Procalcitonin Clearance Research Articles

Early Kinetics of Procalcitonin in Predicting Surgical Outcomes in Type A Aortic Dissection Patients.

Background:In cardiac surgery, elevation of procalcitonin (PCT) could be observed postoperatively in the absence of any evidence of infection and also seems to be a prognostic marker. PCT levels measured in patients undergoing Type A aortic dissection (TAAD) were used to determine prognostic values for complications and surgical outcomes.Methods:Measurements of PCT, C-reactive protein (CRP), and leukocyte count were observed in TAAD surgery patients (n = 251; average age: 49.02 ± 12.83 years; 78.5% male) at presurgery (T0) and 24 h (T1), 48 h (T2), and 7 days (T3) postsurgery. PCT clearance (PCTc) on days 2 and 7 was calculated: (PCTday1 − PCTday2/day7)/PCTday1 × 100%. Endotracheal intubation duration, length of stay (LOS) in the Intensive Care Unit (ICU)/hospital, and complications were recorded.Results:PCT peaked 24 h postsurgery (median 2.73 ng/ml) before decreasing. Correlation existed between PCT levels at T1 and duration of cardiopulmonary bypass (P = 0.001, r = 0.278). Serum PCT concentrations were significantly higher in nonsurvivor and multiple organ dysfunction syndrome groups on all postoperative days. PCT levels at T1 correlated with length of time of ventilation support and ICU/hospital LOS. Comparing PCT values of survivors versus nonsurvivors, a PCT cutoff level of 5.86 ng/ml at T2 had high sensitivity (70.6%) and specificity (74.3%) in predicting in-hospital death. PCTc-day 2 and 7 were significantly higher in survivor compared with nonsurvivor patients (38% vs. 8%, P = 0.012, 83% vs. −39%, P < 0.001). A PCTc-day 7 cutoff point of 48.7% predicted survival with high sensitivity (77.8%) and specificity (81.8%).Conclusions:PCT level and PCTc after TAAD surgery might serve as early prognostic markers to predict postoperative outcome. PCT measurement may help identify high-risk patients.

PROCALCITONIN TESTING IN RHEUMATOLOGY

Currently, differential diagnosis of systemic bacterial infection and active rheumatic process remains a challenging problem in rheumatology. In the review, current data on the role of procalcitonin biomarker in diagnosis and differential diagnosis of rheumatic diseases (RD) and infectious pathology are presented. In particular, some authors recommend procalcitonin (PCT) test as a marker of bacterial infection in bones and joints at levels above 0.5 ng/ml; at PCT level below 0.3 ng/ml, infection can be ruled out. In patients with microcrystalline arthritis, data on the significance of PCT for differential diagnosis are contradictory. PCT level doesn’t correlate with systemic lupus erythematosus activity and is elevated only during bacterial infection proportionally to its systematicity. In some studies, elevated PCT level was observed in ANCA-associated vasculitis with high activity without bacterial infection. It was shown that in 80 % of adults with Still’s disease, PCT level was higher than the threshold value even without infection. For patients with RD hospitalized in intensive care units, PCT clearance is a more informative predictive characteristic than its level, regardless of the cause of PCT elevation (infection, injury, severe organ damage, etc.); slowdown of its decrease is a factor of poor prognosis and is associated with higher mortality. At the same time, PCT level positively correlates with the SOFA score in presence of bacterial infection. For some rheumatic diseases, the threshold PCT value at which the test has optimal sensitivity and specificity is yet to be established. Nonetheless, PCT should be evaluated in relation to the clinical picture and data of additional examinations. The effect of various therapy methods used in rheumatology on PCT level requires further research.

Serum Procalcitonin and Procalcitonin Clearance as a Prognostic Biomarker in Patients with Severe Sepsis and Septic Shock.

