The Role of Serum Procalcitonin in Predicting Bacterial Sepsis in Patients With Hypothyroidism

Abstract

Context Serum levels of procalcitonin (PCT), a protein produced by the thyroid C cells under physiologic conditions, are high during sepsis. Objective To assess the test performance of serum PCT in predicting bacterial sepsis and septic shock in patients with hypothyroidism compared with those who have euthyroidism. Design and Methods This retrospective study evaluated patients with no history of thyroid dysfunction (euthyroid), primary hypothyroidism [medical hypothyroidism (MH)], and postsurgical hypothyroidism from total thyroidectomy (TT) identified from a prospectively maintained database who had PCT testing from 2005 to 2018. Quick Sequential Organ Failure Assessment score ≥ 2 or positive bacterial cultures identified bacterial sepsis, and a mean arterial pressure less than 65 mm Hg or a vasopressor requirement defined septic shock. Sensitivity and specificity of PCT for evaluation of bacterial sepsis and septic shock were measured. Results We identified 217 euthyroid patients, 197 patients with MH, and 84 patients with TT. Bacterial sepsis was found in 98 (45.2%), 92 (46.7%), and 36 (42.9%) of these patients, respectively (P > 0.05). Septic shock was identified in 13 (6.0%), 13 (6.6%), and 5 (6.0%) patients (P > 0.05), respectively. With use of a PCT cutoff of 0.5 µg/L for bacterial sepsis, the sensitivity was 59%, 61%, and 53% (P > 0.05) and specificity was 81%, 77%, and 81% (P > 0.05) for the diagnosis of bacterial sepsis in euthyroid, MH, and TT patients, respectively. With use of a PCT cutoff of 2.0 µg/L for septic shock, the sensitivity was 46%, 62%, and 63% (P > 0.05) and specificity was 86%, 82%, and 91% (P > 0.05) for the diagnosis of septic shock in these patients, respectively. Conclusions Despite the thyroidal origin of PCT, hypothyroidism did not affect the diagnostic performance of serum PCT levels in predicting bacterial sepsis or septic shock.

Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans–A potential marker for disease severity

“…Additionally, it is unknown whether PCT levels can be tracked serially to show a trend in patient condition. Historically, PCT level has been mainly associated with bacterial sepsis [38][39][40][41][42][43][44][45][46][47][48][49] and not with viral infections [50][51][52][53]. However, a few studies have shown elevated PCT levels in patients with multi-system organ failure and systemic inflammation without bacterial infection [54][55][56][57].…”

The Evaluation of Inflammatory Biomarkers in Predicting Progression of Acute Pancreatitis to Pancreatic Necrosis: A Diagnostic Test Accuracy Review

“…At present, CRP has been considered as a triage test to identify AP among patients without organ failure; these patient groups are then radiologically tested if the CRP test values indicate necrosis [31]. PCT is a protein typically found in the thyroid, but all tissues can produce it; patients with severe inflammation and sepsis have elevated PCT levels [32,33]. Since PN is directly correlated to ongoing inflammation, PCT may serve as a utilizable biomarker in distinguishing necrotizing pancreatitis and edematous pancreatitis [34].…”

Determination of procalcitonin content in blood serum, urine, and ejaculate for the diagnosis of urogenital tract pathology

“…С начала 90-х годов выполнено большое количество исследований, подтвердивших высокое диагностическое и прогностическое значение динамики ПКТ для диагностики, мониторинга течения сепсиса и синдрома системной воспалительной реакции [3][4][5]. В большинстве случаев концентрация данного белка изучалась в образцах сыворотки крови: в норме у здоровых взрослых людей она составляет менее 46 пг/мл.…”

“…Данное состояние практически всегда является следствием тяжелого бактериального сепсиса или септического шока. Высокая концентрация ПКТ связана с развитием синдрома полиорганной недостаточности, косвенно указывает на увеличение риска летального исхода [3][4][5].…”