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Published on: June 16, 2023
A pregnancy-specific reference interval for procalcitonin
Samuel Dockree1, Jennifer Brook2, Tim James2
1Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Insights
Procalcitonin (PCT) levels in pregnant women are similar to non-pregnant individuals, establishing a new reference interval. This finding supports using PCT for diagnosing sepsis in pregnancy and guiding antibiotic treatment.
Area of Science:
- Maternal Health
- Infectious Disease Diagnostics
- Biomarker Research
Background:
- Sepsis significantly contributes to maternal mortality, necessitating accurate diagnostic tools.
- Current inflammatory markers lack specificity, complicating infection diagnosis in pregnancy.
- Procalcitonin (PCT) aids bacterial sepsis diagnosis, crucial during pregnancy, especially with COVID-19 risks.
Purpose of the Study:
- To establish a pregnancy-specific reference interval for procalcitonin (PCT).
- To determine if physiological changes in pregnancy affect PCT levels.
- To inform the clinical utility of PCT in diagnosing sepsis in pregnant women.
Main Methods:
- A cross-sectional study involving 323 healthy pregnant women.
- Longitudinal blood sampling was conducted across all trimesters of pregnancy.
- Analysis focused on establishing the upper reference limit for PCT.
Main Results:
- The upper reference limit for PCT in pregnancy was determined to be 0.05 ng/mL.
- PCT levels showed no significant variation across different gestational ages, BMI, maternal age, or fetal sex.
- Findings indicate PCT levels are comparable between pregnant and non-pregnant populations.
Conclusions:
- Normal physiological changes during pregnancy do not materially alter procalcitonin (PCT) levels.
- Pregnancy status should not prevent the use of PCT for suspected sepsis diagnosis.
- PCT can be reliably used to guide antibiotic therapy for bacterial infections at any stage of pregnancy.
Background And Aims:
Sepsis is a leading cause of maternal death, and developing diagnostic tests for infection is increasingly important to reduce maternal mortality. The existing inflammatory markers, like C-reactive protein, are not specific for infection, which introduces diagnostic uncertainty. Procalcitonin (PCT) is used to accurately diagnose bacterial sepsis and differentiate it from other conditions, which is now particularly important given the vulnerability to COVID-19 in pregnancy. There are few studies of PCT in pregnancy as the reference interval for pregnant women is unknown. This study aimed to define the pregnancy-specific reference interval for PCT.
Materials And Methods:
Cross-sectional study of 323 healthy pregnant women, with longitudinal sampling in each trimester.
Results:
The upper reference limit for PCT was 0.05 ng/mL and did not vary materially between any observed group of gestational age, body mass index, maternal age, mean arterial blood pressure or fetal sex.
Conclusion:
Our study has shown that levels of PCT are similar in pregnant and non-pregnant populations despite the physiological changes of normal pregnancy. Therefore, pregnancy should not preclude the use of PCT in pregnant women with suspected sepsis, or for guiding antibiotic therapy in women with a diagnosed bacterial infection at any stage of pregnancy.
