The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Characteristics and Clinical History
- Demographic data (age, sex).
- Vital signs at the ED admission (arterial pressure, heart rate, body temperature).
- Clinical symptoms (including cough, chest pain, abdominal pain, vomiting, gastrointestinal bleeding, neurological impairment, renal failure, asthenia).
- Comorbidities: We recorded the comorbidities included in the Charlson’s comorbidity score which was calculated for all the patients [27]. In particular, history of cancer, solid and hematological transplantation, inflammatory bowel disease (IBD), ischemic cardiac disease, heart failure, chronic obstructive pulmonary disease (COPD), diabetes mellitus, chronic renal failure, liver disease, and dementia were collected from clinical records.
- Laboratory findings included hemoglobin, white cell count, fibrinogen glucose, platelet count, procalcitonin, C-reactive protein, and serum creatinine. The procalcitonin determination was obtained upon request of the emergency physician based on patient evaluation and clinical judgment. Procalcitonin determinations were available 24 h a day in our ED, with a lab time response of about 1 h.
- Clinical outcomes were evaluated at hospital discharge or death and included all-cause in-hospital death, length of hospital stay (LOS), need for abdominal surgery, diagnosis of infective gastroenteritis (either bacterial or viral), diagnosis of bloodstream infection, diagnosis of any infective disease.
2.2. Outcome Measures
2.3. Study Endpoints
2.4. Statistical Analysis and Sample Size
2.5. Statement of Ethics
3. Results
3.1. Early PCT Determination in Infective Intestinal Diagnosis
3.2. Early PCT Determination in Non-Intestinal Infection Diagnosis
4. Discussion
4.1. Study Limitations
4.2. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | PCT Values | Univ. | ||
---|---|---|---|---|
<0.5 (n. 1258) | >0.5 (n. 649) | p Values | ||
Males | 893 (46.8%) | 583 (46.3%) | 310 (47.5%) | 0.617 |
Median age (years) | 70 [55–80] | 69 [53–80] | 71 [59–80] | 0.008 |
ED Presentation | ||||
Triage Code | <0.001 | |||
| 97 (5.1%) | 42 (3.3) | 55 (8.4) | |
| 528 (27.6%) | 308 (24.5) | 220 (33.7) | |
| 1285 (67.3%) | 908 (72.2) | 377 (57.8) | |
Associated symptoms | ||||
Cough | 193 (10.1) | 148 (11.8) | 45 (6.9) | 0.001 |
Vomiting | 636 (33.3) | 429 (34.1) | 207 (31.7) | 0.301 |
Abdominal pain | 716 (37.5) | 485 (38.6) | 231 (35.4) | 0.181 |
Chest pain | 49 (2.6) | 35 (2.8) | 14 (2.1) | 0.405 |
Syncope | 188 (9.8) | 117 (9.3) | 71 (10.9) | 0.269 |
Gastrointestinal bleeding | 101 (5.3) | 76 (6.0) | 25 (3.8) | 0.041 |
