Serum Procalcitonin Levels In Patients Research Articles

Relationship between serum procalcitonin level and severity and prognosis in patients with traumatic brain injury in plateau areas

To analyze the changes rule of serum procalcitonin (PCT) levels in patients with traumatic brain injury in plateau areas, and to evaluate its value in assessing the severity and prognosis of the patients. A prospective cohort study was conducted. The patients with traumatic brain injury admitted to the critical care medicine departments of Xining Third People's Hospital (at an altitude of 2 260 metres) and Golmud City People's Hospital (at an altitude of 2 780 metres) from May 2018 to September 2022 were enrolled. According to the Glasgow coma scale (GCS) score at admission, the patients were divided into mild injury group (GCS score 13-15), severe injury group (GCS score 9-12), and critical injury group (GCS score 3-8). All patients received active treatment. Chemiluminescence immunoassay was used to measure the serum PCT levels of patients on the 1st, 3rd, 5th, and 7th day of admission. The Kendall tau-b correlation method was used to analyze the correlation between serum PCT levels at different time points and the severity of the disease. The patients were followed up until October 30, 2022. The prognosis of the patients was collected. The baseline data of patients with different prognosis were compared. The Cox regression method was used to analyze the relationship between baseline data, serum PCT levels at different time points and prognosis. Receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of serum PCT levels at different time points for death during follow-up. Finally, a total of 120 patients with traumatic brain injury were enrolled, including 52 cases in the mild injury group, 40 cases in the severe injury group, and 28 cases in the critical injury group. The serum PCT levels of patients in the mild injury group showed a continuous downward trend with the prolongation of admission time. The serum PCT levels in the severe injury and critical injury groups reached their peak at 3 days after admission, and were significantly higher than those in the mild injury group (μg/L: 3.53±0.68, 4.47±0.63 vs. 0.40±0.14, both P < 0.05), gradually decreasing thereafter, but still significantly higher than the mild injured group at 7 days. Kendall tau-b correlation analysis showed that there was a significant positive correlation between serum PCT levels on days 1, 3, 5, and 7 of admission and the severity of disease (r value was 0.801, 0.808, 0.766, 0.528, respectively, all P < 0.01). As of October 30, 2022, 92 out of 120 patients with traumatic brain injury survived and 28 died, with a mortality of 23.33%. Compared with the survival group, the GCS score, serum interleukin-6 (IL-6) levels, white blood cell count (WBC) in peripheral blood, and PCT levels in cerebrospinal fluid at admission in the death group were significantly increased [GCS score: 5.20±0.82 vs. 4.35±0.93, IL-6 (ng/L): 1.63±0.45 vs. 0.95±0.27, blood WBC (×109/L): 14.31±2.03 vs. 11.95±1.98, PCT in cerebrospinal fluid (μg/L): 11.30±1.21 vs. 3.02±0.68, all P < 0.01]. The serum PCT levels of patients in the survival group showed a continuous downward trend with prolonged admission time. The serum PCT level in the death group peaked at 3 days after admission and was significantly higher than that in the survival group (μg/L: 4.11±0.62 vs. 0.52±0.13, P < 0.01), gradually decreasing thereafter, but still significantly higher than the survival group at 7 days. Cox regression analysis showed that serum IL-6 levels [hazard ratio (HR) = 17.347, 95% confidence interval (95%CI) was 5.874-51.232], WBC in peripheral blood (HR = 1.383, 95%CI was 1.125-1.700), PCT levels in cerebrospinal fluid (HR = 1.952, 95%CI was 1.535-2.482) at admission and serum PCT levels on admission days 1, 3, 5, and 7 [HR (95%CI) was 6.776 (1.844-24.906), 1.840 (1.069-3.165), 3.447 (1.284-9.254), and 6.666 (1.214-36.618), respectively] were independent risk factors for death during follow-up in patients with traumatic brain injury (all P < 0.05). ROC curve analysis showed that the AUC of serum PCT levels on days 1, 3, 5, and 7 for predicting death during follow-up in patients with traumatic brain injury was all > 0.8 [AUC (95%CI) was 0.898 (0.821-0.975), 0.800 (0.701-0.899), 0.899 (0.828-0.970), 0.865 (0.773-0.958), respectively], indicating ideal predictive value. The optimal cut-off value for serum PCT level at 3 days of admission was 1.88 μg/L, with the sensitivity of 78.6% and specificity of 88.0% for predicting death during follow-up. Abnormal expression of serum PCT levels in patients with traumatic brain injury on the 3rd day of admission was found. The serum PCT levels greater than 3 μg/L may be related to severe illness. The serum PCT levels greater than 1.88 μg/L can predict the poor prognosis of patients. Dynamic observation of changes in serum PCT levels has good evaluation value for the severity and prognosis of patients with traumatic brain injury in plateau areas.

