Plasma Procalcitonin Levels Research Articles

Procalcitonin as a prognostic marker in non-infected critically ill cardiovascular patients

Summary Background: Procalcitonin (PCT) is a marker of inflammation in systemic bacterial infections. The aim of this study was to determine the role of PCT as a prognostic marker in cardiovascular intensive care unit (ICU) p atients with non-infectious conditions. Methods: 253 critically ill medical patients were consecutively included during a 4-month period. The highest PCT plasma level during the first 72 hours of ICU stay was taken for analysis, and a level ≥0.5 ng/ml was defined as elevated. Hospital m ortality rates stratified by PCT level were compared among the patients w ithout an infection at ICU admission (n = 223) and among a subgroup of non-infected patients with a cardio vascular diagnosis (n = 164). Results: The non-infected patients with an elevated PCT level had a 38% mortality rate (15/40), whereas a 9% mortality rate was observed among the non-infected patients with a normal PCT (16/183) (p <0.001). The mortality rate was 42% among the subgroup of cardio vascular patients with an elevated PCT level (11/26), whereas it was 4% among the cardiovascular patients with a normal PCT (6/138) (p <0.001). For PCT, the area under the receiver operating characteristic curve for the prediction of mortality was 0.81 (95% confidence interval [CI] 0.74−0.89) in all non-infected patients and 0.90 (95% CI 0.84−0.96) in the cardiovascular subgroup. Conclusions: In apparently non-infected critically ill medical patients, particularly in cardiovascular patients, elevated PCT plasma levels are associated with an increased hospital mortality. Nevertheless, PCT v alues should be interpreted carefully in the clinical context.

Diagnostic Potential of Endotoxin Scattering Photometry for Sepsis and Septic Shock

Endotoxin scattering photometry (ESP) is a novel Limulus amebocyte lysate (LAL) assay that uses a laser light-scattering particle-counting method. In the present study, we compared ESP, standard turbidimetric LAL assay, and procalcitonin assay for the evaluation of sepsis after emergency gastrointestinal surgery. A total of 174 samples were collected from 40 adult patients undergoing emergency gastrointestinal surgery and 10 patients with colorectal cancer undergoing elective surgery as nonseptic controls. Plasma endotoxin levels were measured with ESP and turbidimetric LAL assay, and plasma procalcitonin levels were assessed with a standard procalcitonin assay. Plasma endotoxin and procalcitonin levels increased corresponding to the degree of sepsis. Endotoxin scattering photometry significantly discriminated between patients with or without septic shock: sensitivity, 81.1%; specificity, 76.6%; positive predictive value, 48.4%; negative predictive value, 93.8%; and accuracy, 77.6%. The area under the receiver operating characteristic curve for septic shock with the ESP assay (endotoxin cutoff value, 23.8 pg/mL) was 0.8532 ± 0.0301 (95% confidence interval, 0.7841-0.9030; P < 0.0001). The predictive power of ESP was superior to that of turbidimetric assay (difference, 0.1965 ± 0.0588; 95% confidence interval, 0.0812-0.3117; P = 0.0008). There was no significant difference in predictive power between ESP and procalcitonin assay. Endotoxin scattering photometry also discriminated between patients with and without sepsis. Area under the receiver operating characteristic curve analysis showed that ESP had the best predictive power for diagnosing sepsis. In conclusion, compared with turbidimetric LAL assay, ESP more sensitively detected plasma endotoxin and significantly discriminated between sepsis and septic shock in patients undergoing gastrointestinal emergency surgery.

Can procalcitonin levels tell us when to operate? A double blinded study to investigate the role of plasma procalcitonin (PCT) levels as an adjunct marker in clinically suspected appendicitis

Can procalcitonin levels tell us when to operate? A double blinded study to investigate the role of plasma procalcitonin (PCT) levels as an adjunct marker in clinically suspected appendicitis

Papel de la procalcitonina plasmática en el diagnóstico de la neumonía asociada a ventilación mecánica: revisión sistemática y metaanálisis

