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Reference values for C-reactive protein and procalcitonin at term pregnancy and in the early postnatal period
Caroline M Joyce1,2, Shane Deasy1, Hala Abu3
1Department of Clinical Biochemistry, Cork University Hospital, Cork, Ireland.
Insights
This study establishes reference values for procalcitonin in pregnant women and postpartum. Procalcitonin is a more specific marker than C-reactive protein for identifying infection in this population.
Area of Science:
- Obstetrics and Gynecology
- Infectious Disease Diagnostics
- Clinical Biochemistry
Background:
- Early sepsis recognition and treatment are crucial for patient outcomes.
- C-reactive protein (CRP) indicates tissue damage, while procalcitonin (PCT) is more specific for bacterial infections.
- Limited data exists on CRP and PCT values during late pregnancy and the postpartum period.
Purpose of the Study:
- To establish reference values for CRP and PCT in healthy women at term pregnancy and during the early postpartum period.
- To assess the utility of PCT as a diagnostic marker for infection in this demographic.
Main Methods:
- A prospective cross-sectional study involving 196 healthy pregnant women aged 19-45 years.
- Blood samples were collected at term gestation (37-40 weeks) and on postpartum days 1 and 3.
- Measurements included C-reactive protein and procalcitonin levels.
Main Results:
- Established reference values for procalcitonin in term pregnancy and postpartum.
- Maximum procalcitonin value at term pregnancy was 0.1 μg/L.
- On postpartum day 1, 90% (vaginal delivery) and 86.8% (cesarean section) of procalcitonin results were below 0.25 μg/L, with 91.5% specificity for ruling out infection.
Conclusions:
- Defined procalcitonin reference ranges for healthy term and postpartum women.
- C-reactive protein variability limits its clinical use for sepsis assessment in this group.
- A procalcitonin cutoff of 0.25 μg/L is a valuable tool for clinicians to rule out infection in pregnancy and postpartum.
Background:
Early recognition of sepsis and prompt treatment improves patient outcome. C-reactive protein is a sensitive marker for tissue damage and inflammation, but procalcitonin has greater specificity for bacterial infection. Limited research exists regarding the use of C-reactive protein and procalcitonin at term pregnancy and the immediate postpartum period.
Aim:
This study sought to define reference values for C-reactive protein and procalcitonin at term and the early postnatal period.
Methods:
A prospective cross-sectional study was performed in a university teaching hospital. Venous blood was collected from healthy women (n = 196), aged between 19 and 45 years with an uncomplicated singleton pregnancy, at term (37-40 weeks' gestation) and on day 1 and day 3 postpartum for the measurement of C-reactive protein and procalcitonin.
Results:
The reference population comprised of 189 participants: term pregnancy (n = 51), postpartum day 1 vaginal delivery (n = 70) and caesarean section (n = 38) and day 3 (caesarean section, n = 30). The maximum procalcitonin value at term pregnancy was 0.1 μg/L. On day 1 postpartum, 90% and 86.8% of procalcitonin results for vaginal delivery and caesarean section, respectively, were below the decision-threshold of 0.25 μg/L. The specificity of procalcitonin to rule out infection in the reference population was 91.5%.
Conclusions:
Reference values for procalcitonin were established in a well-characterized population of healthy pregnant women at term and immediately postpartum. The variability of C-reactive protein limits its clinical utility in the assessment of systemic sepsis. Application of the procalcitonin cut-off of 0.25 μg/L in this population will be a valuable adjunct to clinicians ruling out infection in pregnancy and postpartum.