We evaluated the tendency of the plasma concentration and procalcitonin (PCT) clearance (PCTc) to act as biomarkers of prognosis in patients with severe sepsis and septic shock. From 2011 to 2013, we prospectively analyzed patients with sepsis admitted to the intensive care unit (ICU). The serum PCT was evaluated at the time of sepsis diagnosis and again after 48 h (day 3) and 96 h (day 5). PCTc after 48 h (PCTc-day 3) and 96 h (PCTc-day 5) was also calculated to evaluate the prognostic value for survival in patients with sepsis. A total of 48 patients were included. Overall mortality was 16.7% (8 patients). PCTc was higher in survivors than in nonsurvivors, with significant differences on day 3 and day 5 (p = 0.033; p = 0.002, resp.); however, serum PCT levels on day 1, day 3, and day 5 were not significant prognostic factors for survival. The prognosis of patients with severe sepsis and septic shock may be associated with PCTc. Dynamic changes of PCT reflected as PCTc at 48 h (day 3) and 96 h (day 5) after admission to the ICU may serve as a predictor of survival in critically ill patients with severe sepsis.

The utility of initial procalcitonin and procalcitonin clearance for prediction of bacterial infection and outcome in critically ill patients with autoimmune diseases: a prospective observational study.

BackgroundThe diagnostic value of procalcitonin (PCT) for patients with autoimmune diseases (AID) remains controversial and few studies focused on ICU patients. We sought to determine its diagnostic and prognostic values in this clowd.MethodsA prospective observational study was conducted in AID patients admitted to the ICU. Serum PCT levels were measured on ICU admission and subsequently at days 1, 3, 5 and 7, and peak PCT levels within 24 h (PCTpeak) were analyzed the utility for bacterial infection. The relationship of PCTpeak and SOFA score and severity of sepsis was performed correlation analysis. The change of PCT over time reflected as PCT clearance was compared to ICU 28-day mortality.ResultsOne hundred twelve patients were divided into bacterial infection group (group I, n = 54) and nonbacterial condition group (group II, n = 58). The median PCTpeak (range, μg/L) was higher in the group I than that in the group II (1.95 [0.38–37.56] vs. 0.64 [0.05–7.83], p = 0.002). PCTpeak had the best single predictor of bacterial infection (area under the curve [AUC], 0.902, p < 0.001) with a sensitivity of 79.6 % and a specificity of 89.6 % at the threshold of 0.94 μg/L. PCTpeak was also positive correlation with severity of sepsis (r = 0.731, p = 0.002), but its correlation with SOFA score was only found in subjects with bacterial infection (r = 0.798, p < 0.001). Importantly, the 5-day PCT clearance (PCTc-d5), rather than absolute PCT values, could earlier discriminate survivors (n = 73) from nonsurvivors (n = 39) (68.8 ± 9.8 vs. 21.8 ± 17.5 %, p < 0.001, respectively). PCTc-d5 < 50 % was an independent predictor of mortality (odds ratio 5.1, 95 % confidence interval 3.5 to 7.5; p = 0.001).ConclusionsIn critically ill patients with AID, elevated PCT levels are valuable for bacterial infection and are significantly positive correlation with the septic severity. Five-day PCT clearance may provide independent prognostic information. Larger, prospective trials are warranted to confirm the benefit.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-015-0122-9) contains supplementary material, which is available to authorized users.

Procalcitonin or lactate clearance, or both, for risk assessment in patients with sepsis? Results from a prospective US ICU patient cohort

Blood lactate level is a routinely used biomarker for management of patients in septic conditions in the ICU. There is a lack of clinical research data comparing lactate with novel sepsis biomarkers, such as procalcitonin, in regard to the diagnostic and prognostic potential. Herein, we investigated the diagnostic and prognostic value of initial lactate and procalcitonin levels and their kinetics within the ICU stay for prediction of positive blood cultures and fatal outcome in a well characterized cohort of sepsis patients in a US critical care setting.

Can we consider procalcitonin as a consolidated biomarker in sepsis management?