ObjectiveTo determine the role of plasma procalcitonin (PCT) levels in diagnosing ventilator-associated pneumonia. DesignA systematic review of publications prospectively assessing the diagnostic role of PCT in ventilator-associated pneumonia was carried out. The search was performed using Medline, Embase, the Cochrane Collaboration and MEDION, with reviewing of the references of retrieved articles. We extracted data that allowed the calculation of sensitivity, specificity, likelihood ratios and diagnostic odds ratio.Intervention Metaregression was performed to determine whether exposure to previous antibiotic treatment, the time to occurrence of ventilator-associated pneumonia and the type of patients had an impact upon the diagnostic performance of procalcitonin. ResultsSeven studies were considered (373 patients, 434 episodes). We found no publication bias or threshold effect. High plasma PCT levels were associated to an increased risk of suffering ventilator-associated pneumonia (OR: 8.39; 95% CI: 5.4-12.6). The pooled data on sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio found were 76% (69-82), 79% (74-84), 4.35 (2.48-7.62), 0.26 (0.15-0.46) and 17.9 (10.1-31.7), respectively. Diagnostic yield was modified by prior exposure to antibiotics (rDOR 0.11, 0.02-0.069), but not by the type of critically ill patient or the time to occurrence of ventilator-associated pneumonia. ConclusionsOur results suggest that PCT provides additional information on the risk of VAP. Inclusion of PCT in diagnostic algorithms could improve their effectiveness.

Procalcitonin plasma level and microbiology in cardiovascular implantable electronic device infections

Purpose: To investigate the relationship between procalcitonin (PCT) plasma levels and microbiology in cardiovascular implantable electronic device (CIED) infections. Methods: Prospectively collected data on consecutive patients (pts) with CIED infection who underwent device and lead removal at our center in 2012 were reviewed for positive microbiological cultures obtained from ≥2 blood samples, infected pocket samples, explanted leads. Only pts with positive microbiological cultures and available PCT and CRP tests were included. Pts were divided into a low (<2.3 ng/ml) and high (≥2.3 ng/ml) PCT plasma level group. Results: Twenty-one of 58 pts (36%) who underwent removal of an infected CIED had positive microbiological cultures. Of these 21 pts (median age 71 [62 – 76], 85% male), 5 (24%) were identified in the high (median 23.22 [15.08-31.50]) and 16 (76%) in the low PCT plasma level group (median 0.11 [0.07-0.19]). Six (29%) pts had signs of local, 15 (71%) of a systemic infection. Lead vegetations and bloodstream infection was evident in all high PCT-group pts compared to 63% (P=ns) and 31% (P=0.012) in low PCT-group pts. High PCT-group pts had significantly higher CRP plasma levels (median 96 [68-191] vs. 15 [10-45] mg/dl, P=0.004) and tended to present longer intervals from last pocket intervention to extraction (median 19 [7-74] vs. 7 [3-23] months, P=ns). The graph depicts isolates according to the PCT plasma level. A high PCT yielded a specificity of 84% for infection with staphylococcus aureus. ![Figure][1] Graph 1 Conclusions: Elevated PCT plasma levels (≥2.3 ng/ml) seem to be associated with staphylococcus aureus-related systemic infections in pts with infected CIED. Conversely, low PCT plasma levels are related to less severe local or systemic infections mediated by staphylococcus epidermidis. [1]: pending:yes

How reliable is procalcitonin as an inflammatory marker?1)

Abstract The role of procalcitonin (PCT) plasma levels as a diagnostic tool for intensive care patients has been intensively investigated during the past years. In particular for recognition of bacterial infections, PCT levels have been shown to be superior to other clinical and biochemical markers. Furthermore, some very recent studies show that in patients with lower respiratory tract infections PCT guided antibiotic therapy reduces antibiotic use and thereby may also reduce duration of stay of patients in hospital and thus cut hospitalisation costs. However, various studies indicate that the value of PCT as a prognostic marker is limited because of false positive or negative values. Despite these limitations PCT plasma levels are currently measured in intensive care units. The present study summarises the possible clinical uses of this laboratory marker as a diagnostic tool for the assessment of critically ill patients.

