Procalcitonin has been described as being useful in assisting physicians in the diagnosis of acute infection in several different conditions. Some of these are:

• The differential diagnosis of bacterial versus viral infections.
• The diagnosis of bacteremia and septicemia in adults and children (including neonates)
• The diagnosis and monitoring of septic shock.
• The diagnosis of systemic secondary infection post-surgery, and in severe trauma, burns, and multi-organ failure.
• The monitoring of therapeutic response to antibacterial therapy

Due to potential carryover, a test request for this assay on the Roche platform, cannot be added on to any tube which has been opened and previously run on the Roche analyzers.

Lt green plasma separator (PST)

Immediately following collection, mix sample thoroughly by gently inverting 8 - 10 times to prevent clotting

Spin within two (2) hours of sample collection

Plasma separator (Lt green PST)

Gold serum separator (SST) tube

Lavender (EDTA), 4mL

Immediately following collection, thoroughly mix sample by gently inverting 5 times

Gold:

1. Allow sample to clot for a minimum of 30 minutes
2. Spin within two (2) hours of sample collection

Lavender: 

1. Spin
2. Transfer the plasma to an AHL False Bottom Plasma/Serum Transport Tube labeled as the appropriate plasma type, within two (2) hours of sample collection

Gold serum separator (SST) tube

False bottom plasma/serum transport vial/tube (AHL)

Refrigerated (preferred) - 2 days

Ambient - 1 day

Frozen - 12 months

• Improper labels (unlabeled or mislabeled)
• Hemolysis (some procedures)
• Improper anticoagulant or ratio
• Delay in transport
• Improper storage temperature affecting results
• Improper container
• Leaking container resulting in compromised specimen
• Quantity not sufficient (QNS)

• Add-on Alert: Due to potential carryover, a test request for this assay on the Roche platform, cannot be added on to any tube which has been opened and previously run on the Roche analyzers.

Electrochemiluminescence immunoassay (ECLIA)

< 0.50 ng/mL

PCN is the prohormone of calcitonin (CT). Whereas CT is secreted by the C-cells of the thyroid after hormonal stimulation, PCN can be produced by numerous cell types and organs after proinflammatory stimulation, especially when caused by a bacterial triggering event.

One major advantage of PCN compared to other inflammatory parameters is its early and highly specific increase in response to severe systemic bacterial infections and sepsis. PCN levels closely parallel the severity of the inflammatory insult, with higher levels associated with more severe disease and declining levels with resolution of illness. In septic conditions, increased PCN levels can be observed within 3 to 6 hours after a triggering event, and peaks by 12 to 24 hours with a half-life of 24 to 35 hours, making it suitable for serial monitoring. PCN levels are usually low in viral infections, chronic inflammatory disorders or autoimmune processes. PCN levels in sepsis are generally greater than 0.5 - 2 ng/mL and often reach values between 10 and 100 ng/mL, or considerably higher in individual cases, thereby enabling diagnostic differentiation between these various clinical conditions and a severe bacterial infection (sepsis).

The dependence of sustained PCN elevations on ongoing inflammatory stimuli allows for the identification of secondary septic events in conditions that can result in noninfectious PCN elevations, such as cardiac surgery, severe trauma, severe burns, and multi-organ failure. PCN levels should fall at a predictable pace in the absence of secondary infection.

INTERPRETATION

The following interpretation table is currently in use within Allina Health.

Procalcitonin for initial assessment of Lower Respiratory Tract Infection:

*If suspicion of infection high, clinically unstable, or immunosuppressed: initiate antibiotics. Repeat PCT testing in 6-24 hours.
**Repeat PCT testing every 1-2 days while on antibiotics to assess response to therapy.

Procalcitonin for initial assessment of severe sepsis risk:

Note: PCT levels below 0.5 ng/mL do not exclude an infection, because localized infections may also be associated with such low levels. If the PCT measurement is done very early after the systemic infection process has started (usually <6 hours), these values may still be low.

PCT levels between 0.5 ng/mL and 2.0 ng/mL should be interpreted in the context of the specific clinical background and conditions of the individual patient. It is recommended to re-test PCT within 6-24 hours if any concentrations <2.0 ng/mL are obtained.