Is procalcitonin a useful biomarker for the risk stratification of facial cellulitis?

Abstract

Background: Facial cellulitis is an infectious disease that may require emergency surgical drainage based on clinical assessment. To date, no biological marker has been reported to be useful for risk stratification. Procalcitonin (PCT) is a diagnostic and prognostic sepsis biomarker. We aimed to study the usefulness of PCT dosage for the risk-stratification of facial cellulitis.

Patients and methods: This was a monocentric prospective study conducted in a referral center for maxillofacial emergencies. Patients with a diagnosis of facial cellulitis were included and underwent a PCT measurement at admission. The main criterion was the requirement for surgical drainage.

Results: Seventy consecutive patients were included in a 7-months period, mean age 35 ± 14 years. Surgical drainage was required for 48 patients (68%). Serum PCT concentrations were strictly negative in most patients (median [IQR]: 0.05 μg/L [0.05; 0.10]). Only 6 patients (9%) had PCT values above the clinical threshold of 0.25 μg/L. At a threshold of 0.1 μg/L, PCT was 30% sensitive and 100% specific for surgical drainage requirement.

Conclusion: PCT level usually remains in a low range in facial cellulitis and seems to have a limited added value for risk stratification.

Keywords: Emergency department; Facial cellulitis; Procalcitonin; Severity assessment.