Systemic Inflammatory Response Syndrome and Serum Procalcitonin in Odontogenic Maxillofacial Infection

INTRODUCTION: The systemic inflammatory response syndrome (SIRS) is a progressive, pathophysiological process which may be caused by a variety of clinical precursor events including local or generalized infection, or non-infective inflammatory process.&#x0D; АIM: To determine the development of systemic inflammatory response syndrome (SIRS) and serum procalcitonin level in patients with odontogenic infection of the maxillofacial area.&#x0D; MATERIALS AND METHODS: The prospective observational study evaluated on 158 medical patients from 2015 to 2018 at the Department of maxillofacial surgery, Faculty of Stomatology, Vitebsk state medical University. The patients were divided into 3 groups: 1 group (96 people) had acute purulent odontogenic osteomyelitis of mandible complicated by the cellulitis of one space cellular spaces, group 2 (36 patients) had acute purulent odontogenic osteomyelitis of mandible complicated by the cellulitis of 24 cellular spaces, group 3 (26 people) had acute purulent odontogenic osteomyelitis of the mandible complicated by Ludwig's angina. Blood tests of all patients were performed. Based on the blood test, breath rate, heart rate and body temperature SIRS was determined.&#x0D; RESULTS: Acute odontogenic osteomyelitis, complicated by cellulitis, is characterized by the development of SIRS. In case of one cellular space cellulitis SIRS developed in 9.0% of patients, in case of 24 cellular spaces cellulitis in 36.0%, in case of Ludwig's angina in 80.0%. PCT blood level in healthy group was 0.009 (0.0060.018) pg/ml. All patients groups had significantly higher PCT blood level compared with the healthy group: 1 group 0.034 (0.0190.050) pg/ml, U = 23, р = 0.01; 2 group 0.11 (0.060.24) pg/ml, U =12, р = 0.003; 3 group 0.41 (0.301.15) pg/ml, U = 17, р 0.001.&#x0D; CONCLUSION: Odontogenic maxillofacial infection is accompanied by SIRS. The search for significant diagnostic criteria for the development of life-threatening conditions should continue.

Clinico-bacterial and prognostic factors in patients with suspected blood stream infection and elevated serum procalcitonin levels.

ABSTRACTThis study determined prognostic factors by comparing clinico-bacterial factors based on significant elevated serum procalcitonin levels in patients with suspected bloodstream infection (BSI). We retrospectively analyzed the medical records of 1,052 patients (age ≥16 years) with fever (temperature ≥38°C) and serum procalcitonin levels of ≥2.0 ng/mL, and blood culture results. The optimal cutoff value of the significant elevation of procalcitonin was determined using the minimum P-value approach. Clinico-bacterial factors were analyzed per the procalcitonin levels, and significant independent factors for short-term survival were investigated in 445 patients with BSI. Patients with suspected BSI were aged, on average, 72.3 ± 15.1 years, and the incidence of positive blood culture was 42.3%; and the 14-day survival was 83.4%. Procalcitonin ≥100 ng/mL was the most significant predictor for survival. Multivariate analysis in patients with suspected BSI showed that estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 and procalcitonin ≥100 ng/mL were significant independent unfavorable prognostic factors. Microorganisms were similar between patients with procalcitonin level 2–99 ng/mL (n=359) and those with ≥100 ng/mL (n=86). Multivariate analysis in patients with BSI showed that eGFR <30 mL/min/1.73 m2, procalcitonin ≥100 ng/mL, and primary infectious foci were significant independent prognostic factors. Patients with foci in the gastrointestinal tract and respiratory system had unfavorable 14-day survival. In conclusions, eGFR <30 mL/min/1.73 m2 and procalcitonin ≥100 ng/mL were significant independent unfavorable prognostic factors for suspected BSI. Primary infectious foci (gastrointestinal tract and respiratory system) were associated with unfavorable short-term survival in patients with positive blood culture.

