Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

Abstract

Objectives To determine the significance of a newly described marker of inflammation procalcitonin (PCT), and to investigate its relationship to conventional markers of inflammation, such as C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR), in patients on peritoneal dialysis (PD) and with peritonitis. Design A prospective, observational clinical study. Setting The Nephrology Division of a University-affiliated teaching hospital. Patients and Methods 51 consecutive patients on PD were included in the study. Of this number, 16 developed peritonitis during the observational period. Baseline PCT, CRP, and fibrinogen concentrations and ESR of 51 PD patients were determined at a time point (TB) prior to any evidence of infection. These results were compared with laboratory values from 74 hemodialysis patients and 34 nonuremic control subjects. All PD patients then were followed prospectively for evidence of peritonitis. In addition to routine blood tests, including hemoglobin and leukocyte count, and routine biochemical tests, blood samples were taken to measure PCT, CRP, and fibrinogen concentrations and ESR at the time (T0) when patients first were diagnosed with PD peritonitis and also on the 4th (T4) and the 14th (T14) days after treatment for peritonitis was initiated. PCT was assayed by immunoluminometry. Results No significant difference was observed between baseline median serum PCT concentrations in PD and hemodialysis patients; however, in both groups, baseline median PCT concentrations were significantly higher than those of nonuremic controls ( p < 0.05). The 16 patients on PD who developed peritonitis had 21 PD peritonitis episodes during the study period. The increased PCT concentration observed at T0 in PD peritonitis episodes decreased with therapy, and this change was statistically significant ( p < 0.05). In a receiver operating characteristic curve analysis for peritonitis, the area under the curve (AUC) for PCT was 0.80, which was significantly lower than the AUC for CRP and greater than the AUCs for fibrinogen and ESR. The sensitivity of PCT for peritonitis was lower than the sensitivity of conventional markers of inflammation; however, the specificity of PCT was higher. Conclusions Median serum PCT concentration in PD patients was significantly higher than in nonuremic controls but not hemodialysis patients. Serum PCT concentrations may serve as a useful adjunct to traditional markers of inflammation in detecting and monitoring inflammation and peritonitis in PD patients.

Significance of serum procalcitonin as biomarker for detection of bacterial peritonitis: a systematic review and meta-analysis

“…Having reviewed the full text of the remaining 80 articles, we then excluded another 62 studies: among them, 25 was review article; 7 was case reports; 2 was animal studies, 7 did not investigate the diagnostic value of serum PCT level or explore other outcomes; and 15 was not English or Chinese in the text; and 6 studies was unable to reconstruct 2 × 2 tables. Finally, 18 eligibility studies were included in the analysis [ 17 – 34 ] [Figure 1 ].…”

“…Nine studies were published in English [ 17 – 25 ], and nine in Chinese [ 26 – 34 ], representing an international experience from 5 countries. There were two trials performed by the same research unit [ 26 , 29 ], but the patients in these two studies were recruited from different cohorts.…”

“…4 of them referred to peritonitis in peritoneal dialysis patients [ 17 – 20 ], 12 studies reported spontaneous bacterial peritonitis in cirrhotic patients [ 21 – 23 , 25 – 32 , 34 ], 1 study were from spontaneous bacterial peritonitis of chronic severe hepatitis patients [ 24 ], and 1 study was from spontaneous bacterial peritonitis of end stage liver disease patients [ 33 ]. Fourteen studies [ 21 – 34 ] used ascitic polymorphonuclear(PMN) cells >250/mm 3 , while four studies [ 17 – 20 ] used ascitic PMN >50/mm 3 as the reference diagnostic standard for peritonitis. Common bacteria isolated were Escherichia coli, and Streptococcus species.…”

“…Common bacteria isolated were Escherichia coli, and Streptococcus species. PCT levels were measured in serum sample in 17 studies [ 17 – 27 , 29 – 34 ] and in ascites fluid sample in 5 studies [ 22 , 23 , 28 , 29 , 34 ], mostly using the LUMI test kit (BRAHMS, Berlin, Germany) and Semi-quantitative PCT-Q testing assays.…”

“…The QUADAS tool was used for study quality assessment, and Figure 2 provided an overall impression of the quality of the included studies. Five of 18 included studies were prospective [ 17 , 18 , 22 , 23 , 25 ], and 13 studies were retrospective in design [ 19 – 21 , 24 , 26 – 34 ]. All studies had clearly defined inclusion and exclusion criteria.…”