Asthenia | 386 (20.2) | 244 (19.4) | 142 (21.8) | 0.219 |
Confusion | 112 (5.9) | 66 (5.2) | 46 (7.1) | 0.111 |
Anuresis | 35 (1.8) | 15 (1.2) | 20 (3.1) | 0.004 |
Laboratory parameters | ||||
Hb (g/dL) | 12.2 [10.4–13.7] | 12.5 [10.7–13.9] | 11.7 [10.0–13.3] | <0.001 |
WBC (cell/mm3) | 9.9 [6.5–14.7] | 9.1 [6.4–12.8] | 12.4 [7.2–17.8] | <0.001 |
Creatinine (mg/dL) | 1.0 [0.8–1.6] | 0.9 [0.7–1.3] | 1.4 [0.9–2.4] | <0.001 |
Blood glucose (mg/dL) | 111.0 [96.0–140.0] | 109.0 [96.0–133.0] | 118.0 [99.0–150.5] | <0.001 |
Procalcitonin (ng/dL) | 0.19 [0.06–1.01] | 0.09 [0.05–0.18] | 2.60 [0.97–13.9] | <0.001 |
CRP (mg/L) | 81.5 [25.7–156.0] | 47.1 [15.7–115.6] | 156 [88.1–230.2] | <0.001 |
Clinical history | ||||
Charlson comorbidity score | 4 [2–6] | 4 [2–6] | 5 [3–6] | <0.001 |
Cancer | 378 (19.8) | 220 (17.5) | 158 (24.2) | <0.001 |
Immunosuppressive therapy | 54 (2.8) | 37 (2.9) | 17 (2.6) | 0.676 |
IBD | 136 (7.1) | 117 (9.3) | 19 (2.9) | <0.001 |
Ischemic cardiac disease | 174 (9.1) | 108 (8.6) | 66 (10.1) | 0.268 |
Heart failure | 123 (6.4) | 86 (6.8) | 37 (5.7) | 0.327 |
COPD | 150 (7.9) | 99 (7.9) | 51 (7.8) | 0.971 |
Diabetes | 237 (12.4) | 139 (11.0) | 98 (15.0) | 0.012 |
Chronic renal failure | 330 (17.3) | 161 (12.8) | 169 (25.9) | <0.001 |
Liver disease | 145 (7.6) | 92 (7.3) | 53 (8.1) | 0.523 |
Dementia | 147 (7.7) | 101 (8.0) | 46 (7.1) | 0.449 |
Main Infective discharge diagnosis | ||||
Bacterial diarrhea | 207 (10.8) | 142 (11.3) | 65 (10.0) | 0.379 |
Infective diarrhea (any) | 285 (14.9) | 202 (16.1) | 83 (12.7) | 0.053 |
Infection (any) | 1248 (65.3) | 753 (59.9) | 495 (75.9) | <0.001 |
BSI | 337 (17.8) | 92 (7.3) | 245 (37.6) | <0.001 |
COVID-19 infection | 179 (9.4) | 150 (11.9) | 29 (4.4) | <0.001 |
Clinical outcomes | ||||
Lenght of hospitalization | 9.0 [5.7–15.3] | 8.4 [5.5–14.4] | 10.0 [6.0–17.2] | 0.002 |
Death | 207 (10.8) | 100 (7.9) | 107 (16.4) | <0.001 |
ICU admission | 89 (4.7) | 35 (2.8) | 54 (8.3) | <0.001 |
Abdominal surgery | 101 (5.3) | 67 (5.3) | 34 (5.2) | 0.918 |
Variable | Infecrive Diarrhea | Univ. p Value | Odds Ratio [95% CI] | Multiv. p Value | |
---|---|---|---|---|---|
NO (N 1625) | YES (N 285) | ||||
Sex (Male) | 778 (47.9%) | 115 (40.4%) | 0.019 | 0.800 [0.613–1.045] | 0.101 |
Median age (years) | 69 [54–79] | 78 [66–83] | <0.001 | 1.023 [1.013–1.034] | <0.001 |
ED Presentation | |||||
Triage Code | 0.425 | ||||
| 85 (5.2) | 12 (4.2) | |||
| 456 (28.1) | 72 (25.3) | |||
| 1084 (66.7) | 201 (70.5) | |||
Associated symptoms | |||||
Cough | 184 (11.3) | 9 (3.2) | 0.001 | 0.265 [0.133–0.529] | <0.001 |