Procalcitonin levels in COVID-19 patients in a tertiary care center

BACKGROUND: Procalcitonin (PCT) is a glycoprotein calcitonin prohormone released by the thyroid parafollicular cells. In case of a microbial infection, PCT synthesis can be stimulated by the elevation of proinflammatory cytokines, including interleukin-6, interleukin-1b, and tumor necrosis factor-α. These mediators are massively involved in the so-called cytokine storm, typical of the progression from the viremic to the hyperinflammatory stage of COVID-19 and characterized by the onset of respiratory symptoms and interstitial pulmonary infiltrates. Thus, PCT elevation may represent a direct consequence of the COVID-19 cytokine storm and could also be interpreted as a “viral sepsis” syndrome.AIM: (1) To estimate serum PCT levels in patients with COVID-19 infection. (2) To access PCT level as a predictor of mortality.MATERIALS AND METHODS: A cross-sectional study was conducted on a total of 200 patients in Bengaluru during the study period from March 2021 to July 2021. A case record form with follow-up chart was used to record the duration of disease, history of treatment, and complications. Patients underwent biochemical investigations and PCT level.RESULTS: The study includes 200 patients; the majority were above 50 years of age group. Out of 200 patients, 170 were discharged and 30 died. The mean PCT level was 4.44 ± 45.34 ng/ml. PCT in those who are discharged was 1.25 ± 8.81 ng/ml and compared to those who died was 28.06 ± 128.4 ng/ml. This difference was statistically significant (P = 0.00).CONCLUSION: PCT can be used as a prognostic biomarker in COVID-19 patients; initially elevated levels may be used as a prognostic indicator of severity, deteriorating clinical picture, and even mortality.

Asessment of Serum Procalcitonin Level in Patients with Chronic Obstructive Pulmonary Disease

Asessment of Serum Procalcitonin Level in Patients with Chronic Obstructive Pulmonary Disease

The Utility of Serum Procalcitonin Measurement in the Diagnosis of Spontaneous Bacterial Peritonitis in Liver Cirrhosis patients

Background: Ascites in cirrhosis has a poor prognosis, with mortality rates of around 40% at one year and 50% at two years. It is also associated with other complications, such as spontaneous bacterial peritonitis (SBP), which can lead to hepatorenal syndrome (HRS) in 30% of patients. Diagnostic paracentesis is the gold standard for diagnosing SBP. Serum biomarkers such as procalcitonin (PCT) have recently received a lot of attention for the early detection of SBP. Objective: To determine the usefulness of measuring serum procalcitonin levels in patients with liver cirrhosis and ascites for the diagnosis of spontaneous bacterial peritonitis. Patients and methods: A cross-sectional case-control study that was conducted on ninety (90) patients diagnosed with liver cirrhosis. They were divided into three groups: Group (A) included 30 cirrhotic patients with ascites diagnosed as spontaneous bacterial peritonitis, Group (B) included 30 cirrhotic patients with ascites but without spontaneous bacterial peritonitis, and Group (C) included 30 cirrhotic patients without ascites as a control group. Results: Serum procalcitonin levels in SBP patients were significantly higher than in sterile ascites and cirrhotic patients without ascites with a P value of 0.001. It had a better cutoff value of 0.315 ng/ml, sensitivity of 87% and specificity of 97% than serum CRP that had a cutoff value of 16 mg/L, sensitivity of 76% and specificity of 90% in cirrhotic patients for predicting ascitic fluid infection. Conclusion: In cirrhotic patients, serum procalcitonin levels appear to provide a satisfactory diagnostic accuracy in the diagnosis of spontaneous bacterial peritonitis, with a suggested cut-off value of 0.315 ng/ml. Further studies are needed to determine the widespread use of serum PCT as a predictor of SBP clinically.

Prognostic Value of Serum Procalcitonin Levels in Patients With Febrile Neutropenia Presenting to the Emergency Department.

Various risk-stratification scores have been developed to identify low-risk febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) score is a commonly used validated scoring system, although its performance varies due to its subjectivity. Biomarkers like procalcitonin (PCT) are being used in patients with FN to detect bacteremia and additional complications. Our objective was to compare the performance of MASCC score with PCT in predicting adverse outcomes in patients with FN. This was a prospective observational study that included chemotherapy-induced FN in hematologic or solid malignancy. The MASCC score, PCT levels, and blood cultures were taken at the first point of contact, and patient treatment was managed according to routine institutional protocol. The primary outcome was mortality at 30days. A total of 100 patients were recruited, of which 92 had hematologic malignancy and 8 had solid malignancy. Forty-six patients were classified as low risk by MASCC score (≥21). The PCT threshold, 1.42ng/mL, was taken as a cutoff value, with area under the receiver operating characteristic curve (AUROC) of 0.664 (95% confidence interval [CI] -0.55 to 0.77) for predicting mortality. AUROC for MASCC was 0.586 (95% CI 0.462 to 0.711). PCT is a useful marker with better prognostic efficacy than MASCC score in patients with FN and can be used as an adjunct to the score in risk-stratifying patients with FN.

