The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Cutoff value of serum procalcitonin as a diagnostic biomarker of infection in end-stage renal disease patients

  • Lee, Wan Soo (Department of Internal Medicine, Chosun University School of Medicine) ;
  • Kang, Dae Woong (Department of Internal Medicine, Chosun University School of Medicine) ;
  • Back, Jong Hun (Department of Internal Medicine, Chosun University School of Medicine) ;
  • Kim, Hyun Lee (Department of Internal Medicine, Chosun University School of Medicine) ;
  • Chung, Jong Hoon (Department of Internal Medicine, Chosun University School of Medicine) ;
  • Shin, Byung Chul (Department of Internal Medicine, Chosun University School of Medicine)
  • Received : 2014.02.08
  • Accepted : 2014.05.27
  • Published : 2015.03.01
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Abstract

Background/Aims: Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level. Methods: Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20). Results: The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group ($2.95{\pm}3.67ng/mL$ vs. $0.50{\pm}0.49ng/mL$, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL. Conclusions: This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.

Keywords

References

  1. Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Clinical review 167: procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512-1525. https://doi.org/10.1210/jc.2002-021444
  2. Lu XL, Xiao ZH, Yang MY, Zhu YM. Diagnostic value of serum procalcitonin in patients with chronic renal insufficiency: a systematic review and meta-analysis. Nephrol Dial Transplant 2013;28:122-129. https://doi.org/10.1093/ndt/gfs339
  3. Tang H, Huang T, Jing J, Shen H, Cui W. Effect of pro-calcitonin-guided treatment in patients with infections: a systematic review and meta-analysis. Infection 2009;37:497-507. https://doi.org/10.1007/s15010-009-9034-2
  4. Hur M, Moon HW, Yun YM, Kim KH, Kim HS, Lee KM. Comparison of diagnostic utility between procalcitonin and C-reactive protein for the patients with blood culture-positive sepsis. Korean J Lab Med 2009;29:529-535. https://doi.org/10.3343/kjlm.2009.29.6.529
  5. Mitaka C. Clinical laboratory differentiation of infectious versus non-infectious systemic inflammatory response syndrome. Clin Chim Acta 2005;351:17-29. https://doi.org/10.1016/j.cccn.2004.08.018
  6. Pfafflin A, Schleicher E. Inflammation markers in pointof-care testing (POCT). Anal Bioanal Chem 2009;393:1473-1480. https://doi.org/10.1007/s00216-008-2561-3
  7. Whicher J, Bienvenu J, Monneret G. Procalcitonin as an acute phase marker. Ann Clin Biochem 2001;38(Pt 5):483-493. https://doi.org/10.1177/000456320103800505
  8. Boucher BA. Procalcitonin: clinical tool or laboratory curiosity? Crit Care Med 2000;28:1224-1225. https://doi.org/10.1097/00003246-200004000-00056
  9. Kuse ER, Langefeld I, Jaeger K, Kulpmann WR. Procalcitonin in fever of unknown origin after liver transplantation: a variable to differentiate acute rejection from infection. Crit Care Med 2000;28:555-559. https://doi.org/10.1097/00003246-200002000-00044
  10. Herget-Rosenthal S, Marggraf G, Pietruck F, et al. Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant 2001;16:975-979. https://doi.org/10.1093/ndt/16.5.975
  11. Lavin-Gomez BA, Palomar-Fontanet R, Gago-Fraile M, et al. Inflammation markers, chronic kidney disease, and renal replacement therapy. Adv Perit Dial 2011;27:33-37.
  12. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39:206-217. https://doi.org/10.1086/421997
  13. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000;28:68-73. https://doi.org/10.1007/s150100050049
  14. Kang YA, Kwon SY, Yoon HI, Lee JH, Lee CT. Role of C-reactive protein and procalcitonin in differentiation of tuberculosis from bacterial community acquired pneumonia. Korean J Intern Med 2009;24:337-342. https://doi.org/10.3904/kjim.2009.24.4.337
  15. Kim SW, Oh YM, Choe SM, Choe GH, Park KN, Oh JS. Practical application of semiquantitative procalcitonin test in emergency department. J Korean Soc Emerg Med 2008;19:665-671.
  16. Dahaba AA, Rehak PH, List WF. Procalcitonin and C-reactive protein plasma concentrations in nonseptic uremic patients undergoing hemodialysis. Intensive Care Med 2003;29:579-583. https://doi.org/10.1007/s00134-003-1664-8
  17. Level C, Chauveau P, Delmas Y, et al. Procalcitonin: a new marker of inflammation in haemodialysis patients? Nephrol Dial Transplant 2001;16:980-986. https://doi.org/10.1093/ndt/16.5.980
  18. Montagnana M, Lippi G, Tessitore N, et al. Procalcitonin values after dialysis is closely related to type of dialysis membrane. Scand J Clin Lab Invest 2009;69:703-707. https://doi.org/10.3109/00365510902993663
  19. Herget-Rosenthal S, Klein T, Marggraf G, et al. Modulation and source of procalcitonin in reduced renal function and renal replacement therapy. Scand J Immunol 2005;61:180-186. https://doi.org/10.1111/j.0300-9475.2005.01545.x
  20. Lee SJ, Jung YC, Jeon DO, et al. High serum C-reactive protein level predicts mortality in patients with stage 3 chronic kidney disease or higher and diabetic foot infections. Kidney Res Clin Pract 2013;32:171-176. https://doi.org/10.1016/j.krcp.2013.10.001

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