Vomiting | 542 (33.4) | 94 (33.0) | 0.902 | ||
Abdominal pain | 626 (38.5) | 90 (31.6) | 0.026 | ||
Chest pain | 44 (2.7) | 5 (1.8) | 0.348 | ||
Syncope | 162 (10.0) | 26 (9.1) | 0.658 | ||
Gastrointestinal bleeding | 86 (5.3) | 15 (5.3) | 0.964 | ||
Asthenia | 340 (20.9) | 46 (16.1) | 0.064 | ||
Confusion | 96 (5.9) | 16 (5.6) | 0.846 | ||
Anuresis | 32 (2.0) | 3 (1.1) | 0.287 | ||
Laboratory parameters | |||||
Hb (g/dL) | 12.2 [10.4–13.8] | 12.1 [10.4–13.5] | 0.566 | ||
WBC (cell/mm3) | 9.6 [6.3–14.3] | 11.0 [7.6–16.4] | <0.001 | 1.015 [1.002–1.028] | 0.027 |
Creatinine (mg/dL) | 0.9 [0.7–1.3] | 1.4 [0.9–2.4] | 0.018 | 1.040 [0.974–1.111] | 0.244 |
Blood glucose (mg/dL) | 112.0 [97.0–140.7] | 109.0 [94.5–135.5] | 0.151 | ||
PCT (ng/dL) | 0.18 [0.06–1.09] | 0.21 [0.07–13.9] | 0.813 | ||
PCT > 0.5 ng/dL (%) | 569 (35.0) | 83 (29.1) | 0.053 | 0.629 [0.470–0.843] | 0.002 |
CRP (mg/L) | 77.8 [24.6–156.2] | 101.4 [38.3–153.9] | 0.054 | ||
Clinical history | |||||
Charlson comorbidity score | 4 [2–6] | 5 [3–6] | <0.001 | 0.966 [0.906–1.029] | 0.278 |
Immunosuppressive therapy | 48 (3.0) | 8 (2.1) | 0.425 | ||
IBD | 129 (7.9) | 7 (2.5) | 0.001 | 0.336 [0.152–0.740] | 0.007 |
Ischemic cardiac disease | 149 (9.2) | 25 (8.8) | 0.830 | ||
Heart failure | 93 (5.7) | 30 (10.5) | 0.002 | ||
COPD | 123 (7.6) | 27 (9.5) | 0.270 | ||
Diabetes | 196 (12.1) | 41 (14.4) | 0.272 | ||
Chronic renal failure | 265 (16.3) | 65 (22.8) | 0.007 | ||
Liver disease | 130 (8.0) | 15 (5.3) | 0.108 | ||
Dementia | 116 (7.1) | 31 (10.9) | 0.0.29 | ||
Cancer | 349 (21.5) | 29 (10.2) | <0.001 | ||
Clinical outcomes | |||||
Abdominal surgery | 95 (5.8) | 8 (2.1) | 0.009 | ||
Lenght of hospitalization | 8.9 [5.5–15.0] | 9.4 [6.0–15.4] | 0.279 |
Variable | Bacterial Diarrhea | Univ. p Value | Odds Ratio [95% CI] | Multiv. p Value | |
---|---|---|---|---|---|
NO (N 1703) | YES (N 207) | ||||
Sex (Male) | 815 (47.9%) | 78 (37.7%) | 0.006 | 0.728 [0.527–1.005] | 0.054 |
Median age (years) | 69 [54–79] | 79 [71–84] | <0.001 | 1.045 [1.031–1.059] | <0.001 |
ED Presentation | |||||
Triage Code | 0.562 | ||||
| 87 (5.1) | 10 (4.8) | |||
| 477 (28.0) | 51 (24.6) | |||
| 1139 (66.9) | 146 (70.5) | |||
Associated symptoms | |||||
Cough | 187 (11.0) | 6 (2.9) | <0.001 | 0.274 [0.118–0.638] | 0.003 |
Vomiting | 574 (33.7) | 62 (30.0) | 0.279 | ||
Abdominal pain | 653 (38.3) | 63 (30.4) | 0.026 | 0.796 [0.569–1.114] | 0.183 |
Chest pain | 46 (2.7) | 3 (1.4) | 0.282 | ||
Syncope | 170 (10.0) | 18 (8.7) | 0.557 | ||
Gastrointestinal bleeding | 94 (5.5) | 7 (3.4) | 0.194 | ||
