Procalcitonin &amp;ndash; ein neuer Marker der inf lammatorischen Wirtsantwort. Longitudinalstudien bei Patienten mit Sepsis und Peritonitis

Gramm, H.-J.; Dollinger, Philippe; W, Beier

doi:10.1159/000189907

Cited by 52 publications

(44 citation statements)

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“…Although CRP is known to be a very sensitive marker in infection or inflammatory processes associated with tissue damage, it is not a suitable marker in acute bacterial infections. Even in polytraumatized cases, levels of CRP increased, and it was reported as a good marker to differentiate between infection and inflammation [20,21]. In this study, when the patients were admitted to the hospital, the median values of PCT and CRP in serum were found to be significantly higher than those in the healthy control group, but the same values were found to be similar to the PCT values of non-IE cases with bacteremia.…”

Section: Discussionmentioning

confidence: 43%

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Procalcitonin and C-Reactive Protein in Infective Endocarditis: Correlation with Etiology and Prognosis

Kocazeybek¹,

Küçükoğlu²,

Öner

2003

Chemotherapy

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Background: The aim of this study was to investigate the diagnostic values of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in infective endocarditis (IE) and to correlate them with the etiology of the disease and the prognosis of the patients. Methods: Fifty patients who were diagnosed as having IE based on Duke criteria (major and/or minor) were included in the study at the Istanbul University Cardiology Institute and Florence Nightingale Hospital. Forty patients with bacteremia (non-IE) and 50 healthy blood donors were also included in the study as the control group. During the 45 days of medical follow-up, in those patients who had a response to medical therapy based on the results of left ventricular function tests, transesophageal echocardiography (TEE) and culture, among other factors, PCT and CRP levels were measured in 5-cm³ blood samples obtained without anticoagulant when they were first admitted (day 0), as well as 24 h and 15, 30 and 45 days after admission. In the patients who had valve replacement, 5-cm³ blood samples without anticoagulant were similarly obtained on the day of admission, after 24 h and/or on the 15th day, and 1 day before and on the 2nd and 5th days after the operation. Results: In this study, a significant difference (p < 0.001) was found between the IE group and the healthy control group with respect to their serum PCT and CRP levels at the time of admission. No significant difference was found between IE and non-IE groups (p > 0.05). The sensitivity of PCT in comparison to CRP was found to be lower (84 vs. 100%); however, its specificity was determined to be higher (88 vs. 72%). The median values of serum PCT in the nonoperated and operated cases at the time of admission, after 24 h and on the 15th day were 3.71, 5.35 and 0.44, and 2.45, 4.28 and 4.22 ng/ml, respectively, and those of CRP were 9.30, 10.95 and 10.65, and 9.5, 10.9 and 10.2 mg/dl, respectively. The median values of serum PCT were found to be higher in cases with IE and non-IE related to gram-negative bacteria than those related to gram-positive bacteria (p < 0.02). This was found to be insignificant for CRP (p > 0.05). Conclusions: As a result, this study suggests that in the diagnosis of IE, it would be beneficial to use PCT, besides TEE, culture and other clinical criteria, for its high specificity and positive predictive value in comparison to CRP. This study also suggests that in determining the response to medical treatment in the follow-up period, PCT could be a more valuable parameter than CRP, as PCT has a high prognostic value and is a good indicator for valve replacement in addition to the major criteria. Furthermore, serum PCT levels may help the physician to decide on the antimicrobial therapy combination before obtaining the culture results, or in situations in which the agent could not be isolated yet.

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Section: Discussionmentioning

confidence: 43%

“…On the other hand, CRP levels were high during the therapy and decreased slowly over time [14,21,26,33]. Conversely, a slight decrease in PCT levels or persistence at pathological levels was considered a sign of continuation of the infection risk and bad prognosis [14,21,[34][35][36].…”

Section: Discussionmentioning

confidence: 99%

Procalcitonin and C-Reactive Protein in Infective Endocarditis: Correlation with Etiology and Prognosis

Kocazeybek¹,

Küçükoğlu²,

Öner

2003

Chemotherapy

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“…It is not a marker of infection as such since localized infections or infections without systemic manifestation may cause no or only small increases in procalcitonin levels [19]. One study found procalcitonin levels to be very low or undetectable in patients with community-acquired pneumonia (median 0.2, range 0.1±6.7 ng/ml, n = 149) whereas patients with pneumonia and sepsis had very high levels (median 31, range 0.5±5420 ng/ml) [20]. Another study reported mean procalcitonin values of 2.4 ng/ml in patients with pneumonia without sepsis and values of 31 ng/ml in those with sepsis [21].…”