Procalcitonin (PCT) belongs to the calcitonin superfamily of peptides and is encoded by the CALC 1 gene located on the short arm of the chromosome 11. In infective states, the release of bacterial endotoxin results in a ubiquitous expression of CALC 1 gene. It has been suggested that the presence of microbial infection-specific response elements within the CALC 1 gene promoter overrides tissue-specific selective expression pattern leading to an overwhelming response to infective stimuli. As a result, systematic proteolytic cleavage and enzymatic degradation result in the release of PCT into the circulation.[1] Procalcitonin is one of the many biomarkers studied for sepsis (as sTREM1 and others) and appears to be one of the most promising markers of the presence and severity of a relevant bacterial infection.[2] With documented superiority to conventional markers such as white blood cell count or C-reactive protein, which lack diagnostic accuracy and are sometimes misleading, PCT has a significant role in facilitating early diagnosis and management of relevant bacterial infection thus lowering the associated morbidity and mortality. However, a single value of PCT done at the time of admission, cannot predict the prognosis of the critically ill septic patients and we must also remember that because PCT displays wide inter-individual variability, therefore, interpretation may require serial measurements. In this way is interesting, the study from De Azevedo et al.[3] referring that persistently high PCT concentrations in plasma, as well as reduced 24-h PCT clearance, were associated with a significant increase in mortality in patients with severe sepsis and septic shock. We must point out that there is no so much literature relating the prognostic value of the fall of PCT levels, and we enjoy the new scientific papers addressed to obtain this objective. In this sense is relevant, the elegant paper from Sudhir et al.[4] These authors studied different causes of sepsis-like severe generalized bacterial, parasitic or fungal infections with systemic manifestation and propose that although elevated serum PCT values during severe infections may decrease to very low levels with appropriate therapy, this does not always indicate complete eradication of the infection but only that generalization of the infection or the systemic response is under control. In this context is really interesting, the paper entitled “PCT kinetics as prognostic marker in severe sepsis/septic shock” published in these issue:[5] In this prospective paper the PCT value decreased by a median of 59.7% in the entire group; the median value in survivors and non survivors was 73.5% and 24.4%, and the difference was statistically significant (P < 0.01). The conclusion is that in critically ill patients with severe sepsis/septic shock, change (fall) in PCT is associated with good outcome. On the other hand, the duration of antibiotic therapy in Intensive Care Unit (ICU) is often undefined, and clinical features are of limited help in guiding discontinuation of therapy. At the present time, we can consider PCT as the most extensively studied biomarker in the setting of both discontinuation and change of antibiotic therapy. In the excellent systematic review from the Agency for Healthcare Research and Quality,[6] the authors found that PCT guidance reduces antibiotic use for adult patients in both medical and surgical ICUs. Studies included patients who had comorbidities that are common in ICU patients (e.g. cardiac disease, diabetes, chronic lung disease, cirrhosis, chronic renal failure, cancer), and thus, the evidence from these studies is applicable to the usual clinical practice in the ICU setting. They also refer that PCT guidance for initiation and discontinuation of antibiotic (AB) therapy significantly reduced antibiotic prescription rates and duration in patients with acute respiratory tract infections, including acute exacerbations of chronic obstructive pulmonary disease, community-acquired pneumonia, and acute bronchitis (high evidence). In the excellent and recent paper of our colleagues of the Department of Anesthesia of our hospital; the authors refer that in critically ill patients with secondary peritonitis PCT-guidance produced 50% reduction in AB duration (P < 0.001, log-rank test).[7] The value of PCT-guided antibiotic therapy depends on the clinical benefits of reduced antibiotic use, which is difficult to quantify. Immediate consequences may include a decrease in allergic reactions, drug toxicities, and frequency of Clostridium difficile infection. A major downstream effect of reducing antibiotic use may be a lower probability of emergence of antibiotic–resistant strains. In contrast, PCT-guided intensification of antibiotics in adult ICU patients increases morbidity (moderate evidence).[8]

The application value of the procalcitonin clearance rate on therapeutic effect and prognosis of ventilator associated pneumonia