Procalcitonin as a Predictive Biomarker for Total Body Irradiation–Induced Bacterial Load and Lethality in Mice

Sepsis is the leading cause of mortality in intensive care units. Early detection and intervention are critical to prevent death. The acute radiation syndrome is characterized by damage of the gastrointestinal and hematopoietic systems. Translocation of intestinal microflora combined with immune system compromise may lead to septicemia and death. This work examined the utility of procalcitonin, a clinical sepsis biomarker, in a mouse model of radiation toxicity. C57/BL6 mice were exposed to total body irradiation (TBI). Intestinal mucosal permeability was measured in vivo, and liver bacterial load and plasma levels of procalcitonin (PCT), lipopolysaccharide (LPS), and LPS-binding protein were measured at baseline and at 3.5, 7, and 10 days after TBI. The value of early PCT in predicting subsequent lethality was determined by receiver operating characteristic analysis. Four days after TBI, a dose-dependent increase in permeability of the intestinal mucosa was observed, whereas bacterial translocation was present from day 7 onward. There was a high positive correlation between bacterial translocation and all sepsis biomarkers, with PCT exhibiting the strongest correlation. Moreover, plasma PCT levels were elevated already from day 3.5 onward, whereas LPS was elevated from day 7 and LPS-binding protein only 10 days after TBI. Receiver operating characteristic analysis revealed that PCT levels measured 3.5 days after TBI predicted lethality at 10 days. These data demonstrate the value of PCT as an early biomarker in radiation-induced bacteremia for mouse studies and suggest that clinical results from other septic conditions may apply to postradiation septicemia in humans.

Elevation of vitamin D‐binding protein levels in the plasma of patients with generalized aggressive periodontitis

Vitamin D-binding protein (DBP) is a multifunctional and highly expressed plasma protein. Among its diverse roles, including those in the immune and inflammatory responses, it is the primary carrier of vitamin D, which has been implicated in periodontitis. We hypothesized that there is a correlation between systemic DBP levels and generalized aggressive periodontitis (GAgP). Forty-four patients with GAgP and 32 healthy controls were recruited. Clinical parameters were examined, including the mean bleeding index, probing depth, attachment loss and percentage of severely affected sites. Blood chemistry analyses were performed for each subject. Plasma levels of DBP, interleukin-6 (IL-6) and procalcitonin (PCT) were measured using ELISAs, and plasma levels of 25-hydroxy-vitamin D(3) (25(OH)D(3)) were detected using a radioimmunoassay. Significantly higher levels of plasma DBP, IL-6, PCT and 25(OH)D(3), as well as leukocyte counts, neutrophil counts and neutrophil percentages were found in patients with GAgP compared with healthy controls (p < 0.05 for all). Multiple linear regression analysis showed that the plasma DBP levels were significantly correlated with GAgP, plasma PCT levels and smoking status (p < 0.05 for all). In the GAgP group, the plasma DBP levels in smokers were significantly higher than those in nonsmokers (p < 0.001). Elevated plasma vitamin DBP levels are associated with GAgP.

INNATE IMMUNITY AND CKD PROGRESSION

Alterations in innate immunity play a role in renal damage in experimental models but the role of these alterations in the progression of CKD in humans is still poorly defined. Procalcitonin (PCT), is a biomarker of innate immunity produced by C-cells of the thyroid and by the adipose tissue. We measured serum plasma PCT levels in a cohort of 670 patients with stage 3–5 CKD and tested the relationship between this biomarker metrics of adiposity, proteinuria, GFR and progression to kidney failure over a 3 year follow-up. None of the patients had intercurrent infectious or acute inflammatory processes. PCT was measured by an ultrasensitive immunoluminometric assay. The GFR was estimated by a Cystatin-C based equation. The relationship between PCT and renal events was tested by multivariate Cox’s regression and interaction analysis. Procalcitonin exceeded the upper limit of the normal range (>0.064 ng/mL) in 492 patients (67 %) while the corresponding figure for high sensitivity CRP (>1 mg/L) was 170 (%). PCT was higher (P<0.001) in males and strongly associated with the GFR (r=) as well as diabetes (P=0.004) and a history of cardiovascular (CV) events (P=0.007). Furthermore PCT was inversely related with Hb (r=−0.16, P<0.001) and with serum albumin (r=−0.10, P=0.009) and directly associated with CRP (r=0.23, P<0.001) and with white blood cells count (r=0.12, P=0.002). Of note, PCT was higher (P<0.001) in patients with large waist hip ratio (IVth quartile) than in those normal or high normal WHR (1st to 3rd quartiles). During the follow up, PCT predicted the combined renal end-point (30% GFR loss, dialysis or transplantation) (HR for 1 ng/ml increase: 2.37, 95%CI:1.25–4.48, P=0.009) in a model adjusting for age, sex, diabetes, BP, smoking, cholesterol, background cardiovascular events and PCT interacted with baseline GFR in predicting renal outcomes. Indeed the risk of for the combined end-point was minimal in patients with low PCT and high GFR and maximal in those with low GFR and high PCT. Plasma procalcitonin is a more sensitive biomarker of innate immunity than CRP in CKD patients and in part reflects excessive adiposity. High PCT in CKD patients predicts progression toward kidney failure. These results are compatible with the hypothesis that alterations in innate immunity play a role in the progression of CKD in humans.

