Use of Procalcitonin in Patients on Chronic Hemodialysis: Procalcitonin Is Not Related with Increased Serum Calcitonin

Abstract

Objectives. To investigate whether procalcitonin (PCT) could be useful for detecting bacterial infections in patients on hemodialysis (HD) and with increased calcitonin (CT). Methods. This prospective study included 42 males and 34 females on HD. The infection group consisted of 15 patients with proven bacterial infections; the other 61 patients were designated as the noninfection group. Serum C-reactive protein (CRP), interleukin (IL)-6, white blood cell (WBC) count, immature and total neutrophil (I/T) ratio, and CT were measured at the beginning of HD, and serum PCT levels at the beginning of HD and after HD. Results. The mean CT level in the both groups was apparently higher than that of nonchronic kidney disease. Significantly higher values between the infection and noninfection groups were seen for CRP, IL-6, WBC, I/T ratio, PCT, and CT. The PCT value of the area under the receiver operating characteristic curve was 0.921, which was significantly higher than the values for CRP (0.853; P < 0.01), IL-6 (0.739; P < 0.01), WBC (0.692; P < 0.01), and I/T ratio (0.584; P < 0.01). Conclusions. PCT was useful marker of bacterial infection in patients on HD and with increased CT. PCT levels should be determined before HD.

A hemodialysis patient with Mycobacterium avium complex pericarditis in which remarkable presepsin elevation was not accompanied by procalcitonin elevation

“…Because the serum PCT and plasma P-SEP levels increase with the deterioration of the renal function [12], reference values have not been established for HD patients without infection. The previously reported pre-HD PCT levels in patients without infection are approximately 0.17-0.79 ng/mL (median) and 0.20-0.50 ng/mL (mean) [13][14][15][16][17][18]; thus, the PCT levels did not increase at all in the present case (Table 2). On the other hand, the previously reported pre-HD P-SEP levels in patients without infection are approximately 1434-1510 pg/mL (median) and 1327 pg/mL (mean) [12,[19][20][21][22]; thus, the patient showed persistently high P-SEP levels from January to September 2019 ( Table 2, Fig.…”

How should procalcitonin and C‐reactive protein levels be interpreted in haemodialysis patients?

“…There are a few studies that report a cut-off value for PCT alone. Mori et al 21 reported in their study that PCT values are higher than normal in HD patients. They suggested a cut-off value of 0.5 ng/mL for PCT for the diagnosis of infection.…”

“…2,5-16 Studies have linked the high level of CRP to the fact that when leukocytes face the dialysis membranes, the cytokines released from inflammatory cells trigger the inflammatory process. Mori et al 21 reported in their study that PCT values are higher than normal in HD patients. [13][14][15][16][17][18] Looking at the studies in which these two parameters were assessed in combination, Level et al 19 studied the PCT and CRP levels of 62 HD patients: 30 males and 32 females with a mean age of 61.8 AE 17.1.…”

The Effect of Vitamin D Levels on Inflammation in Patients With Chronic Renal Failure

“…As a conclusion, they reported that the PCT was a good marker for bacterial infection in patients who received HD treatment. Because the PCT levels may be affected by hemodialysis membrane, it is emphasized that PCT is a good marker of bacterial infection, and must be determined before HD; and the cut-off levels, which are indicative of bacterial infection in HD patients, must be determined as 0.5 ng/mL [54]. In our study, the samples were taken before the hemodialysis by considering that the PCT levels could be affected by hemodialysis membrane; and based on the findings, it was concluded the PCT level could be a good marker for bacterial infection in patients receiving HD and PD treatment.…”