Co esponding au ho : Mazi Mohammed Alanazi.
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
The p ecision o p ocalci onin as a bioma ke o sepsis in adul eme gency
depa men isi s: A sys ema ic e iew
Mazi Mohammed Alanazi 1, *, Moayad Abdullah Jabe Za bh 2 and Fahad Salman Salem Shalwan 2
1 Saudi and Jo danian Boa d Eme gency Medicine, Head o Eme gency Resea ch Uni , Eme gency Depa men , Fi s Heal h
Clus e , Riyadh, Saudi A abia.
2 Saudi boa d eme gency medicine esiden s, A med o ces hospi al sou he n egion, Abha, Saudi A abia.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
Publica ion his o y: Recei ed on 04 Ap il 2025; e ised on 11 May 2025; accep ed on 13 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1883
Abs ac
Backg ound: Sepsis is a li e- h ea ening condi ion and a signi ican cause o mo ali y among pa ien s p esen ing o
eme gency depa men s (EDs). Ea ly diagnosis is essen ial o ini ia e ea men and imp o e ou comes. P ocalci onin
(PCT), le el inc ease in esponse o bac e ial in ec ion, has been ecen ly examined o i s ole in diagnosing and
p ognos ica ing sepsis. This sys ema ic e iew aimed o e alua e he diagnos ic accu acy o PCT in adul pa ien s wi h
suspec ed sepsis in he ED se ing.
Me hods: The e iew was conduc ed in acco dance wi h PRISMA guidelines. We conduc a li e a u e sea ch o PubMed,
Scopus, Web o Science, and Google Schola o s udies published be ween 2015 and 2024. S udies we e included i hey
in es iga ed se um PCT le els in adul ED pa ien s wi h sepsis and epo ed diagnos ic o p ognos ic ou comes. Nine
eligible o iginal s udies we e included.
Resul s: P ocalci onin show a mode a e o high speci ici y in di e en ia ing sepsis om non-in ec ious condi ions.
Ele a ed PCT on admission we e associa ed wi h highe isks o sep ic shock, bac e emia, and mo ali y. Sensi i i y
di e s depending on disease s age and pa ien popula ion. PCT was enhanced when combined wi h o he bioma ke s
o sco ing sys ems such as IL-6, MDW, o qSOFA.
Conclusion: PCT is a use ul bioma ke o ea ly sepsis de ec ion in eme gency se ings. I s use in combina ion wi h
clinical ools p o ide be e diagnos ic accu acy and imp o e pa ien managemen .
Keywo ds: P ocalci onin; Sepsis, Bioma ke s; Eme gency Depa men ; Diagnosis; P ognosis; Sys ema ic Re iew;
Sepsis-3; Qso a; Bac e ial In ec ion
1. In oduc ion
Sepsis is a majo heal h p oblem and leading cause o mo bidi y and mo ali y in eme gency depa men s (EDs). Ea ly
ecogni ion is impo an in imp o ing ou comes o pa ien s wi h sepsis. Ea ly diagnosis is challenging due o he
nonspeci ic clinical signs and delays in mic obiological con i ma ion. Recen ly, bioma ke s we e ega ded as aluable
in es iga ion in addi ion o clinical assessmen . P ocalci onin (PCT) shown a good imp o emen in he diagnos ic
accu acy in sepsis managemen (Cong e al. 2021). PCT is a p ecu so o calci onin, no mally p oduced by hy oid C-
cells, and up egula ed in esponse o sys emic bac e ial in ec ions. PCT is less a ec ed by non-in ec ious in lamma ion
and ises ea lie in bac e ial in ec ions, gi ing a good me hod o ea ly de ec ion o sepsis in he ED se ing (Song e al.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
1924
2019). This bioma ke ge a en ion o i s diagnos ic accu acy and i s u ili y in guiding an ibio ic s ewa dship (Naze
e al. 2024).
