Diagnostic value of serum procalcitonin for diagnosis of bacterial infection in patients with chronic kidney disease under hemodialysis

Rasoul Estakhri,Hamid Noshad,Hojjat Barghi,Nava Moghadasian Niaki,Mohammad Asghari

doi:10.15171/ipp.2020.08

Abstract

Introduction: Bacterial infections are common causes of mortality and morbidity among chronic kidney disease (CKD) patients under hemodialysis. Objectives: In this study the diagnostic value of serum procalcitonin for diagnosis of bacterial infections in patients with CKD under hemodialysis was assessed. Patients and Methods: In this cross-sectional comparative investigation, 47 patients with CKD under hemodialysis were enrolled to the study. We studied the relationship of serum procalcitonin (PTC) and C-reactive protein (CRP) levels (before and after dialysis) with "positive bacterial culture" and "systemic inflammatory response syndrome (SIRS)" results. Sensitivity and specificity were determined by ROC test. Results: Serum PTC before and after dialysis as well as the CRP before dialysis had no significant association with positive bacterial culture (P=0.492, P=0.1 and P=0.268 respectively), however after-dialysis CRP had a significant association with positive bacterial culture (P=0.032). Conclusion: According to the obtained results, it may be concluded that the diagnostic value of serum PTC for diagnosis of positive culture bacterial infections in hemodialysis patients is not satisfactory since the serum CRP level especially after dialysis is more useful.

Highlights

Bacterial infections are common causes of mortality and morbidity among chronic kidney disease (CKD) patients under hemodialysis
In a study on 47 patients with CKD under hemodialysis, we found that serum C-reactive protein had better applicability versus procalcitonin and the increase in C-reactive protein had a better predictive value
The important causes of differed results between culture and systemic inflammatory response syndrome (SIRS) were slow-growth of some organisms, simultaneous fungal or parasitic infections, human errors, non-reliable drug history especially for self-prescribed use of antibiotics leading to high-effect in PCT versus C-reactive protein (CRP) when used in current 48 hours

Summary

Introduction

Bacterial infections are common causes of mortality and morbidity among chronic kidney disease (CKD) patients under hemodialysis. Objectives: In this study the diagnostic value of serum procalcitonin for diagnosis of bacterial infections in patients with CKD under hemodialysis was assessed. We studied the relationship of serum procalcitonin (PTC) and C-reactive protein (CRP) levels (before and after dialysis) with “positive bacterial culture” and “systemic inflammatory response syndrome (SIRS)” results. Conclusion: According to the obtained results, it may be concluded that the diagnostic value of serum PTC for diagnosis of positive culture bacterial infections in hemodialysis patients is not satisfactory since the serum CRP level especially after dialysis is more useful. The symptoms of infection in these patients are usually mild and non-specific since, the usual laboratory markers are affected by uremic status such as leukocyte count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and interleukins including interleukin

Objectives

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Discussion

Conclusion