Plasma procalcitonin and the risk of cardiovascular events and death: a prospective population‐based study

A number of inflammatory biomarkers such as C-reactive protein (CRP) are independent predictors of cardiovascular risk. The inflammatory biomarker procalcitonin (PCT) has previously been shown to be associated with coronary atherosclerosis and the metabolic syndrome. We evaluated the ability of PCT to predict future cardiovascular events in a population of apparently healthy individuals. We measured plasma PCT levels in 3713 subjects with no previous history of cardiovascular disease, randomly selected from the Malmö Diet and Cancer cohort. The correlation between PCT concentration and the incidence of coronary events, stroke and cardiovascular death over a median follow-up period of 13.7 years was studied using a Cox regression analysis corrected for age, sex, CRP level, traditional risk factors and renal function. Age and sex were strong determinants of PCT; the concentration of PCT was significantly higher in men than in women. PCT was associated with several of the established cardiovascular risk factors (CRP, hypertension, diabetes and renal function) as determined by multivariate linear regression. Of note, PCT was inversely correlated with HDL and smoking. We found significant correlations between PCT levels, coronary events and cardiovascular death. However, these relationships lost statistical significance when the analysis was corrected for CRP and the traditional risk factors. This is the largest population-based prospective study to demonstrate a positive association between plasma PCT levels and cardiovascular risk in subjects with no previous history of acute cardiovascular events. However, the high degree of covariation between PCT and other cardiovascular risk factors limits the value of PCT as an independent cardiovascular risk predictor.

Validity of the D4/D0 plasma procalcitonin level ratio as a predictor for mortality in ventilation-associated pneumonia patients

Objectives To evaluate the plasma procalcitonin (PCT) levels estimated at the time of (D0) and 4 days (D4) after the diagnosis of ventilator-associated pneumonia (VAP) as a predictor for mortality. Patients and methods VAP was diagnosed when pneumonia developed after 48 h of mechanical ventilation. Patients were evaluated clinically using the APACHE II score and septic status was graded according to Bone’s criteria. Blood samples were obtained D0 and D4 for the estimation of plasma PCT levels. Patients were categorized into two groups: survivors, that is, patients discharged through or at the end of 28 days (day 28), and nonsurvivors. Clinical data, plasma PCT levels and the D4/D0 ratio were analyzed as predictors for mortality. Results The study included 40 patients, but 15 patients died, yielding a mortality rate of 37.5%. The mean duration of mechanical ventilation before D0 (day of VAP diagnosis) was 5±1.5 days; 29 patients developed early VAP, whereas 11 patients developed late VAP. The mean D0 and D4 plasma PCT levels were significantly higher in all the patients compared with the control levels. The mean D4 plasma PCT levels were significantly higher in all the patients studied and in the patients categorized according to outcome compared with D0 levels and in nonsurvivors compared with survivors. The mean D0/D4 ratio of PCT plasma levels was significantly higher in nonsurvivors compared with survivors. Receiver operating characteristic curve analysis defined the D4/D0 plasma PCT ratio and severity of sepsis as significant predictors for mortality, but the difference was more significant for the D4/D0 ratio. Conclusion VAP is associated with a high mortality rate and estimated levels of plasma PCT were significantly higher in nonsurvivors despite treatment compared with survivors. A high D4/D0 ratio of plasma PCT levels was found to be a highly specific predictor of mortality among VAP patients.