To assess the disease severity and prognosis value by observing the kinetic change of serum procalcitonin (PCT) and PCT clearance rate (PCTc) in the patients with ventilator associated pneumonia (VAP). A single-center prospective observational study was conducted. A total of 128 patients with VAP admitted into intensive care unit (ICU) of First Affiliated Hospital of Xinjiang Medical University from February 2012 to June 2014 were enrolled. The patients were divided into recovery group (n=88) and deterioration group (n=40) according to the therapeutic outcome. The acute physiology and chronic health evaluation II (APACHEII) scores were estimated within 24 hours when VAP was diagnosed. The serum PCT (PCT1, PCT5, PCT7, PCT9) and PCTc (PCTc5, PCTc7, PCTc9) were examined at 1, 5, 7 and 9 days after the VAP was diagnosed. The diagnostic and predictive performance of PCT, PCTc and APACHEII scores were assessed by the receiver operating characteristic curve (ROC). APACHEII scores in recovery group were significantly lower than those in the deterioration group (14.49 ± 5.30 vs. 18.90 ± 5.30, t=-4.349, P=0.000). There was no significant difference in PCT level (μg/L) at 1 day after VAP was diagnosed between recovery group and deterioration group [2.84 (0.81, 6.43) vs. 3.50 (0.97, 10.27), Z=-1.431, P=0.152]. With prolonged treatment, PCT was gradually decreased in recovery group, while remained at higher level in deterioration group, which was significantly lowered at 5 days after VAP diagnosed in recovery group compared with that in the deterioration group [1.28 (0.65,3.13) vs. 2.39 (0.78, 9.35), Z=-2.012, P=0.044]. PCTc maintained higher level in recovery group which was gradually increased with the improvement of the disease, and PCTc in deterioration group was lowered which was gradually decreased with the development of the disease. PCTc at 5, 7, 9 days in recovery group was significantly higher than that in deterioration group [5 d: 50.43 (20.39, 80.60)% vs. -56.68 (-286.28, 172.92)%, Z=-2.250, P = 0.024;7 d:54.01 (5.70, 102.30)% vs. -76.91(-335.03,181.21)%, Z=-2.561,P=0.010; 9 d:63.88(25.93, 101.80)% vs. -133.49(-547.20, 280.16)%, Z=-3.133,P=0.002]. The area under ROC curve (AUC) of PCT5, PCT7, PCT9 predicting the prognosis was 0.591, 0.683, 0.746, respectively [95% confidence interval (95% CI) was 0.456-0.726 (P=0.161), 0.557-0.808 (P=0.005), 0.631-0.860 (P=0.000)]. When PCT9 was 5.65 μg/L, the sensitivity of 95% and the specificity of 61%. The AUC of PCTc5, PCTc7 and PCTc9 was 0.648, 0.685, 0.729, respectively [95%CI was 0.513-0.783 (P=0.028), 0.555-0.815 (P=0.006), 0.607-0.851 (P=0.001)]. When PCTc9 was 92%, the sensitivity was 98% and the specificity was 71%. The AUC of APACHEII score was 0.693 (95% CI 0.578-0.808, P=0.003). When APACHEII score was 19.5, the sensitivity was 77% and the specificity was 58%. The increased levels of PCT in patients with VAP were associated with the poor control of infection and may indicate the deterioration of VAP, it also can reflect the activity of lung infection in time. Keep observing the dynamic change of PCT and analyzing PCTc is more useful. The PCTc levels may provide evidence of disease progression and helpful in risk stratification in patients with VAP, and lower level of PCTc may accompany serious infection and predict poor prognosis.

