Overview of procalcitonin in pregnancy and in pre-eclampsia

Abstract

Procalcitonin (PCT), a precursor for calcitonin, is a prohormone involved in the inflammatory processes, which has been poorly studied in the context of pregnancy. During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. In normal pregnancy, PCT is basally expressed at very low level by decidual cells, even if decidual macrophages, which in normal pregnancy are skewed to M2 macrophages, are resistant to lipopolysaccharide (LPS)-induced production of PCT. As PCT increase is associated with an inflammatory state, several research groups investigated whether PCT can be considered a marker of pre-eclampsia, a pregnancy disease characterized by systemic inflammation. The first aim of this review is to summarize what is already known about the tissues synthesizing PCT, about the stimuli that cause the increase of circulating PCT levels and how PCT acts as a proinflammatory stimulus by itself. Secondly, we will describe the role of this prohormone in normal pregnancy and in pregnancies complicated by pre-eclampsia, highlighting the involvement of the decidual macrophages and the proinflammatory cytokine tumor necrosis factor-α in the modulation of PCT expression in the decidual microenvironment.

Procalcitonin in preterm rupture of membranes: a systematic review and meta-analysis

“…During severe inflammation or sepsis, serum levels of PCT rapidly increase. For this reason, PCT is now generally accepted as a good predictive and diagnostic marker of the inflammatory process and as an additional tool to guide antibiotic prescription [3]. Serum PCT levels rise more rapidly than C-reactive protein (CRP) levels and peak within a short period before returning to normal levels, also more quickly [3].…”

Analysis of risk factors, pathogenic bacteria of maternal sepsis in term pregnant women with positive blood culture during hospitalization

“…During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. [ 19 , 20 ] It is specifically elevated in plasma during bacterial infection, sepsis, and multi-organ failure. The elevated of PCT is closely related to bacterial infection.…”

The immunology of the fetal–placental unit comes of age

“…Unfortunately, procalcitonin predictive power appears to be limited [5]. Its ability to reflect mutated inflammatory conditions could make it a valuable tool for prediction of pregnancy complications and for identification of early infection.…”

“…Mangogna and collaborators focus on procalcitonin, a prohormone precursor for calcitonin. Procalcitonin is a useful biomarker in the clinical practise because it is produced during systemic conditions, sepsis included [5]. As discussed above, pregnancy is primarily an inflammatory event and modulation of immune signatures early after embryo implantation is a hallmark of healthy pregnancy and of successful pregnancies of patients with systemic autoimmune diseases [6].…”

“…Procalcitonin levels rise in pregnant patients after the onset of preeclampsia and correlate with disease severity, making it a valuable tool for diagnosis and prognosis. Unfortunately, procalcitonin predictive power appears to be limited [5].…”