Differential kinetics of plasma procalcitonin levels in cerebral malaria in urban Senegalese patients according to disease outcome

&lt;em&gt;P. falciparum&lt;/em&gt; malaria continues as the serial killer of over a million lives yearly, mainly for children in sub-Saharan Africa. For severe malaria, we are still on the quest for a prognostic marker of fatal outcome. We analysed the association between serum levels of Procalcitonin (PCT), a marker of septic inflammation, and clinical outcome in Senegalese patients admitted with confirmed cerebral malaria in the intensive care facility of Hopital Principal. A total of 98 patients living in the hypoendemic urban area of Dakar, Senegal, were enrolled during transmission seasons. Levels of PCT were compared between surviving vs the 26.5 % fatal cases in blood samples of the 3 days following hospitalisation. Mean PCT levels were elevated in patients with active infection, with a large range of values (0.1 to 280 nanog per mL), significantly higher on day 0 in fatal cases than in surviving (53.6 vs 27.3; P=0.01). No exact individual threshold level could indicate occurrence of fatality, however mortality could be most accurately predicted by PCT level above 69 nanog per ML and there was a very clear different profile of evolution of PCT levels on the 3 days of observation decreasing early from day 1 in surviving patients (P&amp;lt;10–3), contrary to fatal cases. These results indicate that PCT kinetic rather than intrinsic level could be of use to predict a reduced risk of fatality in patient with cerebral malaria and could serve as potential predicting marker for severe malaria.

Wie verlässlich ist die Bestimmung von Procalcitonin als Entzündungsmarker auf Intensivstation?/How reliable is procalcitonin as an inflammatory marker?

Zusammenfassung Die Rolle von Procalcitonin (PCT)-Plasmaspiegel bei kritisch kranken Patienten wurde in den vergangenen Jahren intensiv untersucht. Insbesondere zur Erkennung von Infektionen erwiesen sich PCT-Plasmaspiegel in vielen Fällen anderen klinischen und biochemischen Markern überlegen. Neuere Untersuchungen zeigen, dass mit Hilfe der PCT-Spiegel bei bestimmten Erkrankungen die antibiotische Therapie gesteuert und damit der Antibiotika-Verbrauches reduziert werden kann. Für die Beurteilung der Prognose von kritisch kranken Intensivpatienten scheint der Parameter jedoch nur eingeschränkt verwertbar zu sein. Darüber hinaus können in seltenen Fällen falsch positive und falsch negative Werte auftreten. Trotz dieser Einschränkungen werden heutzutage PCT-Plasmaspiegel bereits vielfältig auf Intensivstationen eingesetzt. Die möglichen klinischen Anwendungen dieses Labormarkers als diagnostisches Werkzeug zur Beurteilung kritisch kranker Patienten sollen im Folgenden dargestellt werden.

Plasma levels of procalcitonin and eight additional inflammatory molecules in febrile neutropenic patients

OBJECTIVE:This study aimed to examine the association between different inflammatory markers and specific clinical endpoints in patients with febrile neutropenia.METHOD:We prospectively evaluated the expression of procalcitonin (PCT), interleukin 8 (IL-8), induced protein-10, tumor necrosis factor alpha (TNF-α), two soluble TNF-α receptors (sTNF-R I and sTNF-R II), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1 alpha, and eotaxin in 37 episodes of febrile neutropenia occurring in 31 hospitalized adult onco-hematologic patients. Peripheral blood samples were collected in the morning at inclusion (day of fever onset) and on days 1, 3, and 7 after the onset of fever. Approximately 2–3 ml of plasma was obtained from each blood sample and stored at -80°C.RESULTS:The sTNF-R II level at inclusion (day 1), the PCT level on the day of fever onset, and the change (day 3 - day 1) in the IL-8 and eotaxin levels were significantly higher in patients who died during the 28-day follow-up. A requirement for early adjustment of antimicrobial treatment was associated with higher day 3 levels of IL-8, sTNF-R II, PCT, and MCP-1.CONCLUSION:Procalcitonin, sTNF-R II, IL-8, MCP-1, and eotaxin could potentially be used to assess the risk of death and the requirement for early adjustment of antimicrobial treatment in febrile, neutropenic onco-hematologic patients. The levels of the other markers showed no association with any of the evaluated endpoints.