Serum Procalcitonin Levels in Patients with Acute Central Nervous System Infections

BACKGROUND: Bacterial infections of the brain are associated with high mortality and neurological sequelae, whereas viral diseases are usually self-limiting. A fast and easy-to-perform biomarker is needed to improve management in these patients.&#x0D; AIM: Procalcitonin (PCT) testing has already been implemented in many laboratories for evaluating septic patients and it is an easily accessible biomarker, so we aimed to examine its role specifically in discriminating acute bacterial from viral infections of the central nervous system (CNS).&#x0D; MATERIALS AND METHODS: This prospective study included 80 patients with both clinical symptoms and laboratory findings suggesting acute CNS infection. The microbiological analysis included direct microscopy, culturing, latex-agglutination test, and multiplex polymerase chain reaction. PCT levels were measured by enzyme-linked fluorescent assay technology.&#x0D; RESULTS: Following the results of the microbiological analysis, the cases were divided into three groups – bacterial 26.3% (n = 21), viral 17.5% (n = 14), and unidentified neuroinfections – 56.2% (n = 45). A statistically significant difference in the median serum PCT was observed between the bacterial and viral neuroinfections (p = 0.004) as well as between bacterial and unidentified infections of the brain (p = 0.000). No significant difference was found (p = 1.000) when comparing viral and unidentified neuroinfection. The area under the receiver operating characteristic curve for serum PCT was 0.823 but could be increased to 0.929 when combining serum PCT and C-reactive protein (CRP).&#x0D; CONCLUSION: Serum PCT levels are significantly higher in patients with acute bacterial infections of the brain. As a stand-alone biomarker, its discriminatory power is not superior to the classical laboratory parameters in the cerebrospinal fluid and serum CRP. However, when combined with serum CRP, excellent discriminatory power is observed.

Utility of procalcitonin as an early diagnostic marker of bacteremia in individuals with periodontitis Stage II and III.

The aim of the present study is to assess the ability of procalcitonin (PCT) to differentiate between periodontal health and Stage II and III periodontitis. We further assessed, if PCT can reflect early bacteremia induced by non-surgical periodontal treatment (NSPT). Sixty-four systemically healthy individuals were divided into Group I, periodontally healthy, and Group II, Stage II and III periodontitis. NSPT was done for both the groups. Standardized serum and salivary samples were obtained and analyzed for PCT levels using highly sensitive double antibody sandwich enzyme-linked immunosorbent assay at baseline and 2 weeks. In addition, the serum levels of PCT were recorded at immediate and 1-hour post-NSPT. Mean PCT levels (saliva=0.03ng/mL and serum=0.05ng/mL) in periodontally healthy group were considerably lower than that in the periodontitis group (saliva=0.22ng/mL and serum=1.85ng/mL) with significant intergroup comparison at P< 0.001. Post NSPT the mean serum PCT values increased from 1.854ng/mL to 1.871ng/mL at the immediate interval and remained at 0.879ng/mL after 2 weeks at P< 0.001. Spearman correlation showed highly significant positive correlation between serum and salivary PCT values to clinical attachment level (CAL) at P< 0.001 and rho=0.78 and 0.75, respectively. Linear regression model showed serum PCT to be a significant predictor for CAL. Screening for serum PCT levels in patients with periodontitis could act not only as a guide to assess the bacterial load and use of antibiotics but also as a predictor for CAL loss in patients with periodontitis.

Modestly Elevated Serum Procalcitonin Levels in Patients with Rheumatoid Arthritis Free of Active Infection.