Section: Introduction Of Procalcitonin As a Marker Of Infectionmentioning

confidence: 99%

Procalcitonin as a marker of the systemic inflammatory response to infection

2000

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K. R. has been reimbursed by B. R.A. H.M. S. Diagnostica GmbH, the manufacturer of procalcitonin, for organizing educational symposia, research projects, speaking, and consulting. M. M. has received funds for research and fees for speaking from B. R IntroductionSevere infections and sepsis are common causes of morbidity and mortality in intensive care units. Such conditions are accompanied by clinical and laboratory signs including changes in body temperature, leukocytosis, and tachycardia. However, these manifestations of systemic inflammation may be noninfectious in origin and are neither specific nor sensitive for sepsis. A similar inflammatory response occurs in patients suffering from pancreatitis [1], major trauma [2], and burns [3] without infectious complications. It is therefore frequently difficult to distinguish between patients in organ dysfunction or shock who have systemic infection and those who do not [4]. Bacteriological evidence of infection may not develop concurrently with clinical signs of sepsis. Positive bacteriological results may be due to contamination, and negative results do not exclude the presence of infection or sepsis. Since these standard clinical and laboratory parameters lack sensitivity and specificity, other markers are needed to provide an early indication of an infectious cause of a generalized inflammatory response, and thus allow early diagnosis and more specific therapeutic interventions. One such parameter, procalcitonin, has recently gained interest as a possible marker of the systemic inflammatory response to infection. Biology of procalcitoninProcalcitonin, a propeptide of calcitonin, is normally produced in the C-cells of the thyroid gland [5,6]. A specific protease cleaves procalcitonin to calcitonin, katacalcin, and an N-terminal residue [5]. Normally all the procalcitonin is cleaved, and none released into the bloodstream. Procalcitonin levels are therefore very low (< 0.1 ng/ml) in healthy humans. However, during severe infections with systemic manifestations procalcitonin levels increase to over 100 ng/ml. Remarkably, the large amounts of procalcitonin produced during infections do not lead to an increase in plasma calcitonin levels or activity [7]. In contrast to the short half-life of calcitonin (10 min), procalcitonin has a long half-life of approximately 22±35 h in serum [8,9].During severe systemic infections procalcitonin is probably produced by extrathyroid tissues. Patients who have previously undergone total thyroidectomy can still produce high levels of procalcitonin during a severe infectious episode [7]. The exact site of procalcitonin production during sepsis is uncertain. In a hamster model of sepsis procalcitonin mRNA was found in numerous tissues [10]. Studies in our laboratory have implicated mononuclear leukocytes [11]; endotoxin and sepsis-related proinflammatory cytokines had pronounced stimulatory effects on procalcitonin mRNA expression in human mononuclear leukocytes when measured by the reverse-transcriptase polymerase chain reaction. End...

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“…The reference value of serum PCT concentrations in healthy individuals is below 0.5 ng/ml [2,17]. Since the original publication by Assicot and co-workers [4], who demonstrated that serum PCT levels increase at the onset of bacterial infection and that serum PCT concentrations are correlated with the severity of sepsis, recent clinical studies have shown that PCT is a valid marker for the presence of bacterial infection in patients with severe sepsis [2,6,7,9,10,11,15,25,27].…”

Section: Introductionmentioning

confidence: 99%

Serum procalcitonin (PCT): a valuable biochemical parameter for the post-mortem diagnosis of sepsis

Tsokos

Reichelt

Nierhaus

et al. 2001

International Journal of Legal Medicine

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The aim of this prospective study was to investigate whether serum procalcitonin (PCT) can be used as a post-mortem marker of sepsis and to determine whether this biochemical parameter can be employed in the forensic elucidation of death due to sepsis. At least three blood samples were collected between 0.3 and 139 h post-mortem from sepsis-related fatalities (n = 8) and control individuals (n = 53, where death was due to various natural and unnatural causes). Additionally one ante-mortem blood sample was collected shortly before death from the patients in the sepsis group. In the sepsis group, serum PCT concentrations, determined by using an immunoluminometric assay, were elevated in all patients for the whole observation period, whereas in the control group serum PCT was not detectable in 94% of the cases. Measurement of PCT levels seems reasonable until at least approximately 140 h postmortem, depending on the ante-mortem levels. A linear regression model is presented that allows the serum PCT concentration of an individual at the time of death to be estimated on condition that at least two positive post-mortem PCT values have been determined. Ante-mortem PCT values correlated well with the predicted PCT values at the time of death in the sepsis group using the standardized PCT logarithms. According to the results of the present study, PCT is a valuable biochemical parameter for the post-mortem discrimination between sepsis and underlying non-septic causes of death.

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Procalcitonin – ein neuer Marker der inf lammatorischen Wirtsantwort. Longitudinalstudien bei Patienten mit Sepsis und Peritonitis

Cited by 52 publications

References 0 publications

Procalcitonin and C-Reactive Protein in Infective Endocarditis: Correlation with Etiology and Prognosis

Procalcitonin and C-Reactive Protein in Infective Endocarditis: Correlation with Etiology and Prognosis

Procalcitonin as a marker of the systemic inflammatory response to infection

Serum procalcitonin (PCT): a valuable biochemical parameter for the post-mortem diagnosis of sepsis

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