Dynamics of procalcitonin and bacteremia in neutropenic adults with acute myeloid leukemia

Sensitive markers of infection are rare or of limited validity in neutropenic patients. Procalcitonin (PCT), a precursor protein of calcitonin, is a specific and sensitive marker of severe bacterial infections during short-term neutropenia. Because the value of PCT measurements among patients undergoing long periods of neutropenia remains uncertain and because several mechanisms, such as bacterial or fungal infections, reactions to drugs or blood products or tumor-associated events, can cause fever, we described the dynamics of PCT in 29 acute myeloid leukemia (AML) patients with 39 instances of chemotherapy-induced neutropenia. Plasma levels of PCT were determined prospectively by an immunoluminometric assay every four days starting at the onset of chemotherapy and continuing until the resolution of fever. We found that bacteremia did increase PCT levels above 0.5 ng/mL and these levels predicted bacteremia at day 15 of chemotherapy. This finding may be relevant in the decision to alter antibiotic regimens to decrease toxicity and cost when patients remain febrile at day 15.

Procalcitonin and C-reactive protein levels at admission as predictors of duration of acute brain dysfunction in critically ill patients

IntroductionNon-intensive care unit (ICU) cohorts have shown an association between inflammatory disturbances and delirium, though these relationships have not been studied in critically ill patients. This study sought to investigate the relationship between two inflammatory biomarkers, procalcitonin and C-reactive protein (CRP), and duration of acute brain dysfunction in ventilated patients.MethodsPatients enrolled in the Maximizing Efficacy of Targeted Sedation and Reducing Neurological Dysfunction (MENDS) trial were assessed daily for delirium using the Confusion Assessment Method-ICU. Plasma levels of procalcitonin and CRP were obtained within 24 hours of enrollment. Proportional odds logistic regression was used to examine the association between procalcitonin and CRP separately with delirium/coma-free days, adjusting for age, acute physiology score (APS) of the Acute Physiology And Chronic Health Evaluation (APACHE) II, sedation group (dexmedetomidine vs. lorazepam), and sepsis. Secondary analyses examined the association of these markers with other organ dysfunctions and 28-day survival.ResultsEighty-seven patients were included in this analysis. The median age of the patients was 60 years with APACHE II scores of 28; 68% had sepsis within 48 hours of admission. Higher levels of procalcitonin were associated with fewer delirium/coma-free days [odds ratio (OR), 0.5; 95% confidence interval (CI), 0.3 to 1.0; P = 0.04], whereas higher CRP levels showed trends towards fewer delirium/coma-free days (OR, 0.6; 95% CI, 0.3 to 1.1; P = 0.08). Similar relationships were found regardless of the presence of sepsis. No associations were found between procalcitonin or CRP with 28-day survival (P = 0.40 and 0.16, respectively).ConclusionsIn our pilot study, high baseline inflammatory biomarkers predicted prolonged periods of acute brain dysfunction, implicating inflammation as an important mechanism in the pathophysiology of delirium and coma during critical illness, irrespective of whether patients had sepsis or not.

Dynamics of Procalcitonin and Bacteremia In Adult Acute Myeloid Leukemia with Chemotherapy-Induced Neutropenia

AbstractAbstract 4378Sensitive markers of infection are rare or of limited validity in neutropenic patients. Procalcitonin (PCT), a precursor protein of calcitonin, is a specific and sensitive marker of severe bacterial infections during short-term neutropenia. Because the value of PCT measurements among patients undergoing long periods of neutropenia remains uncertain and because several mechanisms, such as bacterial or fungal infections, reactions to drugs or blood products or tumor-associated events, can cause fever, we described the dynamics of PCT in 29 acute myeloid leukemia (AML) patients with 39 instances of chemotherapy-induced neutropenia. Plasma levels of PCT were determined prospectively by an immunoluminometric assay every four days starting at the onset of chemotherapy and continuing until the resolution of fever. We found that bacteremia did increase PCT levels above 0.5 ng/mL and these levels predicted bacteremia at day 15 of chemotherapy. This finding may be relevant in the decision to alter antibiotic regimens to decrease toxicity and cost when patients remain febrile at day 15.Table 1:Diagnostic relevance of different PCT cut-off values in predicting bacteremiaPCT=0.5ng/mLPCT=0.8ng/mLPCT=1ng/mLSensibility (%)606050Sensitivity (%)658286PPV (%)37,55455PNV (%)828683 Disclosures:No relevant conflicts of interest to declare.

