Massive elevation of procalcitonin plasma levels in the absence of infection in kidney transplant patients treated with pan-T-cell antibodies

Sabat, Robert; Höflich, Conny; Döcke, Wolf‐Dietrich; Oppert, Michael; Kern, Florian; Windrich, Bettina; Rosenberger, Christian; Kaden, J; Volk, Hans‐Dieter; Reinke, Petra

doi:10.1007/s001340100949

Cited by 55 publications

(44 citation statements)

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“…[9][10][11] This evidence is confirmed and broadened by our data derived from paediatric patients with haematological or oncological diseases.…”

Section: Discussionsupporting

confidence: 75%

“…[4][5][6][7][8] However, there are sporadic reports on high PCT levels in adult patients after T-cell antibody infusion following kidney transplantation with no evidence of infection. [9][10][11] To further investigate these observations, we analysed the characteristics of PCT and CRP serum levels in paediatric patients with haematological or oncological diseases during treatment with T-cell antibodies and compared these with those occurring with episodes of Gram-negative sepsis. Furthermore, the roles of cytotoxic chemotherapy, irradiation and blood products were examined in the context of other potential stimuli for the release of these parameters.…”

mentioning

confidence: 99%

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Procalcitonin and C-reactive protein do not discriminate between febrile reaction to anti-T-lymphocyte antibodies and Gram-negative sepsis

Dornbusch

Strenger

Kerbl

et al. 2003

Bone Marrow Transplant

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Summary:Treatment with antibodies against T-lymphocytes usually triggers a febrile response potentially mimicking or masking infection. Procalcitonin (PCT) is considered a sensitive and specific marker of systemic bacterial and fungal infection. It was the aim of this study to investigate the characteristics of PCT and C-reactive protein (CRP) during treatment with polyclonal or monoclonal anti-Tcell antibodies, in order to examine the ability of these parameters to distinguish between systemic bacterial infection and reaction to antibody treatment. Thus, 15 consecutive febrile episodes after T-cell antibody infusion without clinical signs of infection were compared with nine episodes of Gram-negative sepsis. After T-cell antibody infusion PCT and CRP serum levels increased to a similar extent as in Gram-negative sepsis. Therefore, during T-cell antibody treatment neither PCT nor CRP are adequate for differentiating between fever due to infection or to unspecific cytokine release. Bone Marrow Transplantation (2003) 32, 941-945.

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“…[9][10][11] This evidence is confirmed and broadened by our data derived from paediatric patients with haematological or oncological diseases.…”

Section: Discussionsupporting

confidence: 75%

mentioning

confidence: 99%

Procalcitonin and C-reactive protein do not discriminate between febrile reaction to anti-T-lymphocyte antibodies and Gram-negative sepsis

Dornbusch

Strenger

Kerbl

et al. 2003

Bone Marrow Transplant

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“…(91)(92)(93)]. Its implication in the cytokine cascade stems from demonstrated increases of TNF␣ before increases in PCT (54,94 ) and a documented correlation between the concentrations of these biomarkers (r ϭ 0.86) (35 ). Furthermore, a study involving in vivo LPS stimulation showed an exponential increase over the period 2-6 h after injection, with a plateau from 8 to 24 h (54 ).…”

Section: Biomarker Detectionmentioning

confidence: 99%

“…Additionally, gram-positive and gram-negative organisms cause increases in PCT concentrations that are not significantly different (37,38,78,88 ). However, the definitive evidence of the role of PCT in immune response has been offset by contradictory reports of increased concentrations attributable to various inflammatory insults, including hepatic dysfunction (38 ), trauma (increases within 3 h of trauma) (43,96 ), anti-T-cell therapy (57,94 ), burns, heat stroke, and fungal infection (36 ) [for the exclusion criteria, see Ref. (92 )].…”

Section: Biomarker Detectionmentioning

confidence: 99%

Toward Resolving the Challenges of Sepsis Diagnosis

Scott²,

2004

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Sepsis in the UnitedStates has an estimated annual healthcare cost of $16.7 billion and leads to 120 000 deaths. Insufficient development in both medical diagnosis and treatment of sepsis has led to continued growth in reported cases of sepsis over the past two decades with little improvement in mortality statistics. Efforts over the last decade to improve diagnosis have unsuccessfully sought to identify a "magic bullet" proteic biomarker that provides high sensitivity and specificity for infectious inflammation. More recently, genetic methods have made tracking regulation of the genes responsible for these biomarkers possible, giving current research new direction in the search to understand how host immune response combats infection. Despite the breadth of research, inadequate treatment as a result of delayed diagnosis continues to affect approximately one fourth of septic patients. In this report we review past and present diagnostic methods for sepsis and their respective limitations, and discuss the requirements for more timely diagnosis as the next step in curtailing sepsis-related mortality. We also present a proposal toward revision of the current diagnostic paradigm to include real-time immune monitoring.

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“…Indeed, interferon-␥ inhibits IL-1␤-induced calcitonin mRNA expression (15). Conversely, massive serum PCT elevations have been reported after administration of pan-T cell antibodies (16,17).…”

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confidence: 99%

Procalcitonin in Children with Escherichia coli O157:H7 Associated Hemolytic Uremic Syndrome

et al. 2006

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Shiga toxin producing Escherichia coli (STEC) are noninvasive enteric pathogens that may cause hemorrhagic colitis (HC) and diarrhea-associated hemolytic uremic syndrome (Dϩ HUS). We hypothesized that development of Dϩ HUS is associated with increased serum procalcitonin (PCT) levels. PCT was measured by an immunoluminometric assay in 113 patients. Concentrations of PCT were different in normal controls, disease control groups (rotavirus enteritis, HC due to non-STEC pathogens, chronic renal failure), and children with uncomplicated O157:H7 HC or Dϩ HUS. Children with Dϩ HUS showed higher PCT levels than those with uncomplicated O157:H7 HC, and increased concentrations were noted in cases requiring peritoneal dialysis. Severely increased concentrations were observed in children with Dϩ HUS on d 5 or 6 after the onset of enteritis, whereas serial measurements in those with uncomplicated O157:H7 HC remained within the normal range throughout the first week of illness. PCT was correlated with serum concentrations of lipopolysaccharide (LPS)-binding protein and serum levels of alanine aminotransferase. Using two separate sets of real-time PCR primers, we were unable to detect elevated PCT mRNA transcripts in nonadherent undifferentiated (monocytic) or differentiated (macrophage-like) THP-1 cells stimulated with purified Shiga toxin-1 and/or LPS. Our data show that serum levels of PCT are associated with the severity of illness in children with Dϩ HUS. Further studies are needed to determine the role of PCT in the pathogenesis of thrombotic microangiopathy associated to childhood Dϩ HUS. (Pediatr Res 59: 579-583, 2006)

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Massive elevation of procalcitonin plasma levels in the absence of infection in kidney transplant patients treated with pan-T-cell antibodies

Abstract: PCT monitoring for evaluating infectious complications in kidney transplant patients must be very careful during pan-T-cell antibody therapy.

Cited by 55 publications

References 0 publications

Procalcitonin and C-reactive protein do not discriminate between febrile reaction to anti-T-lymphocyte antibodies and Gram-negative sepsis

Procalcitonin and C-reactive protein do not discriminate between febrile reaction to anti-T-lymphocyte antibodies and Gram-negative sepsis

Toward Resolving the Challenges of Sepsis Diagnosis

Procalcitonin in Children with Escherichia coli O157:H7 Associated Hemolytic Uremic Syndrome

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