Background and objectives: To investigate the serum procalcitonin (PCT) levels among patients with rheumatoid arthritis (RA) without active infection compared with healthy controls and to understand the relationship of PCT with RA disease activity, and treatment received by patients. Materials and Methods: Patients aged 20 years and above with clinician-confirmed diagnosis of RA and healthy volunteers were included during regular outpatient visits, and those with active infection symptoms and signs were excluded. RA disease activity was measured using the Disease Activity Score-28 for Rheumatoid Arthritis with erythrocyte sedimentation rate (DAS28-ESR). Medications received by the patients were also recorded. Results: A total of 623 patients with RA and 87 healthy subjects were recruited in this study. The mean PCT were significantly higher in patients with RA (6.90 ± 11.81 × 10−3 ng/mL) compared with healthy controls (1.70 ± 6.12 × 10−3 ng/mL) (p < 0.001) and the difference remained statistically significant after adjusting for age and sex. In addition, multiple linear regression analysis showed that a lower rank-transformed PCT serum level was significantly correlated with the use of biologics (p = 0.017) and a high DAS28-ESR score (p = 0.028) in patients with RA. Conclusion: Patients with RA have a significantly higher serum PCT levels compared with healthy controls. The use of biologics and an active RA disease activity were associated with a lower level of PCT in patients with RA. Further investigation is required to determine the optimal cutoff value of PCT among patients with RA and its association with disease activity and biologic usage.

The predictive value of serum procalcitonin level as a prognostic marker for outcomes in out-of-hospital cardiac arrest patients

Background: Patients who have successful return of spontaneous circulation after cardiac arrest may experience post-cardiac arrest syndrome. Procalcitonin can be used to assess the severity of post-cardiac arrest syndrome. The association between procalcitonin and outcomes in Asian patients with post-cardiac arrest syndrome has not been extensively studied. Objective: This study aimed to investigate the predictive value of serum procalcitonin level in the prognosis of patients hospitalized after out-of-hospital cardiac arrest. Methods: A retrospective observational study using the multicenter Korean Cardiac Arrest Research Consortium registry between October 2015 and June 2018 was performed. Serum procalcitonin level at the early phase of hospital presentation was obtained from the patients hospitalized after out-of-hospital cardiac arrest. In-hospital mortality and neurologic outcomes at hospital discharge were estimated. The relationship between serum procalcitonin level and in-hospital mortality and neurologic outcomes of patients was analyzed. Results: A total of 254 patients hospitalized after out-of-hospital cardiac arrest were included. Serum procalcitonin level was significantly elevated in non-survivors compared to survivors (0.17 (0.05–0.18) ng/dL vs. 0.10 (0.05–0.39) ng/dL, p = 0.017, respectively). In addition, serum procalcitonin level was significantly elevated in patients with unfavorable outcomes at hospital discharge compared to those with favorable outcomes (0.16 (0.06–1.10) ng/dL vs. 0.07 (0.04–0.22) ng/dL, p &lt; 0.001, respectively). However, serum procalcitonin level had a weak predictive value for in-hospital mortality (area under the receiver operating characteristic curve: 0.587, 95% confidence interval: 0.517–0.657, p = 0.017, cut-off = 0.12 ng/dL, specificity = 57.4%) and unfavorable outcomes (area under the receiver operating characteristic curve: 0.646, 95% confidence interval: 0.571–0.721, p &lt; 0.001, cut-off = 0.11 ng/dL, specificity = 62.3%). Conclusion: Elevated serum procalcitonin level in patients hospitalized after out-of-hospital cardiac arrest at the early phase of hospital presentation is associated with poor outcomes. However, serum procalcitonin level had weak diagnostic accuracy for predicting in-hospital mortality and unfavorable outcomes.

Neglected Variables in the Interpretation of Serum Procalcitonin Levels in Patients With Septic Shock.

The interpretation of serum procalcitonin (PCT) levels in septic patients is facilitated by reviewing the known stimuli that activate the PCT family of genes. Herein we describe 7 pathways that, alone or in combination, can increase serum PCT levels. As a marker of activation of innate immunity, high PCT levels affect clinical diagnosis, can be trended as a measure of "source" control, and can guide duration of antibacterial therapy in septic patients. Low PCT levels reflect little to no activation of an innate immune response, influence the differential diagnosis, and support the discontinuation of empiric antibiotic therapy. Understanding the pathways that result in elevated serum PCT levels is necessary for interpretation and subsequent clinical management.