Valor pronóstico de la proteína fijadora de lipopolisácaridos y la procalcitonina en pacientes con sepsis grave y shock séptico ingresados en una unidad de cuidados intensivos

Aims1) To assess the prognostic value of levels on admission and serial measurements of lipopolysaccharide binding protein (LBP) and procalcitonin (PCT) in relation to in-hospital mortality; and 2) to determine whether the addition of these parameters to severity scores (APACHE II and SOFA) is able to improve prognostic accuracy. DesignA single-center, prospective observational study was carried out. SettingIntensive Care unit of a university hospital. PatientsOne hundred severe sepsis and septic shock patients were included. Data collectedDemographic data, APACHE II and SOFA scores, PCT and LBP levels on admission and after 48hours, and in-hospital mortality. ResultsThe best area under the curve for predicting in-hospital mortality corresponded to APACHE II on admission and SOFA after 48h (AUC ROC: 0.75 for both). PCT and LBP levels on admission and LBP clearance were not statistically different between in-hospital survivors and non-survivors. Only PCT clearance was higher among in-hospital survivors than in non-survivors (AUC ROC: 0.66). The combination of severity scores and PCT clearance did not result in superior areas under the curve. ConclusionsLBP and PCT levels on admission and LBP clearance showed no prognostic value in severe sepsis and septic shock patients. Only PCT clearance was predictive of in-hospital mortality. The prognostic accuracy was significantly better for APACHE on admission and SOFA after 48h than for any of the analyzed biomarkers, and the addition of PCT clearance did not improve their prognostic value.

Procalcitonin Clearance for Early Prediction of Survival in Critically Ill Patients with Severe Sepsis

Introduction. Serum procalcitonin (PCT) diagnosed sepsis in critically ill patients; however, its prediction for survival is not well established. We evaluated the prognostic value of dynamic changes of PCT in sepsis patients. Methods. A prospective observational study was conducted in adult ICU. Patients with systemic inflammatory response syndrome (SIRS) were recruited. Daily PCT were measured for 3 days. 48 h PCT clearance (PCTc-48) was defined as percentage of baseline PCT minus 48 h PCT over baseline PCT. Results. 95 SIRS patients were enrolled (67 sepsis and 28 noninfectious SIRS). 40% patients in the sepsis group died in hospital. Day 1-PCT was associated with diagnosis of sepsis (AUC 0.65 (95% CI, 0.55 to 0.76)) but was not predictive of mortality. In sepsis patients, PCTc-48 was associated with prediction of survival (AUC 0.69 (95% CI, 0.53 to 0.84)). Patients with PCTc-48 > 30% were independently associated with survival (HR 2.90 (95% CI 1.22 to 6.90)). Conclusions. PCTc-48 is associated with prediction of survival in critically ill patients with sepsis. This could assist clinicians in risk stratification; however, the small sample size, and a single-centre study, may limit the generalisability of the finding. This would benefit from replication in future multicentre study.

Procalcitonina como biomarcador de prognóstico da sepse grave e choque séptico

To evaluate the tendency of the plasma concentration and clearance of procalcitonin (PCT-c) as biomarkers of prognosis of patients with severe sepsis and septic shock, compared to another early prognosis marker, the number of SIRS criteria at sepsis diagnosis. We conducted a prospective, observational, cohort study, with patients with severe sepsis and septic shock. The serum procalcitonin was determined at diagnosis of sepsis and after 24 and 48 hours. Demographic data, APACHE IV, SOFA score on arrival, number of SIRS criteria at diagnosis, site of infection and microbiological results were recorded. Twenty-eight patients were included, 19 clinical and nine surgical. In 13 (46.4%) the source of sepsis was pulmonary, abdominal in seven (25.0%), urinary in five (17.9%) and soft tissue in three cases (10.7%). Fifteen patients had severe sepsis and 13 septic shock. Overall mortality was 17.9% (five patients), three with septic shock. Twenty-eight PCT determinations were performed at sepsis diagnosis, 27 after 24 hours and 26 after 48 hours. The initial concentration was not significantly different between survivors and non-survivors groups, but the differences between the two groups after 24 and 48 hours were statistically significant. There was no difference in the number of SIRS criteria. The 24-hour procalcitonin clearance proved to be significantly higher in the group of survivors (-3.0 versus -300.0, p = 0.028). Although the 48-hour procalcitonin clearance has shown to be higher in the group of survivors when compared to non-survivors, the difference did not reach statistical significance. Persistently high procalcitonin concentrations in plasma, as well as reduced 24-hours PCT clearence, were associated with a significant increase in mortality in patients with severe sepsis and septic shock.

Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study

ObjectiveTo evaluate procalcitonin clearance as a prognostic biomarker in septic shock. DesignProspective, observational pilot study. SettingIntensive care unit. PatientsPatients admitted to the ICU due to septic shock and multiorgan dysfunction. InterventionsSerum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. Data collectedDemographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). ResultsProcalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4–83.8]% vs 22.7 [−331–58.4], p<0.05) and 48h (81.6 [71.6–91.3]% vs −7.29 [−108.2–82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54–0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69–1.0, p<0.05) at 48h. ConclusionsICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker.

Prognostic value of procalcitonin, C-reactive protein and leukocytes in septic shock

ObjectivesThis study evaluates the potential prognostic value of serial measurements of different biomarkers (procalcitonin [PCT], C-reactive protein and leukocytes [CRP]) in septic shock patients. DesignProspective observational study. SettingIntensive care unit of a third-level University Hospital. PatientsThe study comprised a total of 88 septic shock patients defined using the 2001 Consensus Conference SCCM/ESICM/ACCP/ATS/SIS criteria. The PCT, CRP and leukocytes were recorded on admission to the ICU and again 72h after admission. InterventionsNone. ResultsThose patients with increasing procalcitonin levels showed higher hospital mortality than those with a decreasing levels (58.8% vs 15.4%, p<0.01). No such effect was observed in relation to C-reactive protein or leukocytes. The best area under the curve for prognosis was for procalcitonin clearance (0.79). A procalcitonin clearance of 70% or higher offered a sensitivity and specificity of 94.7% and 53%, respectively. ConclusionsSerial procalcitonin measurements are more predictive of the prognosis of septic shock patients than single measurements of this parameter. The prognostic reliability of the latter is also better than in the case of C-reactive protein and leukocytes. The application of serial procalcitonin measurements may allow the identification of those septic patients at increased mortality risk, and help improve their treatment.

Usefulness of procalcitonin clearance as a prognostic biomarker in septic shock. A prospective pilot study

ObjectiveTo evaluate procalcitonin clearance as a prognostic biomarker in septic shock. DesignProspective, observational pilot study. SettingIntensive care unit. PatientsPatients admitted to the ICU due to septic shock and multiorgan dysfunction. InterventionsSerum concentrations of procalcitonin were determined within 12h of onset of septic shock and multiorgan dysfunction (coinciding with admission to the ICU), and the following extractions were obtained after 24, 48 and 72h in patients who survived. Data collectedDemographic data, Acute Physiology and Chronic Health Evaluation II score, and Sequential Organ Failure Assessment score, data on the primary focus of infection, and patient outcome (ICU mortality). ResultsProcalcitonin clearance was higher in survivors than in non-survivors, with significant differences at 24h (73.9 [56.4–83.8]% vs 22.7 [−331–58.4], p<0.05) and 48h (81.6 [71.6–91.3]% vs −7.29 [−108.2–82.3], p<0.05). The area under the ROC curve was 0.74 (95%CI, 0.54–0.95, p<0.05) for procalcitonin clearance at 24h, and 0.86 (95%CI, 0.69–1.0, p<0.05) at 48h. ConclusionsICU mortality was associated to sustained high procalcitonin levels, suggesting that procalcitonin clearance at 48h may be a valuable prognostic biomarker.

Valor pronóstico del aclaramiento de procalcitonina, PCR y leucocitos en el shock séptico