Asthenia | 354 (20.8) | 32 (15.5) | 0.071 | ||
Confusion | 100 (5.9) | 12 (5.8) | 0.965 | ||
Anuresis | 33 (1.9) | 2 (1.0) | 0.325 | ||
Laboratory parameters | |||||
Hb (g/dL) | 12.3 [10.5–13.8] | 11.7 [10.3–13.2] | 0.022 | 0.988 [0.921–1.060] | 0.739 |
WBC (cell/mm3) | 9.6 [6.3–14.2] | 12.3 [8.3–18.1] | <0.001 | 1.023 [1.008–1.038] | 0.003 |
Creatinine (mg/dL) | 1.0 [0.8–1.6] | 1.1 [0.7–2.0] | 0.103 | ||
Blood glucose (mg/dL) | 111.0 [97.0–140.0] | 113.0 [94.0–137.0] | 0.434 | ||
PCT (ng/dL) | 0.18 [0.06–1.06] | 0.21 [0.08–0.78] | 0.430 | ||
PCT > 0.5 ng/dL (%) | 587 (34.5) | 65 (31.4) | 0.379 | 0.617 [0.420–0.906] | 0.014 |
CRP (mg/L) | 75.7 [24.8–154.1] | 116.7 [45.1–160.8] | 0.002 | 1.002 [1.000–1.004] | 0.024 |
Clinical history | |||||
Charlson comorbidity score | 4 [2–6] | 5 [4–6] | <0.001 | 0.960 [0.889–1.037] | 0.303 |
Immunosuppressive therapy | 51 (3.0) | 3 (1.4) | 0.205 | ||
IBD | 130 (7.6) | 6 (2.9) | 0.012 | 0.483 [0.189–1.231] | 0.127 |
Ischemic cardiac disease | 157 (9.2) | 17 (8.2) | 0.635 | ||
Heart failure | 102 (6.0) | 21 (10.1) | 0.021 | ||
COPD | 127 (7.5) | 23 (11.1) | 0.065 | ||
Diabetes | 208 (12.2) | 29 (14.0) | 0.459 | ||
Chronic renal failure | 280 (16.4) | 50 (24.2) | 0.006 | ||
Liver disease | 133 (7.8) | 12 (5.8) | 0.302 | ||
Dementia | 120 (7.0) | 27 (13.0) | 0.002 | ||
Cancer | 359 (21.1) | 19 (9.2) | <0.001 | ||
Clinical outcomes | |||||
Need for abdominal surgery | 95 (5.6) | 6 (2.9) | 0.104 | ||
Lenght of hospitalization | 8.5 [5.5–15.0] | 11–0 [7.2–19.0] | <0.001 |
Variable | Infection (Any) | Univ. p Value | Odds Ratio [95% CI] | Multiv. p Value | |
---|---|---|---|---|---|
NO (N 662) | YES (N 1248) | ||||
Males | 309 (46.7%) | 584 (46.8%) | 0.961 | ||
Median age (years) | 66 [52–78] | 72 [58–82] | <0.001 | 1.030 [1.022–1.038] | <0.001 |
Ed Presentation | |||||
Triage Code | 0.372 | ||||
| 32 (4.8) | 65 (5.2) | |||
| 196 (29.6) | 332 (26.6) | |||
| 434 (65.6) | 851 (68.2) | |||
Vital signs | |||||
Heart rate | 90 [78–105] | 90 [79–104] | 0.967 | ||
Maximum Blood pressure (mmHg) | 120 [103–139] | 120 [103–139] | 0.837 | ||
Fever (>37.5 °C) | 421 (63.6) | 984 (78.8) | <0.001 | ||
Associated symptoms | |||||
Cough | 42 (6.3) | 151 (12.1) | <0.001 | 1.888 [1.280–2.784] | 0.001 |
Vomiting | 221 (33.4) | 415 (33.3) | 0.954 | ||
Abdominal pain | 293 (44.3) | 423 (33.9) | <0.001 | 0.775 [0.624–0.962] | 0.021 |
Chest pain | 22 (3.3) | 27 (2.2) | 0.127 | ||
Syncope | 65 (9.8) | 123 (9.9) | 0.979 | ||
Gastrointestinal bleeding | 56 (8.5) | 46 (3.6) | <0.001 | 0.539 [0.344–0.844] | 0.007 |
Asthenia | 151 (22.8) | 235 (18.8) | 0.039 | ||
