Procalcitonin (PCT), contemporary indicator of infection and inflammation

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Procalcitonin (PCT), contemporary indicator of infection and inflammation

Violetta Dymicka-Piekarska 1 , Alicja Wasiluk 2

1. Zakład Laboratoryjnej Diagnostyki Klinicznej Uniwersytetu Medycznego w Białymstoku
2. Klinika Neonatologii i Intensywnej Terapii Noworodka Uniwersytetu Medycznego w Białymstoku

Published: 2015-06-25
DOI: 10.5604/17322693.1158796
GICID: 01.3001.0009.6545
Available language versions: en pl
Issue: Postepy Hig Med Dosw 2015; 69 : 723-728

 

Abstract

Procalcitonin is a protein synthesized during sepsis and inflammation. In these states, its production is stimulated by inflammatory mediators and bacterial toxins. Routine determination of PCT concentration is useful in the rapid detection and monitoring of bacterial and fungal infections. The article presents the latest meta-analysis and clinical reports on the use of the PCT and comparison of its diagnostic sensitivity and specificity with other indicators of inflammation and infection in both neonates and in the adult population. Synthesis, properties and metabolism of PCT and the available methods and conditions of the determination are discussed. Presented data indicate a high sensitivity and specificity of PCT determinations, especially in bacterial infection and, what is very important, short duration of the assay and the use of a small sample volume. Assess the dynamics of changes in the concentrations of PCT can provide information not only about the course of infection but also facilitates the decision to introduce and then to discontinue antibiotic therapy.

