Fairview Diagnostic Laboratories

Procalcitonin

Abbrev Code:	PCAL
Order Code:	LAB5727	Order Name:	Procalcitonin
Synonyms:	PCT
Methodology:	ELISA St Joseph: CMIA
CPT Codes:	84145 x1
Turnaround Time:	Performed and reported 24 hours/day.

Collection Instructions

Specimen:	Blood
Optimal Volume:	3.0 mL
Minimum\Peds Volume:	1.0 mL
Container:	Green (lithium heparin, gel), St Johns/St Joseph/Woodwinds - Red (no gel)
Causes for Rejection:	Hemolysis, icterus and lipemia, greater than moderate. Samples greater than 4 hours at room temperature. Samples greater than 48 hours old. Serum or EDTA specimen.

Processing and Shipping

Specimen Processing:	Centrifuge and aliquot 1.5 mL, 0.4 mL minimum. Samples are stable at room temperature for 4 hours and refrigerated for 48 hours. Store in refrigerator.
Shipping Instructions:	Ship at refrigerated temperature.
Test Performed at or Referral Lab	Chemistry (Range, UMMC-West Bank, UMMC-East Bank, Southdale, Grand Itasca, St. Joseph's, St. John's, Woodwinds)

Interpretive

Critical Range:

Greater than or equal to 5.00 ng/mL

Reference Range:

Less than 5 ng/mL

Interpretation Guidelines

	Interpretation	Recommendations
<0.05 ng/mL	Normal	Very low risk of bacterial infection. Strongly discourage antibiotics.
0.05-0.24 ng/mL	Low risk of systemic infection. Local bacterial infection possible.	Assess other clinical features of infection. Discourage antibiotics.
0.25-0.49 ng/mL	Possible early systemic infection or localized infection	Encourage antibiotics only in correct clinical context. Consider obtaining blood cultures or other relevant cultures. Recheck PCT in 6-12 hours to ensure baseline low level. If repeat PCT is rising, consider early systemic infection and consider starting antibotics.
0.50-1.99 ng/mL	Moderate risk of systemic infection.	Recommend antibiotics. Evaluate culture results and clinical features to target antibacterial therapy. Obtain blood cultures and other relevant cultures if not done. If empiric antibiotics were started, recheck PCT in 2 days to guide antibiotic de-escalation. Discontinue or de-escalate antibiotics when PCT concentration is <80% of peak or abs PCT <0.5. If empiric antibiotics wre NOT started, recheck PCT in 6-12 hours to re-evaluate need for antibiotics.
2.00-9.99 g/mL	High risk for progression to severe sepsis.	Strongly recommend initiating or continuing antibiotics. Evaluate culture results and clinical features to target antibacterial therapy. Obtain blood cultures and other relevant cultures if not done. Repeat PCT in 2 days to guide antibiotic de-escalation. Consider de-escalating antibiotics when PCT concentration is <80% or peak or abs PCT < 0.05.
≥ 10 ng/mL	Very high likelihood of severe sepsis or septic shock.	Strongly recommend initiating or continuing antibiotics. Evaluate culture results and clinical features to target antibacterial therapy. Obtain blood cultures and other relevant cultures if not done. Repeat PCT in 2 days to guide antibiotic de-escalation. Consider de-escalating antibiotics when PCT concentration is <80% of peak or abs PCT < 1.

Use:

Useful in the diagnosis of systemic bacterial infection and sepsis and optimization of antibiotic therapy. Procalcitonin (PCT) is a calcitonin precursor produced during periods of heightened inflammation. PCT production is particularly pronounced in the presence of bacterial infection. High PCT levels might indicate severe infection, and low and/or decreasing levels might assist in deciding the most appropriate time to discontinue antimicrobial therapy.

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