
Background:
- Distinguishing infection in elderly patients is challenging due to atypical presentations.
- Biomarkers like procalcitonin (PCT) and C-reactive protein (CRP) are used to aid diagnosis.
- The utility of PCT in geriatric populations requires further investigation.
Purpose of the Study:
- To compare the diagnostic accuracy of procalcitonin (PCT) against other clinical and biological markers for infection detection in elderly patients.
- To evaluate the effectiveness of PCT in identifying infections in an acute geriatric care setting.
Main Methods:
- Prospective observational study involving 218 elderly patients (≥75 years) admitted to an acute geriatric unit.
- Collected data included demographics, comorbidities, clinical signs, SIRS, sepsis status, functional scores (FIM), and biological markers (PCT, CRP, leukocytes, albumin).
- Compared PCT levels with other markers in infected versus uninfected patients using multivariate analysis.
Main Results:
- Sepsis and elevated CRP (≥3 mg/mL) were significantly associated with infection in multivariate analysis.
- Procalcitonin (PCT) levels (≥0.5 ng/mL) showed no significant association with infection in multivariate analysis.
- PCT demonstrated high specificity (94%) but low sensitivity (24%), with false negatives linked to lower infection severity and potential effects of aging.
Conclusions:
- Procalcitonin (PCT) is not a reliable marker for discriminating infection from non-infection in elderly patients admitted to acute geriatric wards.
- PCT may have utility in identifying severely ill elderly patients but should be interpreted cautiously.
- Elevated CRP and the presence of sepsis are more robust indicators of infection in this population.