Procalcitonin Levels Associate with Severity of Clostridium difficile Infection

Krishna Rao, Seth T. Walk, Dejan Micic, Elizabeth Chenoweth, Lili Deng, Andrzej T. Galecki, Ruchika Jain, Itishree Trivedi, Marie Yu, Kavitha Santhosh, Cathrin Ring, Vincent B. Young, Gary B. Huffnagle, David M. Aronoff

Research output: Contribution to journalReview articlepeer-review

38 Scopus citations


Objective: Clostridium difficile infection (CDI) is a major cause of morbidity and biomarkers that predict severity of illness are needed. Procalcitonin (PCT), a serum biomarker with specificity for bacterial infections, has been little studied in CDI. We hypothesized that PCT associated with CDI severity. Design: Serum PCT levels were measured for 69 cases of CDI. Chart review was performed to evaluate the presence of severity markers and concurrent acute bacterial infection (CABI). We defined the binary variables clinical score as having fever (T >38°C), acute organ dysfunction (AOD), and/or WBC >15,000 cells/mm3 and expanded score, which included the clinical score plus the following: ICU admission, no response to therapy, colectomy, and/or death. Results: In univariate analysis log10 PCT associated with clinical score (OR 3.13, 95% CI 1.69-5.81, P<.001) and expanded score (OR 3.33, 95% CI 1.77-6.23, P<.001). In a multivariable model including the covariates log10 PCT, enzyme immunoassay for toxin A/B, ribotype 027, age, weighted Charlson-Deyo comorbidity index, CABI, and extended care facility residence, log10 PCT associated with clinical score (OR 3.09, 95% CI 1.5-6.35, P =. 002) and expanded score (OR 3.06, 95% CI 1.49-6.26, P =. 002). PCT >0.2 ng/mL was 81% sensitive/73% specific for a positive clinical score and had a negative predictive value of 90%. Conclusion: An elevated PCT level associated with the presence of CDI severity markers and CDI was unlikely to be severe with a serum PCT level below 0.2 ng/mL. The extent to which PCT changes during CDI therapy or predicts recurrent CDI remains to be quantified.

Original languageEnglish (US)
Article numbere58265
JournalPloS one
Issue number3
StatePublished - Mar 7 2013
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General


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