Published September 6, 2021 | Version v1
Journal article Open

Utility of Procalcitonin Over C-Reactive Protein and WBC as an Early and Rapid Diagnostic Marker of Bacterial Infections in Febrile Patients with or no Hemoculture Results as Gold Standard in a Malaria Endemic Zone of Cameroon

Creators

  • 1. 1Institutue of Medical Research and Medicinal Plant Studies, Center of Medical Research, Human Biology Laboratory, Cameroon 2Department of Microbiology, Faculty of Science, University of Yaoundé 1, Cameroon
  • 2. Department of Microbiology, Haematology, Parasitology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon.
  • 3. Department of Microbiology, Haematology, Parasitology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaoundé , Yaoundé, Cameroon.
  • 4. Clinical Biology Laboratory–Douala General Hospital,Department of Biological Sciences, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Cameroon
  • 5. Institutue of Medical Research and Medicinal Plant Studies, Center of Medical Research, Human Biology Laboratory, Cameroon,Department of Microbiology, Faculty of Science, University of Yaoundé , Cameroon
  • 6. Department of Microbiology, Faculty of Science, University of Buea, Cameroon,Institutue of Medical Research and Medicinal Plant Studies, Center of Medical Research, Human Biology Laboratory, Cameroon
  • 7. Institutue of Medical Research and Medicinal Plant Studies, Center of Medical Research, Human Biology Laboratory, Cameroon

Description

Background & objectives: Early identification of bacterial infection in patients with fever is
important for prompt and specific treatment. However, the available biomarkers such as C-reactive
protein (CRP) and leukocyte counts are not specific to bacterial diagnosis. This study aimed to
assess the diagnostic value of procalcitonin (PCT) over CRP and leukocyte counts for bacterial
infection screening in febrile patients while awaiting their hemoculture results, which takes up to
7 Days before results are available though it is the gold standard for the diagnosis of bacterial
infections.
Methods: Blood samples were collected from febrile patients between January and July 2020 then
processed for blood cultures. PCT, CRP and WBC levels were measured. The patients were divided
into two groups according to the final diagnosis: bacterial infection group (group1) and nonbacterial
infection group (group 2).SPSS version 20.0 software package was used for data analysis
and normally distributed variables were calculated using mean, standard deviation and ANOVA
test while median and range were used for variables without a normal distribution. Significance
testing was done using Kruskal-Wallis h test and Wilcoxon two sample test and the diagnostic
accuracy was assessed by calculating the area (AUC) under the receiver operating characteristic
curve (ROC).
Results: There were significant (P<0.05) difference in the levels of PCT, CRP and WBC among
the two groups. The PCT levels of patients in the bacterial infections group were significantly
higher than those in the nonbacterial infections group (27.9 vs., 11.7 P < 0.001). The best cut-off
value to detect bacterial infections was 1.46 ng/ml for PCT. PCT, CRP and WBC had areas under
the curve of 0.71, 0.66 and 0.45 respectively and sensitivity of 100%, 72.7% and 27.3%
respectively.
Interpretation & conclusions: Our results showed that PCT was a valuable marker for the early
and rapid diagnosis of bacterial infections in febrile patients in our setting when compared to
CRP and WBC. However, prospective and large scale studies are warranted to confirm these
findings in Cameroon.

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