A Brief Overeview: The Role of Procalcitonin in the Emergency Medicine Volume 52- Issue 4

ȚAPOȘ GABRIELA-FLORENTINA*

• Department of Emergency Medicine, Arad County Emergency Clinical Hospital, Romania

Received: August 23, 2023;   Published: September 06, 2023

*Corresponding author: ȚAPOȘ GABRIELA-FLORENTINA, Department of Emergency Medicine, Arad County Emergency Clinical Hospital, Calea Victoriei, 310037 Arad, Romania

DOI: 10.26717/BJSTR.2023.52.008294

Abstract PDF

This review aims highlight the role and need for procalcitonin in emergency medicine. Șevere bacterial infections, such as sepsis is medical emergency, thus requiring prompt treatment and diagnosis. Procalcitonin, a precursor to calcitonin, was defined 40 years ago [1,2], that helps in emergency department and in intensive care unit to diagnose bacterial infection. Over time, many articles have emerged on the role and need for procalcitonin in intensive care units, as well as in emergency department. A global problem is resistance on antibiotics.

Keywords: Procalcitonin; Emergency Medicine; Intensive Care; Bacterial Inefction; Sepsis

Abbreviations: PCT: Procalcitonin

A hard searching in PubMed, MDPI and Google Șcholar carried out in July-August 2023 brought to a review of several articles with the approach of procalcitonin (PCT). PCT is defined for the first time in 1984, but in 1993 was recognized as having a diagnostic significance [1-3]. Șevere bacterial infections and sepsis leads to multiple organ failure, thus increasing morbidity and mortality, in intensive care unit and in emergency departament. PCT can be considered as a first-line test –to diagnose bacterial infection versus viral infection (for example, viral pneumonia compared to bacterial one), especially in emercengy medicine, because other diagnostic tests such as blood cultures, urine culture, culture of cerebrospinal fluid or C-reactive protein (CRP) cannot be used in emercengy departament, thus requiring a few days until the result is recived. Across the globe, bacterial resistance to antibiotics is constatly increasing, this is the reasone why in emercengy medicine PCT dosing plays a crucial role because this marker guides the clinician in deciding if a patient can or cannot start antibiotic therapy; this can significantly reduce the rate of resistance on antibiotics and mortality.

About PCT was written a lot of researches, with a particular importance showing the importance of this biomarker in determining the infection, especially in the case of sepsis and the need to start antibiotic therapy. However in emercengy medicine the role of PCR is not fully known but in intensive care units this indicator is used more and more often [1]. In 1984, Le Moullec and colab. define PCT as a biomarker cosisting of about 116 amino acides, formed biochemically cosisting of three section:

1. Amino-terminal;

2. Imature calcitonin;

3. Ketacalcin.

PCR together with other peptides (for example amyline, related to calcitonin, adrenomodulin I and II genes) grow in an infection process. In about 3-6 hours after onset of infecion, PCR, can be detected in a serum of the patient [2,3]. Assicot and colab. demonstrates the role of PCT in a research that PCR shows increased levels in some patients with specific clinical symptoms of bacterial infection, its reference value decreasing after starting antibiotic treatment. Therefore, the diagnostic significance of PCT has been recognized since 1993 [4]. W. Karzai and colab. quote C. Natanson and colab., W. Șteinberg and colab., F.A. Moore and colab., J.R. Șaffle and colab., thus classifying the major causes of mortality and morbidity in therpay departments. These include: sepsis, multiple organ failure [5,6] , pancreatitis [7], major trauma [8] and burns [9]. The latter can give false-positive results, but still mantian a high level of PCR (on average over 48 hours) it makes us think of a major suspicion of bacterial infection. Velissaric D. And colb. Șay that PCR is a biomarker both diagnostic and prognostic especially in patinets who are in the emergency department with major suspicious of sepsis [10]. Linscheid P. And colab. in a published research in 2003 demonstrates the production of PCT by dipocytes in presence of systemic inflamation, thus obsese patients have a high risk of death compared to normal weight patinets [11]. Hirotada K. And colab., in a published research in 2021 prove that PCT in high concentrations causes mitochonndrial dysfunction which also associated with a increased inflammation throughout the body [12]. Pierre E.C. and colab., have carried out an observational cohort research involving 180 patients with sepsis, hospitalized in the intensive care unit thus demonstrating the effectiveness of the use of PCR in starting antibiotic treatment. It should be noted that a marked decrease in PCR occurs only when used when appropriate antibiotics are used, otherwise the serum level of PCR will not decrease [13]. Briel M. and colab., mention that PCR-guided therapy thus demonstrating that the prescribing rate of prescription of antibiotics was 72% lower than standard therapy (especially in the case of respiratory tract infections) and the duration of use of antibiotics was one day shorter [14].

This review highlights the importance of PCT in emergency departments, thus being a valuable indicator in the identification of systemic bacterial infections. This marker shows, the importance of the immediate onset of antibiotic therapy in case of bacterial infection, reducing morbidity and mortality especially in intensive care units [15]. This biomarker is easily measurable, sensitive, specific and requires little time to obtain a value. In fact, dosing PCT in emergencies can help reduce antibiotic resistance. The following should be noted: PCR, both in the emergency department and in the intensive care unit, cannot replace clinical evaluation and other markers of inflammation. PCT dosing cannot be realized in all departaments of emergency medicine maybe because of costs.

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