A mul icen e p ospec i e s udy ound ha monocy e dis ibu ion wid h (MDW) had a good pe o mance in sensi i i y,
and PCT had be e speci ici y in adul ED pa ien s suspec ed o sepsis (Haus a e e al. 2021). PCT di e en ia e
in ec ious om non-in ec ious causes o sys emic in lamma ion, i had be e speci ici y when compa ed o IL-6 and CRP
o sepsis diagnosis, i s sensi i i y di e s depending on disease se e i y and ime o measu emen (Lee e al. 2022). PCT
is use ul in p edic ing p og ession o sep ic shock o mo ali y. Ele a ed PCT le els upon admission associa ed wi h
wo se ou comes in pa ien s mee ing Sepsis-3 c i e ia (Jeka l e al. 2019). I s u ili y is limi ed in speci ic popula ions,
such as immunocomp omised indi iduals o hose wi h malignancies, whe e in lamma o y esponses di e (Moisa e
al. 2023). P e ious li e a u e sugges s he use o PCT in clinical p o ocols o he e alua ion o sepsis in he ED. I can be
used as a bioma ke o ea ly de ec ion and a ool o imp o e clinical decision-making in u gen si ua ions (Yan and
Zhang 2021). Ou sys ema ic e iew aimed o e alua e he e ec i eness o p ocalci onin o sepsis diagnosis in adul
eme gency depa men pa ien s.
2. Me hod
Ou sys ema ic e iew was conduc ed o discuss he e ec i eness o p ocalci onin (PCT) in adul pa ien s wi h sepsis.
The s udy was conduc ed acco ding o he P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses
(PRISMA) guidelines.
2.1. Sea ch S a egy and S udy Selec ion
We conduc a comp ehensi e li e a u e o iden i y pee - e iewed s udies examined he ole o PCT in he diagnosis and
p ognosis o sepsis. We sea ched o English a icles published in he pe iod om 2015 o 2024 in elec onic da abases
(PubMed, Web o Science, Scopus, and Google Schola ). Sea ch e ms used include a combina ion o (p ocalci onin, PCT,
sepsis, diagnosis, p ognosis, mo ali y, and bioma ke ). Two au ho s sc eened i les and abs ac s, and ano he wo
au ho s assessed he ull- ex a icles o eligibili y. We e iewed e e ence lis s o included s udies o iden i y any
ele an publica ions. We include 9 o iginal esea ch a icles me he inclusion c i e ia in he inal e iew (Fig 1).
2.2. Inclusion and Exclusion C i e ia
S udies we e included i hey; in ol ed adul pa ien s (≥18 yea s) wi h suspec ed o con i med sepsis; measu ed se um
p ocalci onin le els as a diagnos ic o p ognos ic bioma ke ; epo ed diagnos ic accu acy, o ou comes such as
mo ali y, sep ic shock, o bac e emia; used obse a ional (p ospec i e o e ospec i e) o in e en ional designs. We
exclude s udies on pedia ic popula ions o p egnan women; non-o iginal esea ch such as e iews, edi o ials, and case
epo s; s udies no epo ing speci ic PCT- ela ed ou comes.
2.3. Da a Ex ac ion and Syn hesis
Da a we e ex ac ed om each s udy, including s udy design, popula ion cha ac e is ics, PCT cu -o alues, diagnos ic
ools compa ed, and key ou comes. Due o he e ogenei y in s udy designs and ou come epo ing, a quali a i e syn hesis
was pe o med. Me hodological quali y and isk o bias we e assessed na a i ely by e alua ing inclusion c i e ia cla i y,
sample size, and use o app op ia e s a is ical me hods.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
1925
Figu e 1 PRISMA conso cha o selec ed s udies
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
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3. Resul and discussion
The indings o his s udy discussed he diagnos ic and p ognos ic u ili y o p ocalci onin (PCT) in he managemen o
sepsis. PCT show mode a e o high accu acy in di e en ia ing sepsis om non-in ec ious condi ions and guiding ea ly
in e en ion s a egies. A ecen sys ema ic e iew and me a-analysis, conclude ha PCT is a eliable bioma ke o
ea ly diagnosis o sepsis in eme gency depa men pa ien s. The me a-analysis, included nea ly 3,000 pa ien s, ound
ha ele a ed PCT le els co ela ed wi h bac e ial in ec ions, p o iding a p ac ical ool o dis inguish sepsis om non-
in ec ious SIRS in ED (Zaki e al. 2024). This sys ema ic e iew ound ha PCT show a high sensi i i y and speci ici y in
mul iple coho s, mainly in dis inguishing bac e ial sepsis om sys emic candidiasis o i al illnesses.
