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Procalcitonin and Its Limitations: Why a Biomarker's Best Isn't Good Enough.

Sepsis-related conditions remain the leading causes of mortality, morbidity, and expenditures worldwide despite efforts to standardize care and expedite diagnosis and treatment, which are determinants of outcome. As with most syndromes with complex pathophysiology, no gold standard diagnostic test exists. Diagnosis is complicated by nonspecific symptoms and lengthy blood cultures with high false-negative rates. Empiric antibiotic treatment upon signs of sepsis is an increasing concern for antibiotic overuse and resistance. The need for biochemical biomarkers for sepsis diagnosis is well accepted. Several pro- and antiinflammatory biomarkers have been investigated, but only few are incorporated in clinical practice (1). Procalcitonin (PCT)2 is one such molecule that emerged as a biomarker for bacterial infection and sepsis to guide antibiotic therapy. The clinical value of PCT remains questionable and some hesitate to incorporate PCT into routine standard of care. Here we discuss factors limiting widespread use of PCT, particularly in the US.

PCT is increased after severe inflammation and bacterial infections until resolution. Its use in the US was not as widespread as that in Europe and other countries until recently. PCT was initially indicated to assess the risk of critically ill patients for progression to severe sepsis and shock and the cumulative 28-day risk of all-cause mortality. Intended uses now include supporting antibiotic …