Fp141clinical Application of Procalcitonin in Diagnosis of Bacterial Infection in Hemodialysis Patients
Year: 2018
Type: conference-abstract
Abstract: INTRODUCTION AND AIMS: Procalcitonin (PCT) has attracted attention as a biomarker for bacterial infections. We reported on the physiological variation of PCT last year. The biological variation PCT was 0.24 ng/mL, the within-person biological variation (CVi) was 24.9%, between-person biological variation (CVb) was 54.2%,and the reference change value (RCV) was calculated 96.4% (with 99% probability). At this time, we advanced further analysis and focused on the actual clinical use of PCT. The aim of this study was to determine how useful of PCT in clinical practice. METHODS: We conducted a multicentre prospective cohort study. 123 HD patients without any signs of infectious disease at baseline were enrolled. Baseline PCT value were determined pre-HD, and then repeated pre-HD PCT measurements were performed at 2, 4, 8, 12, 16, 20, and 24 weeks after baseline blood sampling, regardless of the presence or absence of infectious disease. We also measured C-reactive protein, white blood cell and body temperature to diagnose the presence of infections during this period.Sensitivity and specificity, positive/negative neutral ratio and positive/negative likelihood ratio were calculated in reference change value (RCV) 99% confidence value. We examined the usefulness of PCT in hemodialysis patients by taking out cases diagnosed as bacterial infection using fever, CRP, fluctuation in white blood cell count. RESULTS: 893 samples from 123 maintenance dialysis patients who were able to confirm the presence of fever at the time of blood collection, other clinical findings and blood collection results were analyzed. The mean age was 62.7 years, 77% male, and 33% diabetes. The mean duration of HD was 87 months. During the observation period, 12 cases of bacterial infection were confirmed. The RCV (99% confidence value) was calculated to be 96.4%, which was used as cut-off value of PCT change for diagnosing bacterial infection. The sensitivity was 50% in the RCV 99% confidence value, the specificity was 97.1%, the positive neutral rate was 20%, the positive likelihood ratio was 17.2, the negative likelihood ratio was calculated to be 0.51. CONCLUSIONS: The positive likelihood ratio in this study was very high. This study shows doubling or more of the baseline PCT level may imply the presence of a bacterial infection in HD patients. We could not identify the best cut-off level for diagnosing infectious disease in HD patients by a single point assessment, however relative PCT change might be more important than the absolute PCT level for diagnosing bacterial infection. Thus, Procalcitonin levels among hemodialysis patients are useful for diagnosing of bacterial infection.
Authors: Shun Kubo, Ai Matsukane, Masaki Iwasaki, Toshihide Hayashi, Yuri Tanaka, Hiroki Hase, Nobuhiko Joki
Institutions: Toho University, Toho University Ohashi Medical Center
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2804577633