A la ge e ospec i e s udy o eb ile hospi alized pa ien s suppo s he ea ly PCT measu emen . The au ho s ound ha
in pa ien s wi h qSOFA sco es ≥2, ea ly PCT de e mina ion was associa ed wi h educed in-hospi al mo ali y (Co ino
e al. 2021). This suppo s ou inding abou ea ly assessmen o PCT le els which can p o ide ou come p edic ion. Ou
e iewed s udies, including Ko e al. and Mus a ić e al., showed ha imely measu emen o PCT a ED p esen a ion has
p ognos ic alue, in p edic ing sep ic shock o mo ali y.
Among HIV popula ions, PCT has shown simila p ognos ic ele ance. A ecen s udy ound ha ele a ed PCT le els
(≥0.5 ng/mL) associa ed wi h inc eased in-hospi al mo ali y among HIV-posi i e pa ien s wi h e e (Celani e al.
2025). This inding accen ua es he bioma ke ’s ole in immunocomp omised indi iduals, hough cau ion mus be
exe cised in such subg oups due o a iabili y in immune esponse. Ou indings e lec ed challenges in
immunocomp omised popula ions, in he s udy by Keçe e al., PCT and lac a e showed modes diagnos ic pe o mance
among cance pa ien s, which indica e ha bioma ke h esholds need adjus men in such coho s.
Ou indings suppo PCT’s diagnos ic capabili ies, and indica e i s limi a ions as a s andalone ma ke . This iew is
suppo ed by ano he sys ema ic e iew, which in es iga e combina ions o bioma ke s and clinical sco ing sys ems o
mo ali y p edic ion in sepsis. The e iew concluded ha PCT, achie ed he highes p edic i e alue when in eg a ed
wi h lac a e o IL-6 and clinical sco es like SAPS-2 o qSOFA (Tong-Minh e al. 2021). This go in line wi h ou analysis o
s udies like Xie e al. and Woo e al., whe e PCT’s accu acy imp o ed subs an ially when used wi h addi ional ma ke s
o clinical sco ing ools. These mul imodal s a egies p o ide a comp ehensi e pic u e o pa ien s a us and imp o e
clinical decision-making.
I is impo an o no e ha newe bioma ke s such as IL-6 and calp o ec in eme ged. In a ecen p ospec i e s udy, CRP
and IL-6 pe o m be e ha PCT in iden i ying in ec ion in pa ien s wi h suspec ed sepsis in he ED (Ch is ensen e al.
2022). PCT had a good diagnos ic accu acy, bu i s la e peak in compa ison o IL-6 limi ed i s use in ea ly de ec ion.
Ou indings suppo his conclusion abou PCT good speci ici y, bu i was no he mos sensi i e ma ke and
unde achie e in ea ly-s age de ec ion compa ed o newe indica o s like MDW.
Ou e iew suppo ed PCT ole in moni o ing dynamic changes o e ime. Se e al s udies, such as Webb e al., indica ed
he p ognos ic implica ions o se ial PCT measu emen s. This dynamic u ili y was ma ched in he longi udinal design o
Ch is ensen e al., whe e bioma ke s including PCT we e acked h oughou he i s week o hospi aliza ion. PCT
peaked la e han IL-6, i s endency o e ime p o ided complemen a y in o ma ion ha helped e ine in ec ion
ecogni ion and an ibio ic managemen s a egies. Cha ac e is ics o he included s udies p esen ed in (Table 1),
in e en ion and main indings o he included s udies p esen ed in (Table 2).
