National external quality assessment and direct method comparison reflect crucial deviations of Procalcitonin measurements in Germany

[Display omitted] •Procalcitonin EQA schemes reveal crucial deviations of Procalcitonin measurements in Germany.•Human sample comparison confirms the lack of PCT standardization.•Commutability of calibrator materials needs to be characterized intensively.•Medical divergent results from the immunoassays of DiaSys and Abbott can be interchanged using specific non-linear conversion factors. Sepsis is a major concern worldwide, affecting 49 million individuals and being related to 11 million deaths. Its fast diagnosis is the key factor to guarantee a positive prognosis. Procalcitonin (PCT) has emerged as one powerful biomarker to early diagnose sepsis and for monitoring of antibiotic treatment. However, its clinical utility is jeopardized by missing standardisation. Here we present a 1-year follow-up of the External Quality Assessment (EQA) in Germany, depicting substantial discrepancies among manufacturers and the used assay technology of current PCT measurements. A direct method comparison on two immunoassays (Abbott vs. DiaSys) on a set of 135 routine samples was used to analyse the causes of observed deviations. All BRAHMS-licensed manufacturers (Thermo, Roche, Abbott, Siemens, Biomérieux), the Beckman and DiaSys immunoassays as well as all assay types (fluorescence, luminescence, PETIA) reveal substantial recovery differences between each other. However, upon a non-linear re-standardization of calibrators, the two directly compared methods (Abbott, DiaSys) are well interchangeable. This work demonstrates the heterogenic situation of PCT measurements in Germany among manufacturers and all methods. By introducing dedicated correction factors, comparable results of PCT can be achieved. This work also strengthens the inevitability of calibrator traceability and higher metrological reference materials on PCT.