Confusion | 36 (5.4) | 76 (6.1) | 0.563 | ||
Anuresis | 15 (2.3) | 20 (1.6) | 0.304 | ||
Laboratory parameters | |||||
Hb (g/dL) | 12.2 [10.3–13.8] | 12.2 [10.5–13.7] | 0.392 | ||
WBC (cell/mm3) | 9.5 [6.5–13.5] | 10.1 [6.6–13.5] | 0.005 | 1.006 [0.994–1.017] | 0.352 |
Creatinine (mg/dL) | 1.0 [0.7–1.7] | 1.0 [0.8–1.6] | 0.087 | ||
Blood glucose (mg/dL) | 111.0 [96.0–138] | 111.0 [97.0–141.0] | 0.495 | ||
PCT (ng/dL) | 0.14 [0.05–0.47] | 0.25 [0.07–1.68] | <0.001 | ||
PCT > 0.5 ng/dL (%) | 157 (23.7) | 495 (39.7) | <0.001 | 1.634 [1.258–2.121] | <0.001 |
CRP (mg/L) | 50.8 [12.5–129.5] | 95.9 [38.3–171.4] | <0.001 | 1.003 [1.002–1.004] | <0.001 |
Clinical history | |||||
Charlson comorbidity score | 4 [2–6] | 5 [3–6] | 0.125 | 0.859 [0.819–0.902] | <0.001 |
Immunosuppressive therapy | 18 (2.7) | 36 (2.9) | 0.835 | ||
IBD | 99 (15.0) | 37 (3.0) | <0.001 | 0.234 [0.153–0.360] | <0.001 |
Ischemic cardiac disease | 53 (8.0) | 121 (9.7) | 0.222 | ||
Heart failure | 39 (5.9) | 84 (6.7) | 0.477 | ||
COPD | 24 (3.6) | 126 (10.1) | <0.001 | ||
Diabetes | 83 (12.5) | 154 (12.3) | 0.272 | ||
Chronic renal failure | 107 (16.2) | 223 (17.9) | 0.348 | ||
Liver disease | 60 (9.1) | 85 (6.8) | 0.077 | ||
Dementia | 32 (4.8) | 115 (9.2) | 0.001 | ||
Cancer | 192 (29.0) | 186 (14.9) | <0.001 | ||
Clinical outcomes | |||||
Abdominal surgery | 25 (3.8) | 76 (6.1) | 0.032 | ||
Lenght of hospitalization | 7.5 [5.1–12.4] | 10.0 [6.0–17.0] | <0.001 |
Variable | Sepsis | Univ. p Value | Odds Ratio [95% CI] | Multiv. p Value | |
---|---|---|---|---|---|
NO (N 1573) | YES (N 337) | ||||
Males | 734 (46.7%) | 159 (47.2%) | 0.863 | 1.011 [0.768–1.329] | 0.940 |
Median age (years) | 69 [54–80] | 73 [62–81.5] | <0.001 | 1.008 [0.997–1.019] | 0.152 |
ED presentation | |||||
Triage Code | <0.001 | ||||
| 57 (3.6) | 40 (11.9) | |||
| 401 (25.5) | 127 (37.7) | |||
| 1115 (70.9) | 170 (50.4) | |||
Vital signs | |||||
Heart rate | 89 [78–104] | 94 [82.3–94] | 0.001 | ||
Maximum Blood pressure (mmHg) | 121 [106–139] | 113 [95–136] | <0.001 | ||
Fever (>37.5 °C) | 1152 (73.2) | 253 (75.1) | 0.487 | 0.960 [0.697–1.323] | 0.804 |
Associated symptoms | |||||
Cough | 178 (11.3) | 15 (4.5) | 0.001 | ||
Vomiting | 526 (33.4) | 110 (32.6) | 0.778 | ||
Abdominal pain | 613 (39.0) | 103 (30.6) | 0.004 | ||
Chest pain | 42 (2.7) | 7 (2.1) | 0.532 | ||
Syncope | 140 (8.9) | 48 (14.2) | 0.003 | ||
Gastrointestinal bleeding | 89 (5.7) | 12 (3.6) | 0.116 | ||
Asthenia | 314 (20.0) | 72 (21.4) | 0.560 | ||
Confusion | 77 (4.9) | 35 (10.4) | <0.001 | ||
Anuresis | 28 (1.8) | 7 (2.1) | 0.712 | ||
Laboratory parameters | |||||