Point-of-care procalcitonin may predict the need for surgical treatment in patients with small bowel obstruction

BackgroundThe early identification of patients with small bowel obstruction who require surgical treatment could potentially lead to improved patient outcomes. We evaluated the efficacy of point-of-care procalcitonin for predicting surgical treatment among patients with small bowel obstruction. MethodsThis was a prospective observational study. We measured serum procalcitonin levels in patients who presented to the emergency department and were diagnosed with small bowel obstruction from April 1, 2018 through March 31, 2019. Patients were grouped into two groups: the elevated procalcitonin and normal procalcitonin groups. Our primary outcome was surgical treatment. ResultsA total of 53 patients with small bowel obstruction were included in the study, and 11 patients (20.8%) were treated operatively. Baseline characteristics were similar, except for age, between the elevated procalcitonin (≥0.12 ng/ml) and normal procalcitonin groups. The elevated procalcitonin level was significantly correlated with surgical treatment and hospital length of stay (p < 0.05). The sensitivity, specificity, and positive likelihood of procalcitonin for the former were 45.5%, 85.7%, and 5.0 respectively. ConclusionThe patients with small bowel obstruction who had elevated procalcitonin levels on presentation showed significantly higher rate of surgical treatment than those who had normal procalcitonin levels. Point-of-care procalcitonin might predict the need for surgical treatment in patients with small bowel obstruction and could be used as an additional diagnostic test. Further studies with more patients are needed to investigate the predictive value of point-of-care procalcitonin for surgical treatment.

Changes of serum procalcitonin level in patients with severe trauma and its relationship with multiple organ failure

Objective To investigate the changes of serum procalcitonin (PCT) level in patients with severe trauma, and to analyze its relationship with multiple organ failure (MODS). Methods From October 2013 to October 2018, the serum PCT levels were measured in 40 patients with severe trauma complicated with MODS (MODS group: 40 cases) and 62 patients without MODS (non-MODS group: 62 cases) in Yuncheng Central Hospital.The relationship between PCT and severity of trauma score (ISS), sequential organ failure (SOFA), acute physiology and chronic health status score (APACHE Ⅱ) and prognosis was analyzed.The predictive value of PCT in the prognosis of patients with MODS and severe trauma combined with MODS was analyzed by ROC. Results The serum PCT levels of the MODS group were (8.25±2.35)μg/L, (7.26±2.49)μg/L, (3.62±1.75)μg/L on the 1st, 3rd and 7th day after admission, respectively, which were higher than those of the control group (t=7.561, 9.561, 8.251, all P<0.05). The serum PCT level in the MODS group increased with the increase of APACHE Ⅱ score and ISS score (F=12.108, 9.173, all P<0.05). The serum PCT level in the death group was higher than that in the survival group[(11.82±3.75)μg/L vs.(4.92±1.26)μg/L], and the difference was statistically significant (t=7.959, P<0.05). The area under MODS curve predicted by PCT for severe trauma patients was 0.848, with sensitivity and specificity of 80.00%(32/40), 82.50%(33/40), respectively.The area under MODS curve predicted by PCT was 0.747, with sensitivity and specificity of 77.50%(31/40), 72.50%(29/40), respectively. Conclusion The serum PCT level in patients with severe trauma complicated with MODS is significantly higher than that in patients without MODS, and its level is closely related to trauma, disease progression and prognosis.It is of great value to predict the occurrence and prognosis of MODS. Key words: Wounds and injuries; Procalcitonin; Multiple organ failure; Injury severity score; ROC curve; Prognosis; Diagnosis

Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case-control study.

BackgroundInflammation is a necessary component of chronic kidney disease (CKD) that can be attributed to an accumulation of toxins and a reduced clearance of proinflammatory cytokines. Procalcitonin (PCT) is a widely applied biomarker in the diagnosis of infection, and considering the presence of pre‐existing inflammation in CKD patients, the PCT level could be high in such a population; however, no reference value for PCT in CKD patients has been available to date.MethodsDuring the present study period, 361 CKD patients and 119 healthy controls were included. The PCT level and other biochemistry parameters were assayed by using a COBAS system. Statistical analysis was conducted to compare the differences in PCT levels and other biochemistry parameters between the two groups, and linear regression was used to assess the correlation between two variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of PCT and the optimal cutoff value to differentiate between CKD patients and healthy controls.ResultsThe PCT level in CKD patients was significantly higher than that in healthy controls, and among the CKD patients, the PCT level was increased with advanced clinical stage. Moreover, PCT was moderately correlated with CysC. The optimal off‐value was 0.075 with a sensitivity of 94.7% and specificity of 90.8%.ConclusionThe PCT level was significantly higher in CKD patients than in healthy controls, and the reference value for CKD patients should be adjusted to avoid unnecessary antibiotic treatments which may pose a negative impact on residual renal function.

Serum Procalcitonin and Presepsin Levels in Patients with Generalized Pustular Psoriasis.