References

  • 1. Afshari A., Harbath S.: Procalcitonin as diagnostic biomarker ofsepsis. Lancet Infect. Dis., 2013; 13: 382-384
    Google Scholar
  • 2. Ansaloni L., Catena F., Coccolini F., Ercolani G., Gazzotti F., PasqualiniE., Pinna A.D.: Surgery versus conservative antibiotic treatmentin acute appendicitis: a systematic review and meta-analysis of randomizedcontrolled trials. Dig. Surg., 2011; 28: 210-221
    Google Scholar
  • 3. Assicot M., Gendrel D., Carsin H., Raymond J., Guilbaud J., BohuonC.: High serum procalcitonin concentrations in patients with sepsisand infection. Lancet, 1993; 341: 515-518
    Google Scholar
  • 4. Assink-de Jong E., de Lange D.W., van Oers J.A., Nijsten M.W., TwiskJ.W.: Beishuizen A.: Stop Antibiotics on guidance of ProcalcitoninStudy (SAPS): a randomised prospective multicenter investigatorinitiatedtrial to analyse whether daily measurements of procalcitoninversus a standard-of-care approach can safely shorten antibioticduration in intensive care unit patients-calculated sample size: 1816patients. BMC Infect. Dis., 2013; 13: 178
    Google Scholar
  • 5. Becker K.L., Nylen E.S., White J.C., Muller B., Snider R.H.Jr.: Clinicalreview 167: Prokcalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitoninback to its precursors. J. Clin. Endocrinol. Metab., 2004; 89: 1512-1525
    Google Scholar
  • 6. Becker K.L., Snider R., Nylen E.S.: Procalcitonin in sepsis and systemicinflammation: a harmful biomarker and a therapeutic target.Br. J. Pharmacol., 2010; 159: 253-264
    Google Scholar
  • 7. Bihan H., Becker K.L., Snider R.H., Nylen E., Vittaz L., Lauret C.,Modigliani E., Moretti J.L., Cohen R.: Calcitonin precursor levels inhuman medullary thyroid carcinoma. Thyroid, 2003; 13: 819-822
    Google Scholar
  • 8. Brunkhorst F.M., Forycki Z.F., Wagner J.: Procalcitonin-immunoreactivityin patients with cardiogenic shock – does bacterial inflammationinfluence the prognosis? Eur. Heart J., 1996; 17 (Suppl.2): S67-S72
    Google Scholar
  • 9. Brunkhorst F.M., Heinz U., Forycki Z.F.: Kinetics of procalcitoninin iatrogenic sepsis. Intensive Care Med., 1998; 24: 888-889
    Google Scholar
  • 10. Chiesa C., Panero A., Rossi N., Stegagno M., De Giusti M., OsbornJ.F., Pacifico L.: Reliability of procalcitonin concentrations for thediagnosis of sepsis in critically ill neonates. Clin. Infect. Dis., 1998;26: 664-672
    Google Scholar
  • 11. Cotoi O.S., Manjer J., Hedblad B., Engstrom G., Melander O.,Schiopu A.: Plasma procalcitonin is associated with all-cause andcancer mortality in apparently healthy men: a prospective population-basedstudy. BMC Med., 2013; 11: 180-188
    Google Scholar
  • 12. Dandona P., Nix D., Wilson M.F., Aljada A., Love J., Assicot M., BohuonC.: Procalcitonin increase after endotoxin injection in normalsubjects. J. Clin. Endocrinol. Metab., 1994; 79: 1605-1608
    Google Scholar
  • 13. de Kruif M.D., Lemaire L.C., Giebelen I.A., Struck J., MorgenthalerN.G., Papassotiriou J., Elliott P.J., van der Poll T.: The influence ofcorticosteroids on the release of novel biomarkers in human endotoxemia.Intensive Care Med., 2008; 34: 518-522
    Google Scholar
  • 14. Dellinger R.P., Levy M.M., Rhodes A., Annane D., Gerlach H.,Opal S.M., Sevransky J.E., Sprung C.L., Douglas I.S., Jaeschke R., OsbornT.M., Nunnally M.E., Townsend S.R., Reinhart K., Kleinpell R.M.i wsp.: Surviving sepsis campaign: international guidelines for managementof severe sepsis and septic shock: 2012. Crit. Care Med.,2013; 41: 580-637
    Google Scholar
  • 15. Gendrel D., Raymond J., Coste J., Moulin F., Lorrot M., GuerinS., Ravilly S., Lefevre H., Royer C., Lacombe C., Palmer P., Bohuon C.:Comparison of procalcitonin with C-reactive protein, interleukin 6and interferon-alpha for differentiation of bacterial vs. viral infection.Pediatr. Infect. Dis. J., 1999; 18: 875-881
    Google Scholar
  • 16. Herzum I., Renz H.: Inflammatory markers in SIRS, sepsis andseptic shock. Curr. Med. Chem., 2008; 15: 581-587
    Google Scholar
  • 17. Lauterbach R. Sepsa u noworodka: definicja, diagnostyka i terapia.Standardy Medyczne Pediatria 2012: 9: 2-5
    Google Scholar
  • 18. Lencot S., Cabaret B., Sauvage G., Laurans C., Launay E., OrsonneauJ.L., Caillon J., Boscher C, Roze JC, Gras-Le Guen C.: A new procalcitonincord-based algorithm in early-onset neonatal infection:for a change of paradigm. Eur. J. Clin. Microbiol. Infect. Dis., 2014;33: 1229-1238
    Google Scholar
  • 19. Liappis A.P., Gibbs K.W., Nylen E.S., Yoon B., Snider R.H., Gao B.,Becker K.L.: Exogenous procalcitonin evokes a pro-inflammatorycytokine response. Inflamm. Res., 2011; 60: 203-207
    Google Scholar
  • 20. Linscheid P., Seboek D., Nylen E.S., Langer I., Schlatter M., BeckerK.L., Keller U., Muller B.: In vitro and in vivo calcitonin I gene expressionin parenchymal cells: a novel product of human adipose tissue.Endocrinology, 2003; 144: 5578-5584
    Google Scholar