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
1927
Table 1 cha ac e is ics o he included s udies
Ci a io
n
S udy
Design
S udy Aim
Inclusion C i e ia
Me hodology
Miglie
a e al.
2015
Re ospe
c i e
coho
Assess accu acy o PCT, CRP, LDH, and pla ele coun as ea ly
ma ke s o di e en ia ing SIRS, bac e ial sepsis, and sys emic
candidiasis.
ICU pa ien s wi h ≥2 SIRS c i e ia and
clinical signs o sepsis.
Re ospec i e analysis; ROC
cu e analysis o bioma ke s
di e en ia ion.
Ko e al.
2016
Re ospe
c i e
coho
E alua e ini ial p ocalci onin le el as a p edic o o p og ession
o sep ic shock in pa ien s wi h sepsis om acu e pyeloneph i is
(APN) due o u e e al s ones.
Pa ien s p esen ing o ED wi h sepsis
due o APN om u e e al calculi.
Clinical a iables analysis;
logis ic eg ession; ROC
cu es.
Li e al.
2022
P ospec i
e coho
Compa e diagnos ic accu acy o monocy e dis ibu ion wid h
(MDW) and p ocalci onin (PCT) in diagnosing sepsis.
ED pa ien s ca ego ized in o non-
in ec ion, in ec ion wi hou SIRS,
in ec ion wi h SIRS, and sepsis-3.
P ospec i e da a collec ion;
ROC cu es;
sensi i i y/speci ici y
analysis.
Webb
e al.
2020
Re ospe
c i e
coho
E alua e ini ial and subsequen PCT le els o p edic ing
posi i e blood cul u es, in-hospi al mo ali y, and sep ic shock.
Pa ien s p esen ing o ED diagnosed
wi h se e e sepsis.
Re ospec i e e iew;
co ela ion o PCT le els wi h
clinical ou comes.
Mus a i
ć e al.
2018
P ospec i
e coho
E alua e p edic i e alue o PCT in diagnosing sepsis, p edic ing
posi i e blood cul u es, and mo ali y in sep ic pa ien s.
Hospi alized pa ien s mee ing ≥2 SIRS
c i e ia.
P ospec i e e alua ion; ROC
cu e analysis.
Keçe e
al. 2016
P ospec i
e case-
con ol
Compa e diagnos ic and p ognos ic u ili ies o lac a e and PCT
in sepsis among adul cance pa ien s.
Cance pa ien s in ED wi h ≥2 SIRS
c i e ia.
P ospec i e da a collec ion;
ROC cu e analysis o lac a e
and PCT.
Xie e
al. 2020
Re ospe
c i e
coho
Iden i y bioma ke s combina ion o p edic 28-day mo ali y in
sepsis pa ien s upon ED a i al.
ED pa ien s mee ing Sepsis-3 c i e ia.
Mul i a ia e logis ic
eg ession; ROC analysis o
bioma ke combina ions.
Lin e
al. 2017
Re ospe
c i e
coho
E alua e diagnos ic alue o PCT, lac a e, and hs-CRP in
p edic ing bac e emia in adul ED pa ien s.
Adul pa ien s suspec ed o ha ing
sepsis in he ED.
ROC analysis; sensi i i y,
speci ici y, and diagnos ic
odds a io e alua ions.
Woo e
al. 2021
P ospec i
e coho
Compa e monocy e dis ibu ion wid h (MDW) wi h CRP and
PCT o ea ly sepsis de ec ion.
Adul s (18-80 yea s) isi ing he ED.
P ospec i e da a collec ion;
ROC analysis; diagnos ic
pe o mance analysis.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
1928
Table 2 In e en ion and main indings o he included s udies
Ci a ion
Demog aphic
Cha ac e is ics
In e en ion
Ou come
Main Findings
Miglie a
e al.
