Clinical relevance of procalcitonin and C-reactive protein as infection markers in renal impairment: a cross-sectional study

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• 作者：Ji Hyeon Park (1)
  Do Hee Kim (1)
  Hye Ryoun Jang (1)
  Min-Ji Kim (2)
  Sin-Ho Jung (2)
  Jung Eun Lee (1)
  Wooseong Huh (1)
  Yoon-Goo Kim (1)
  Dae Joong Kim (1)
  Ha Young Oh (1)
  
  1. Division of Nephrology ; Department of Medicine ; Samsung Medical Center ; Sungkyunkwan University School of Medicine ; 81 Irwon-ro ; Gangnam-gu ; Seoul ; 135-710 ; Republic of Korea
  2. Biostatistics and clinical epidemiology center ; Samsung Medical Center ; Sungkyunkwan University School of Medicine ; Seoul ; Korea
  
• 刊名：Critical Care
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：18
• 期：6
• 全文大小：678 KB
• 参考文献：1. James, MT, Quan, H, Tonelli, M, Manns, BJ, Faris, P, Laupland, KB, Hemmelgarn, BR (2009) CKD and risk of hospitalization and death with pneumonia. Am J Kidney Dis 54: pp. 24-32 2009.04.005" target="_blank" title="It opens in new window">CrossRef
  2. Dalrymple, LS, Katz, R, Kestenbaum, B, Boer, IH, Fried, L, Sarnak, MJ, Shlipak, MG (2012) The risk of infection-related hospitalization with decreased kidney function. Am J Kidney Dis 59: pp. 356-363 2011.07.012" target="_blank" title="It opens in new window">CrossRef
  3. Girndt, M, Sester, M, Sester, U, Kaul, H, Kohler, H (2001) Molecular aspects of T- and B-cell function in uremia. Kidney Int Suppl 78: pp. S206-S211 23-1755.59.s78.6.x" target="_blank" title="It opens in new window">CrossRef
  4. Herbelin, A, Nguyen, AT, Zingraff, J, Urena, P, Descamps-Latscha, B (1990) Influence of uremia and hemodialysis on circulating interleukin-1 and tumor necrosis factor alpha. Kidney Int 37: pp. 116-125 CrossRef
  5. Panichi, V, Migliori, M, Pietro, S, Taccola, D, Bianchi, AM, Norpoth, M, Metelli, MR, Giovannini, L, Tetta, C, Palla, R (2001) C reactive protein in patients with chronic renal diseases. Ren Fail 23: pp. 551-562 CrossRef
  6. Pepys, MB, Hirschfield, GM (2003) C-reactive protein: a critical update. J Clin Invest 111: pp. 1805-1812 2/JCI200318921" target="_blank" title="It opens in new window">CrossRef
  7. Herget-Rosenthal, S, Marggraf, G, Pietruck, F, Husing, J, Strupat, M, Philipp, T, Kribben, A (2001) Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant 16: pp. 975-979 CrossRef
  8. Castelli, GP, Pognani, C, Meisner, M, Stuani, A, Bellomi, D, Sgarbi, L (2004) Procalcitonin and C-reactive protein during systemic inflammatory response syndrome, sepsis and organ dysfunction. Crit Care 8: pp. R234-R242 2877" target="_blank" title="It opens in new window">CrossRef
  9. Simon, L, Gauvin, F, Amre, DK, Saint-Louis, P, Lacroix, J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39: pp. 206-217 21997" target="_blank" title="It opens in new window">CrossRef
  10. Lu, XL, Xiao, ZH, Yang, MY, Zhu, YM (2013) Diagnostic value of serum procalcitonin in patients with chronic renal insufficiency: a systematic review and meta-analysis. Nephrol Dial Transplant 28: pp. 122-129 CrossRef
  11. Tang, BMP, Eslick, GD, Craig, JC, McLean, AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7: pp. 210-217 2-X" target="_blank" title="It opens in new window">CrossRef
  12. Piraino, B, Bailie, GR, Bernardini, J, Boeschoten, E, Gupta, A, Holmes, C, Kuijper, J, Li, PK-T, Lye, W-C, Mujais, S (2005) ISPD guidelines/recommendations. Perit Dial Int 25: pp. 107-131
  13. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. / Crit Care Med 1992, 20:864鈥?74.
  14. DeLong, ER, DeLong, DM, Clarke-Pearson, DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44: pp. 837-845 2307/2531595" target="_blank" title="It opens in new window">CrossRef
  15. Dumea, R, Siriopol, D, Hogas, S, Mititiuc, I, Covic, A (2014) Procalcitonin: diagnostic value in systemic infections in chronic kidney disease or renal transplant patients. Int Urol Nephrol 46: pp. 461-468 255-013-0542-8" target="_blank" title="It opens in new window">CrossRef