Plasma Procalcitonin Is Associated with Obesity, Insulin Resistance, and the Metabolic Syndrome

Procalcitonin, a well-known biomarker of sepsis and bacterial infections, is produced by adipose tissue and has potential as a marker for chronic low-grade inflammation. The objective of this study was to investigate whether plasma procalcitonin levels in the normal range are associated with obesity, insulin resistance, and metabolic syndrome (MS) in the general population. Plasma procalcitonin (0.006-0.1 ng/ml) was measured in 3197 men and 3638 women (aged 28-75 yr) of the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study using an ultrasensitive immunoluminometric assay. MS was defined according to Adult Treatment Panel III criteria. Median (interquartile range) plasma procalcitonin was 0.018 (0.015-0.022) ng/ml in men and 0.014 (0.012-0.017) ng/ml in women (P < 0.001). Plasma procalcitonin was positively associated with body mass index and waist circumference. In both sexes, cross-sectional associations of plasma procalcitonin with insulin resistance and components of the MS remained significant after adjustment for age, body mass index, waist circumference, and other covariates. The age-adjusted odds ratio (OR) for MS was 3.2 [95% confidence interval (CI) = 2.5-4.2) in men and 4.1 (95% CI = 3.0-5.5) in women, when comparing the highest with the lowest quartile of plasma procalcitonin. The multivariate-adjusted OR for MS was 1.9 (95% CI = 1.4-2.6) in men and 2.3 (95% CI = 1.6-3.3) in women. The multivariate-adjusted OR for insulin resistance was 3.3 (95% CI = 2.4-4.3) in men and 2.5 (95% CI = 1.9-3.4) in women. Elevated plasma procalcitonin levels in the normal range are associated with measures of obesity, insulin resistance, and MS in the general population.

Use of Plasma Procalcitonin Levels as an Adjunct to Clinical Microbiology

Procalcitonin (PCT) is synthesized by a large number of tissues and organs in response to invasion by pathogenic bacteria, fungi, and some parasites. Current PCT assays are rapid, specific, and of sufficient sensitivity to detect increases in PCT serum levels within 4 to 6 h of initiation of infection. Clinically, PCT levels may help in decisions regarding the need for empirical antibiotic therapy, "source control" of infection, and duration of antibiotic therapy. The addition of PCT levels to bacterial culture and viral detection results can assist with the separation of colonization and invasion by pathogenic bacteria.

Diagnostic accuracy of sTREM-1 to identify infection in critically ill patients with systemic inflammatory response syndrome

ObjectivesTo assess the accuracy of plasma levels of soluble Triggering Receptor Expressed on Myeloid cells (sTREM)-1 to diagnose infection in critical patients with systemic inflammatory response syndrome (SIRS). Design and methodsWe prospectively studied 114 patients with SIRS criteria. The patients’ plasma levels of sTREM-1 were measured within 24h of admission to the intensive care unit. The final diagnosis of infection was made independently by two investigators, who were blinded to the levels of sTREM-1. ResultsThe area under the ROC curve of sTREM-1 for the diagnosis of sepsis was 0.62 (95% confidence interval [95% CI] 0.51–0.72). The diagnostic odds ratio of sTREM-1 after adjusting for the Infection Probability Score and procalcitonin plasma levels was 1.81 (95% CI 0.66–4.98; p=0.2508). ConclusionsIn critical patients admitted with SIRS, sTREM-1 has poor discriminative power to identify patients with infection, and sTREM-1 levels do not add diagnostic information to that provided by other routinely available clinical tests.