ObjetivesThis study evaluates the potential prognostic value of serial measurements of different biomarkers (procalcitonin [PCT], C-reactive protein and leukocytes [CRP]) in septic shock patients. DesignProspective observational study. SettingIntensive care unit of a third-level University Hospital. PatientsThe study comprised a total of 88 septic shock patients defined using the 2001 Consensus Conference SCCM/ESICM/ACCP/ATS/SIS criteria. The PCT, CRP and leukocytes were recorded on admission to the ICU and again 72hours after admission. InterventionsNone. ResultsThose patients with increasing procalcitonin levels showed higher hospital mortality than those with a decreasing levels (58.8% vs. 15.4%, P<0.01). No such effect was observed in relation to C-reactive protein or leukocytes. The best area under the curve for prognosis was for procalcitonin clearance (0.79). A procalcitonin clearance of 70% or higher offered a sensitivity and specificity of 94.7% and 53%, respectively. ConclusionsSerial procalcitonin measurements are more predictive of the prognosis of septic shock patients than single measurements of this parameter. The prognostic reliability of the latter is also better than in the case of C-reactive protein and leukocytes. The application of serial procalcitonin measurements may allow the identification of those septic patients at increased mortality risk, and help improve their treatment.

Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure.

To measure the mass transfer and clearance of procalcitonin (PCT) in patients with septic shock during continuous venovenous hemofiltration (CVVH), and to assess the mechanisms of elimination of PCT. The medical department of intensive care. A prospective, observational study. Thirteen critically ill patients with septic shock and oliguric acute renal failure requiring continuous venovenous postdilution hemofiltration with a high-flux membrane (AN69 or polyamide) and a 'conventional' substitution volume (< 2.5 l/hour). PCT was measured with the Lumitest PCT Brahms(R) in the prefilter and postfilter plasma, in the ultrafiltrate at the beginning of CVVH (T0) and 15 min (T15'), 60 min (T60') and 6 hours (T6h) after setup of CVVH, and in the prefilter every 24 hours during 4 days. Mass transfer was determined and the clearance and the sieving coefficient were calculated according to the mass conservation principle. Plasma and ultrafiltrate clearances, respectively, at T15', T60' and T6h were 37 +/- 8.6 ml/min (not significant) and 1.8 +/- 1.7 ml/min (P < 0.01), 34.7 +/- 4.1 ml/min (not significant) and 2.3 +/- 1.8 ml/min (P < 0.01), and 31.5 +/- 7 ml/min (not significant) and 5 +/- 2.3 ml/min (P < 0.01). The sieving coefficient significantly increased from 0.07 at T15' to 0.19 at T6h, with no difference according to the nature of the membrane. PCT plasma levels were not significantly modified during the course of CCVH. We conclude that PCT is removed from the plasma of patients with septic shock during CCVH. Most of the mass is eliminated by convective flow, but adsorption also contributes to elimination during the first hours of CVVH. The effect of PCT removal with a conventional CVVH substitution fluid rate (<2.5 l/hour) on PCT plasma concentration seems to be limited, and PCT remains a useful diagnostic marker in these septic patients. The impact of high-volume hemofiltration on the PCT clearance, the mass transfer and the plasma concentration should be evaluated in further studies.

Plasma concentrations and clearance of procalcitonin during continuous veno-venous hemofiltration in septic patients.

We determined the elimination characteristics of procalcitonin (PCT) during continuous veno-venous hemofiltration (CVVHF) and the resulting effect on PCT plasma levels. A prospective study was conducted in patients with sepsis and acute oliguric renal failure, treated with CVVHF using a polysulfone membrane (Baxter Renaflo II PSHF 1200). Patients had sepsis and PCT plasma levels > 4 ng ml(-1) (n = 26). PCT was measured in the pre- and post-filter plasma and the ultrafiltrate at 0, 5, 10, and 15 min and 1, 2, 4, 6, 12, and 24 h after setup of CVVHF. PCT sieving coefficient was 0.24. Elimination of PCT, however, depended on the duration of filtration, because filter adsorption was the main mechanism of PCT clearance during the first hour of hemofiltration, finally increasing to a clearance of PCT into the ultrafiltrate of 2.8-5.5 mL/min after 2 h. PCT plasma levels were not significantly altered during CVVHF (96% of the initial concentration after 24 h, P = 0.72). Similar to what has been observed with cytokines and other proteins of a comparable molecular weight, PCT is removed from the plasma during CVVHF, but plasma PCT levels are unchanged. Thus, PCT can be used as a diagnostic parameter even in patients with acute renal failure undergoing CVVHF.