Patients with generalized pustular psoriasis (GPP) often present with symptoms that must be differentiated from sepsis. Procalcitonin (PCT) and presepsin (P-SEP) are widely used as biomarkers for sepsis; therefore, we examined the serum PCT and P-SEP levels in patients with psoriatic diseases. The enrolled patients included 27 with psoriasis vulgaris (PV) (22 males, 5 females; mean age 47.7 years), 12 with psoriatic arthritis (PsA) (8 males, 4 females; mean age 51.3 years), and 15 with GPP (10 males, 5 females; mean age 63.7 years). The mean serum PCT levels in patients with PV, PsA, and GPP were 0.01 ng/mL (25th–75th percentile; 0.00–0.03), 0.013 ng/mL (0.00–0.03), and 0.12 ng/mL (0.05–0.18), respectively; the levels of PCT were higher for patients with GPP than with PV or PsA but were lower than the PCT cutoff value (0.5 ng/mL) for the diagnosis of infection. The mean serum P-SEP levels in patients with PV, PsA, and GPP were 144.9 pg/mL (25th–75th percentile; 78–181), 168.1 pg/mL (124–203), and 479.9 pg/mL (216–581), respectively. Unexpectedly, the levels of P-SEP in the patients with GPP were as high as the P-SEP cutoff value (317 to 647 pg/mL) used for the diagnosis of infection. We also found that neutrophils produced P-SEP, suggesting that the high serum P-SEP levels in patients with GPP might arise at least in part due to the P-SEP derived from neutrophils activated in GPP. Both serum PCT and P-SEP might therefore be useful as novel serum biomarkers for GPP because their levels were decreased by GPP treatments. However, the measurement of PCT might be more useful than the measurement of P-SEP for discriminating between GPP and sepsis.

Clinical study of serum procalcitonin level in patients with myocardial infarction complicated by pulmonary infection.

This study determined the serum procalcitonin (PCT) levels in patients with myocardial infarction complicated by pulmonary infection and explore its clinical significance and diagnostic value. A total of 473 patients who were admitted to the Third Affiliated Hospital of Qiqihar Medical University from January 2016 to June 2017 were enrolled as research subjects. Patients were divided into four groups based on their symptom status in myocardial infarction and pulmonary infection. There were 109 patients in normal control group who did not experience symptoms of either myocardial infarction or pulmonary infection. Blood samples were collected from each patient, and PCT levels were measured. The data were analyzed. The serum PCT levels prior to treatment were compared with each other. The PCT levels in the myocardial infarction and the pulmonary infection group were all higher than that in the normal control group (0.040±0.015) (p<0.05). On the contrary, the serum PCT level in the myocardial infarction complicated by pulmonary infection group was higher than that in the normal control group (p<0.001). The serum PCT level after treatment was compared with that before treatment within the same group. The serum PCT levels in the three disease groups were comparable after treatment. The differences in PCT levels before and after treatment were all statistically significant within all three groups (p<0.05). A patient's serum PCT level was correlated with myocardial infarction complicated by pulmonary infection, which suggested it can be used as an important diagnostic marker for this complication. This finding has important clinical value for predicting and evaluating the complicated condition of myocardial infarction and pulmonary infection by providing a more accurate, sensitive, and specific method for early diagnosis of the disease.

Value of serum procalcitonin level in differentiation between infections and tumor-related fever in patients with malignant tumors

Objective To assess the value of serum procalcitonin (PCT) level in the differentiation between infections and tumor-related fever in patients with malignant tumors. Methods Serum levels of PCT and related indicators were measured in 139 patients (173 times) with malignant tumors admitted in the First Affiliated Hospital of Anhui Medical University from December 2014 to December 2015. There were 64 cases of infection with fever, 44 cases of infection without fever, 36 cases of tumor-related fever and 29 non-infection, non-fever cases. Serum PCT levels of patients in 4 groups were compared by non-parametric test, and the value of PCT in the differentiation of infections and tumor-related fever was assessed by receiver operating characteristic (ROC) curve. Results There were significant differences in serum PCT levels among patients with different type of tumors (χ2=11.238, P=0.047) and between patients with metastases and without metastases (χ2=12.658, P=0.005) in infected patients, as well as in non-infected patients (χ2=12.374, 9.942, P=0.015, 0.019; respectively). The PCT levels of infection with fever group, infection without fever group, tumor-related fever group and non-infection, non-fever group were 0.449(0.148, 2.090)μg/L, 0.107(0.056, 0.441)μg/L, 0.254(0.100, 0.530)μg/L and 0.058(0.043, 0.124)μg/L, respectively. There was no significant difference in PCT levels between tumor-related fever group and infection without fever group(Z=-1.480, P=0.139), between tumor-related fever group and blood culture negative infection with fever group (Z=-0.965, P=0.334). According to the ROC, the cut-off value for PCT was defined at 0.955 μg/L, the sensitivity and specificity of PCT in differentiation between infection and tumor-related fever was 0.34 and 0.94, respectively. Conclusion Tumor types and metastasis can affect serum PCT level, and PCT level can be increased in tumor-related fever, which would affect value of PCT in diagnosis of infection in tumor patients. Key words: Neoplasms; Infection; Procalcitonin; Tumor-related fever

High serum procalcitonin levels in patients with periodontitis and chronic migraine.

