High Serum Procalcitonin Levels Do Not Predict Bacteremia in Adult Patients with Acute Fever

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Abstract
SIR—We have been interested in the recent article by Chirouze et al. [1] that demonstrated the usefulness of procalcitonin (PCT) measurement for ruling out a diagnosis of infection in acutely febrile patients admitted to the hospital. Chirouze et al. [1] found that a PCT level of <0.4 ng/mL was associated with a high negative predictive value (98.8%) for ruling out bacteremia, and we agree with this finding. However, the authors' conclusion that“PCT findings...can accurately predict bacteremia” ([1], p. 160) in those patients is questionable. Indeed, the authors reported a positive predictive value of only 25% for PCT levels above a threshold of 0.4 ng/mL. Furthermore, even with a PCT cutoff level of 6.2 ng/mL (see table 3 in Chirouze et al. [1]), the positive predictive value of PCT remained very poor (31%).