  • 21. Magrini L., Travaglino F., Marino R., Ferri E., De Berardinis B.,Cardelli P., Salerno G., Di Somma S.: Procalcitonin variations afterEmergency Department admission are highly predictive of hospitalmortality in patients with acute infectious disease. Eur. Rev. Med.Pharmacol. Sci., 2013; 17 (Suppl. 1): 133-142
    Google Scholar
  • 22. Maruna P., Nedelnikova K., Gurlich R.: Physiology and geneticsof procalcitonin. Physiol. Res., 2000; 49 (Suppl. 1): S57-S61
    Google Scholar
  • 23. Meisner M.: Update on procalcitonin measurements. Ann. Lab.Med., 2014; 34: 263-273
    Google Scholar
  • 24. Meisner M., Lohs T., Huettemann E., Schmidt J., Hueller M.,Reinhart K.: The plasma elimination rate and urinary secretion ofprocalcitonin in patients with normal and impaired renal function.Eur. J. Anaesthesiol., 2001; 18: 79-87
    Google Scholar
  • 25. Meisner M., Tschaikowsky K., Schnabel S., Schmidt J., KatalinicA., Schuttler J.: Procalcitonin-influence of temperature, storage, anticoagulationand arterial or venous asservation of blood sampleson procalcitonin concentrations. Eur. J. Clin. Chem. Clin. Biochem.,1997; 35: 597-601
    Google Scholar
  • 26. Morgenthaler N.G., Struck J., Fischer-Schulz C., Seidel – MullerE., Beier W., Bergmann A.: Detection of procalcitonin (PCT) in healthycontrols and patients with local infection by a sensitive ILMA. Clin.Lab., 2002; 48: 263-270
    Google Scholar
  • 27. Muller B., White J.C., Nylen E.S., Snider R.H., Becker K.L., HabenerJ.F.: Ubiquitous expression of the calcitonin-I gene in multiple tissuesin response to sepsis. J. Clin. Endocrinol. Metab., 2001; 86: 396-404
    Google Scholar
  • 28. Nobre V., Harbarth S., Graf J.D., Rohner P., Pugin J.: Use of procalcitoninto shorten antibiotic treatment duration in septic patients:a randomized trial. Am. J. Respir. Crit. Care Med., 2008; 177: 498-505
    Google Scholar
  • 29. Perren A., Cerutti B., Lepori M., Senn V., Capelli B., Duchini F., DomenighettiG.: Influence of steroids on procalcitonin and C-reactiveprotein in patients with COPD and community-acquired pneumonia.Infection, 2008; 36: 163-166
    Google Scholar
  • 30. Pfister R., Kochanek M., Leygeber T., Brun-Buisson C., CuquemelleE., Machado M.B., Piacentini E., Hammond N.E., Ingram P.R.,Michels G.: Procalcitonin for diagnosis of bacterial pneumonia incritically ill patients during 2009 H1N1 influenza pandemic: a prospectivecohort study, systematic review and individual patient datameta-analysis. Crit. Care, 2014; 18: R44
    Google Scholar
  • 31. Scirè C.A., Cavagna L., Perotti C., Bruschi E., Caporali R., MontecuccoC.: Diagnostic value of procalcitonin measurement in febrilepatients with systemic autoimmune diseases. Clin. Exp. Rheumatol.,2006; 24: 123-128
    Google Scholar
  • 32. Simon L., Gauvin F., Amre D.K., Saint-Louis P., Lacroix J.: Serumprocalcitonin and C-reactive protein levels as markers of bacterialinfection: a systematic review and meta-analysis. Clin. Infect. Dis.,2004; 39: 206-217
    Google Scholar
  • 33. Stocker M., Fontana M., El Helou S., Wegscheider K., Berger T.M.:Use of procalcitonin-guided decision-making to shorten antibiotictherapy in suspected neonatal early-onset sepsis: prospective randomizedintervention trial. Neonatology, 2010; 97: 165-174
    Google Scholar
  • 34. Sugimoto K., Shimizu N., Matsumura N., Oki T., Nose K., NishiokaT., Uemura H.: Procalcitonin as a useful marker to decide upon interventionfor urinary tract infection. Infect. Drug Resist., 2013; 6: 83-86
    Google Scholar
  • 35. Tang B.M., Eslick G.D., Craig J.C., McLean A.S.: Accuracy of procalcitoninfor sepsis diagnosis in critically ill patients: systematicreview and meta-analysis. Lancet Infect. Dis., 2007; 7: 210-217
    Google Scholar
  • 36. Turner D., Hammerman C., Rudensky B., Schlesinger Y., Goia C.,Schimmel M.S.: Procalcitonin in preterm infants during the first fewdays of life: introducing an age related nomogram. Arch. Dis. Child.Fetal Neonatal Ed., 2006; 91: F283-F286
    Google Scholar
  • 37. Wacker C., Prkno A., Brunkhorst F.M., Schlattmann P.: Procalcitoninas a diagnostic marker for sepsis: a systematic review andmeta-analysis. Lancet Infect. Dis., 2013; 13: 426-435
    Google Scholar
  • 38. Wasiluk A.: Sepsa noworodków. Pediatria po Dyplomie, 2010,wyd. specjalne: 11-14
    Google Scholar
  • 39. Wiedermann F.J., Kaneider N., Egger P., Tiefenthaler W., WiedermannC.J., Lindner K.H., Schobersberger W.: Migration of humanmonocytes in response to procalcitonin. Crit. Care Med., 2002;30: 1112-1117
    Google Scholar
  • 40. Wu J.Y., Chen H.C., Lee S.H., Chan R.C., Lee C.C., Chang S.S.: Diagnosticrole of procalcitonin in patients with suspected appendicitis.World J. Surg., 2012; 36: 1744-1749
    Google Scholar
  • 41. Yu C.W., Juan L.I., Wu M.H., Shen C.J., Wu J.Y., Lee C.C.: Systematicreview and meta-analysis of the diagnostic accuracy of procalcitonin,C-reactive protein and white blood cell count for suspectedacute appendicitis. Br. J. Surg., 2013; 100: 322-329
    Google Scholar

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