To evaluate the contribution of chronic periodontitis (CP) to serum procalcitonin (proCT) levels in chronic migraine (CM) patients in a cross-sectional study. We included 138 subjects divided into 4 groups based on clinical features of CM and periodontal parameters: systemically and periodontally healthy individuals (n=37), systemically healthy and CP patients (n=19), CM and periodontally healthy patients (n=34), and CM+CP patients (n=48). Demographic, neurological, clinical data as well as full-mouth periodontal records were obtained. ProCT and high sensitive C-reactive protein (hs-CRP) serum levels were determined from blood samples taken during migraine interictal period. Patients from the CP+CM group (0.056±0.006ng/mL) had significantly higher serum proCT levels in comparison with the systemically and periodontally healthy group (0.029±0.019ng/mL), CM group (0.041±0.002ng/mL), or CP group (0.034±0.014ng/mL) (p<0.001). There were no significant differences in hs-CRP between groups (p=0.081). Multiple linear regression analysis showed that CP was associated with increased proCT levels in CM patients (R2 =0.293, p<0.001). CP independently contributes to elevated serum proCT levels in CM patients. These findings suggest that CP could play a role in migraine chronification.

Value of procalcitonin for diagnosing perioperative pneumonia, urinary infections and superficial surgical site infections in patients undergoing primary hip and knee arthroplasty.

Serum procalcitonin (PCT) levels may be helpful for the diagnosis of infections during the perioperative period of arthroplasty. However, there is much debate in the literature regarding the appropriate cut-off value for different types of surgery and local bacterial infection. The present study aimed to evaluate serum PCT levels in patients undergoing arthroplasty and to determine the cut-off value that may represent perioperative pneumonia, urinary infections and superficial surgical site infections. The present retrospective study included a total of 500 patients treated between July 2014 and August 2015. The case group contained 25 patients with perioperative infections (pneumonia, urinary and superficial surgical site infections), and the control group contained 25 patients without any post-surgical complications. Serum levels of PCT and white blood cells (WBC) were measured pre-operatively (D0) and at post-operative D4, D6 and D8, and the sensitivity, specificity and predictive value of these parameters were assessed. Regarding the comparison of the mean PCT levels between the case and the control group, a significant difference was seen at D8 (P=0.007), while no significant differences were observed at D0 (P=0.010), D4 (P=0.069) and D6 (P=0.093). No statistically significant differences in WBC levels between groups were observed for (P>0.01). In the control group, the PCT levels at D4 (0.062±0.020 ng/ml) were 2-fold of the mean baseline value, followed by a decrease until D6 (0.051±0.019 ng/ml) and a return close to the normal range by D8 (0.032±0.015 ng/ml). The PCT levels in the case group had rapidly increased on D4 (0.510±1.208 ng/ml). In contrast to the control group, they continuously increased on D6 (0.527±1.360 ng/ml) and D8 (0.686±1.117 ng/ml). From a clinical point of view, infection events were indicated in these patients during post-operative follow-up. For PCT, the area under the receiver operating characteristic curve (AUC) was 0.978 [95% confidence interval (CI), 0.933-1.022], and for WBC, the AUC was 0.562 (95% CI, 0.398-0.0.726). Based on the above data, the PCT value was a significant predictor of infection (AUC>0.9). For PCT, the cut-off point of 0.0995 ng/ml was associated with a sensitivity of 96% and a specificity of 100%. However, WBC were not a significant predictor of infection (0.5<AUC<0.7), and the cut-off value of 7.05×109/l was associated with a sensitivity of 64% and a specificity of 44%. In conclusion PCT was found to be a promising marker for diagnosing bacterial infections post-arthroplasty due to its high specificity. Based on the sensitivity and the specificity, detecting PCT may be more valuable than using WBC in the diagnosis of sepsis-associated pathological changes in the perioperative period.