2015
145 ICU pa ien s, mean age 63
yea s
Measu emen o PCT,
CRP, LDH, Pla ele s
Di e en ia ion accu acy among SIRS,
bac e ial sepsis, candidiasis
PCT and CRP signi ican ly highe in bac e ial
sepsis han in SIRS and candidiasis
Ko e al.
2016
49 pa ien s wi h u e e al
s ones, mean hospi aliza ion
=12 days
Ini ial p ocalci onin
measu emen
P edic ion o sep ic shock
High ini ial PCT le el independen ly p edic s
p og ession o sep ic shock
Li e al.
2022
402 ED pa ien s, di ided in o 4
g oups
Monocy e dis ibu ion
wid h and PCT
measu emen
Diagnos ic accu acy o sepsis
Combina ion o MDW and WBC p o ides be e
sensi i i y and speci ici y compa ed o PCT
alone
Webb e
al. 2020
ED pa ien s wi h se e e sepsis;
median ini ial PCT 0.58 ng/mL
Ini ial and subsequen
PCT measu emen
P edic i e co ela ion wi h posi i e
blood cul u es, mo ali y, and sep ic
shock
PCT >2.0 ng/mL signi ican ly co ela es wi h
posi i e blood cul u es, mo ali y, and sep ic
shock
Mus a ić
e al.
2018
106 hospi alized pa ien s wi h
≥2 SIRS c i e ia
PCT, CRP, lac a e
measu emen
Sepsis diagnosis accu acy and 28-day
mo ali y p edic ion
PCT shows excellen p edic i e alue o sepsis
diagnosis and mo ali y p edic ion
Keçe e
al. 2016
86 cance pa ien s, mean age
61 yea s
Measu emen o lac a e
and PCT
Diagnos ic/p ognos ic u ili y in sepsis
Nei he lac a e no PCT alone eliably
di e en ia es sepsis om non-in ec ious SIRS
Xie e al.
2020
90 sepsis pa ien s, 28-day
ollow-up
IL-6, PCT, lac a e,
neu ophil- o-WBC a io
28-day mo ali y p edic ion
Combina ion o IL-6, PCT, lac a e, NWR
p o ides bes p edic i e accu acy o mo ali y
Lin e al.
2017
886 ED pa ien s suspec ed o
sepsis
Measu emen o PCT,
lac a e, hs-CRP
P edic ion o posi i e blood bac e ial
cul u e
PCT ou pe o ms lac a e and hs-CRP in
p edic ing posi i e blood cul u es
Woo e al.
2021
549 ED pa ien s (18-80 yea s)
Measu emen o MDW,
CRP, PCT
Diagnos ic accu acy o ea ly sepsis
MDW compa able o CRP and PCT; combina ion
wi h qSOFA enhances sepsis de ec ion accu acy
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 1923-1930
1929
Lis o abb e ia ions
• PCT: p ocalci onin,
• ED: eme gency depa men ,
• SIRS: sys emic in lamma o y esponse synd ome,
• CRP: C- eac i e p o ein,
• IL-6: in e leukin-6,
• MDW: monocy e dis ibu ion wid h,
• qSOFA: quick Sequen ial O gan Failu e Assessmen ,
• ICU: in ensi e ca e uni ,
• AUC: a ea unde he cu e,
• PLWH: people li ing wi h HIV,
• DDD: de ined daily dose,
• ROC: ecei e ope a ing cha ac e is ic,
• WBC: whi e blood cell,
• COVID-19: co ona i us disease 2019,
• SAPS-2: Simpli ied Acu e Physiology Sco e II.
4. Conclusion
PCT is alida ed in mul iple se ings as a good bioma ke o sepsis diagnosis, se e i y assessmen , and p ognosis. I
p o ides high speci ici y and be e han clinical sco ing sys ems o o he bioma ke s like MDW, IL-6, o WBC. Fu u e
esea ches should ocus on PCT mul imodal diagnos ic algo i hms o imp o e ea ly de ec ion and guide he apeu ic
in e en ions mo e e ec i ely.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
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