Love the first video, (and the popcorn)! When I was a resident, I thought it was interesting to correlate it with the the inflammation/infection. Some patients with severe sepsis had really impressive procal, but so did some patients with malignancy. Decided that more numbers/data would not substitute clinical acumen. Thanks for making the video! -Joan
I’m glad to hear your not on the side of this parameter. I dislike it when ppl reach for this tool readily to make a decision if there is infection or not. Many times I’ve found it is elevated and antibiotics are started when the patient doesn’t look toxic. The residents at my institution know that I don’t like to order it because I make them think classically using the history, exam and labs to decipher what the likelihood is of infection. This leads to better antibiotic stewardship in the long run.
Good video. Procalcitonin can be useful in edge cases if one is really on the fence about antibiotic therapy, like bnp for chf exacerbation or d dimer for pe. But 9 times out of 10 (in my experience) it is ordered in a case in which antibiotics will be given regardless of the result. My residents also often overestimate its specificity for bacterial infections.
Thank you for the video. Procalcitonin is part of the work up routine work up for patients attending the emergency with fever in my institute. We found it helpful in patients with bacterial colonization to direct our decision among other factors. We also saw elevated levels in patients with malaria falciparum infection with high parasitemia.
Excellent and handy review of debatable topic One of roles of procalcitonin I found before giving biologicals in covid patients to be sure of attributing elevated interleukin levels to cytokine storm
Reza, this is a great first video! I remember being in the peds wards and debating with attendings about the utility of procal but being very aware as a medical student nothing I said meant anything. Now that I've graduated and watched your video I'm ready to come back with a vengeance! 😤
Great vid! Isn't it PAMPs which cause stimulation of TLRs from innate immune cells leading to the release of TNF-alpha? Nonetheless, amazing video. Keep making hits!
We used procalcitonin in Covid department to decide whether or not there is bacterial superinfection (and cover it with atb) since COVID, in spite of being virus, often causes high levels of CRP.
Hi Reza, hope you’re doing well. Thank you for uploading this. Some of the residents I worked with as a med student used to order procal only for the sake of hospital protocol and fear of the attending’s reaction if they chose not to. I understand the utility better now! While you did bring up bacterial and viral infections, would you know of procal’s trend in other infectious causes? Like fungal or atypical orgs.
Naba! So sorry for the delay. I totally missed this comment. I do not know but up-to-date has a pretty nice table of atypical organisms that cause elevated procal though my reading the main focus, as you mentioned, was for typical bacteria versus viruses for acute infections.