Hb (g/dL) | 12.4 [10.6–13.9] | 11.2 [9.9–12.8] | <0.001 | ||
WBC (cell/mm3) | 9.7 [6.6–14.1] | 11.1 [5.8–16.9] | <0.001 | 1.002 [0.989–1.015] | 0.759 |
Creatinine (mg/dL) | 0.9 [0.7–1.3] | 1.4 [0.9–2.4] | 0.360 | 0.943 [0.865–1.027] | 0.179 |
Blood glucose (mg/dL) | 111.0 [96.0–138.0] | 116.5 [96.2–148.0] | 0.090 | ||
PCT (ng/dL) | 0.14 [0.05–0.52] | 2.6 [0.36–20.78] | <0.001 | ||
PCT > 0.5 ng/dL (%) | 407 (25.9) | 245 (72.7) | <0.001 | 6.694 [4.869–9.202] | <0.001 |
CRP (mg/L) | 68.4 [22.0–143.7] | 148.7 [69.2–217.4] | <0.001 | 1.002 [1.000–1.003] | 0.025 |
Clinical history | |||||
Charlson comorbidity score | 4 [2–6] | 5 [3–7] | <0.001 | 1.060 [0.992–1.132] | 0.087 |
Immunosuppressive therapy | 41 (2.6) | 13 (3.9) | 0.209 | 2.069 [0.990–4.370] | 0.067 |
IBD | 128 (8.1) | 6 (2.4) | <0.001 | 0.481 [0.212–1.090] | 0.003 |
Ischemic cardiac disease | 136 (8.6) | 38 (11.3) | 0.128 | ||
Heart failure | 101 (6.4) | 22 (6.5) | 0.942 | ||
COPD | 122 (7.8) | 28 (8.3) | 0.732 | ||
Diabetes | 190 (12.1) | 47 (13.9) | 0.345 | ||
Chronic renal failure | 234 (14.9) | 96 (28.5) | <0.001 | ||
Liver disease | 123 (7.8) | 22 (6.5) | 0.417 | ||
Dementia | 122 (7.8) | 25 (7.4) | 0.833 | ||
Cancer | 1290 (18.4) | 88 (26.) | 0.001 | ||
Clinical outcomes | |||||
Abdominal surgery | 384 (5.3) | 17 (5.0) | 0.826 | ||
Lenght of hospitalization | 8.4 [5.4–14.0] | 13.5 [7.8–25.1] | <0.001 |
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Gallo, A.; Covino, M.; Ianua’, E.; Piccioni, A.; Della Polla, D.; Simeoni, B.; Franceschi, F.; Landi, F.; Montalto, M. The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department. Diagnostics 2025, 15, 734. https://doi.org/10.3390/diagnostics15060734
Gallo A, Covino M, Ianua’ E, Piccioni A, Della Polla D, Simeoni B, Franceschi F, Landi F, Montalto M. The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department. Diagnostics. 2025; 15(6):734. https://doi.org/10.3390/diagnostics15060734
Chicago/Turabian StyleGallo, Antonella, Marcello Covino, Eleonora Ianua’, Andrea Piccioni, Davide Della Polla, Benedetta Simeoni, Francesco Franceschi, Francesco Landi, and Massimo Montalto. 2025. "The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department" Diagnostics 15, no. 6: 734. https://doi.org/10.3390/diagnostics15060734
APA StyleGallo, A., Covino, M., Ianua’, E., Piccioni, A., Della Polla, D., Simeoni, B., Franceschi, F., Landi, F., & Montalto, M. (2025). The Prognostic Role of Serum Procalcitonin for Adult Patients with Acute Diarrhea in the Emergency Department. Diagnostics, 15(6), 734. https://doi.org/10.3390/diagnostics15060734