  16. Jacobs, JW, Lund, PK, Potts, JT, Bell, NH, Habener, JF (1981) Procalcitonin is a glycoprotein. J Biol Chem 256: pp. 2803-2807
  17. Herget-Rosenthal, S, Klein, T, Marggraf, G, Hirsch, T, Jakob, HG, Philipp, T, Kribben, A (2005) Modulation and source of procalcitonin in reduced renal function and renal replacement therapy. Scand J Immunol 61: pp. 180-186 2005.01545.x" target="_blank" title="It opens in new window">CrossRef
  18. Dahaba, AA, Rehak, PH, List, WF (2003) Procalcitonin and C-reactive protein plasma concentrations in nonseptic uremic patients undergoing hemodialysis. Intensive Care Med 29: pp. 579-583
  19. Schmidt, M, Burchardi, C, Sitter, T, Held, E, Schiffl, H (2000) Procalcitonin in patients undergoing chronic hemodialysis. Nephron 84: pp. 187-188 CrossRef
  20. Meisner, M, Schmidt, J, Huttner, H, Tschaikowsky, K (2000) The natural elimination rate of procalcitonin in patients with normal and impaired renal function. Intensive Care Med 26: pp. S212-S216 CrossRef
  21. Sitter, T, Schmidt, M, Schneider, S, Schiffl, H (2002) Differential diagnosis of bacterial infection and inflammatory response in kidney diseases using procalcitonin. J Nephrol 15: pp. 297-301
  22. Opatrna, S, Klaboch, J, Opatrny, K, Holubec, L, Tomsu, M, Sefrna, F, Topolcan, O (2005) Procalcitonin levels in peritoneal dialysis patients. Perit Dial Int 25: pp. 470-472
  23. Claeys, R, Vinken, S, Spapen, H, Elst, K, Decochez, K, Huyghens, L, Gorus, FK (2002) Plasma procalcitonin and C-reactive protein in acute septic shock: clinical and biological correlates. Crit Care Med 30: pp. 757-762 246-200204000-00006" target="_blank" title="It opens in new window">CrossRef
  24. Meisner, M, Tschaikowsky, K, Palmaers, T, Schmidt, J (1999) Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 3: pp. 45-50 CrossRef
  25. Karzai, W, Oberhoffer, M, Meier-Hellmann, A, Reinhart, K (1997) Procalcitonin鈥揳 new indicator of the systemic response to severe infections. Infection 25: pp. 329-334 CrossRef
  26. Oberhoffer, M, Stonans, I, Russwurm, S, Stonane, E, Vogelsang, H, Junker, U, Jager, L, Reinhart, K (1999) Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis-related cytokines in vitro. J Lab Clin Med 134: pp. 49-55 22-2143(99)90053-7" target="_blank" title="It opens in new window">CrossRef
  
• 刊物主题：Intensive / Critical Care Medicine; Emergency Medicine;
• 出版者：BioMed Central
• ISSN：1364-8535

文摘

Introduction Although the clinical application of procalcitonin (PCT) as an infection marker in patients with impaired renal function (estimated glomerular filtration rate (eGFR) 2) has been increasing recently, it is unclear whether PCT is more accurate than C-reactive protein (CRP). We investigated the clinical value of CRP and PCT based on renal function. Methods From November 2008 to July 2011, a total of 493 patients who simultaneously underwent CRP and PCT tests were enrolled. The area under the receiver operating characteristic (ROC) curve and characteristics of both markers were analyzed according to infection severity and renal function. Results In patients with impaired renal function, the area under the ROC curve was 0.876 for CRP and 0.876 for PCT. In patients with infection, CRP levels differed depending on whether the infection was localized, septic, or severely septic, whereas PCT levels were higher in patients with severe sepsis or septic shock. In patients without infection, CRP did not correlate with eGFR, while PCT was negatively correlated with eGFR. Conclusion This study demonstrates that CRP is accurate for predicting infection in patients with impaired renal function. The study suggests that in spite of its higher cost, PCT is not superior to CRP as an infection marker in terms of diagnostic value.