Procalcitonin (PCT), contemporary indicator of infection and inflammation
Violetta Dymicka-Piekarska 1 , Alicja Wasiluk 2Abstract
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