Limited significance of procalcitonin in differentiation between sepsis and flare of a rheumatic disease
Authors:
H. Dejmková 1; O. Šléglová 1; R. Bečvář 1; K. Pavelka 1; J. Uhrová 2
Authors‘ workplace:
Revmatologický ústav, Praha, 2Ústav klinické biochemie a laboratorní diagnostiky VFN, Praha
1
Published in:
Čes. Revmatol., 17, 2009, No. 2, p. 79-82.
Category:
Original Papers
Overview
The prognosis of patients with systemic lupus erythematosus has improved due to immunosuppressive therapy. This therapy together with immunological abnormalities associated with SLE leads to an increased risk of severe infections. Differentiation between flare of a disease and infectious complications is difficult. Procalcitonin is a biomarker which has been used mainly in patients in critical condition for the differential diagnosis of systemic inflammatory response syndrome and sepsis. The sensitivity and specificity of increased procalcitonin serum levels in case of an infection varies in different studies. This report presents a basic review of the knowledge on procalcitonin, and targets its potential use in rheumatology. Since the level of procalcitonin increases rapidly with a systemic bacterial or mycotic infection, and is not significantly affected by an autoimmune process or glucocorticoid therapy, it can be speculated, that procalcitonin could serve as a suitable supportive indicator in the differential diagnosis of these two situations. In this report, however, we present a case report which does not confirm this assumption.
Key words:
procalcitonin, sepsis, exacerbation of an autoimmune disease
Sources
1. Cervera R, Khamashta MA, Font J, et al. Morbidity and mortality in systemic lupus erythematodes during a 5-year period. A multicenter prospective study of 1000 patiens. European Working Party on Systemic Lupus erythematodes. Medicine 1999; 78: 167–175.
2. Paton NI. Infections in systemic lupus erythematodes patients. Ann Acad Med Signapore 1997; 26: 694–700.
3. Joshua F, Riordan J, Sturgess A. Salmonella typhimurium mediastinal abscess in a patient with systemic lupus erythematosus. Lupus 2003; 12: 710–3.
4. Wu KC, Yao TC, Yeh KW, Huang JL. Osteomyelitis in patients with systemic lupus erythematosus. J Rheumatol 2004; 31: 1340–3.
5. Meisner M. Biomarkers of sepsis: clinically useful? Curr Opin Crit Care 2005; 11: 473–80.
6. Mokart D, Merlin M, Sannini A, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery. Br J Anaesth 2005; 94: 767–73.
7. Malgorzata A, Verboon-Maciolek, Thijsen SFT, et al.Inflammatory mediators for diagnosis and treatment of sepsis in early infancy. Pediatr Res 2006; 59: 457–61.
8. Zima T, et al. Laboratorní diagnostika. 1. vyd., Galén, Praha 2002; 839–44.
9. Kazda A in ZimaT, et al. Laboratorní diagnostika. 1. vyd., Galén, Praha 2002; 829–44.
10. Delevaux I, André M, Colombier M, et al. Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes? Ann Rheum Dis 2003; 62 (4): 337–40.
11. Assicot M, Gendrel D,Carsin H, et al. High serum procalcitonin concentrations in patiens with sepsis and infection. Lancet 1993; 341: 515–518.
12. Meisner M, Adina H, Schmidt J. Correlation of procalcitonin and C-reactive protein to inflammation, complications, and outcome during the intensive care unit course of multiple-trauma patiens. Critical Care 2006; 10: R1
13. Dorizzi RM, Polati E, Sette P, et al. Procalcitonin in the diagnosis of inflammation in intensive care units. Clin Biochem 2006; 39(12): 1138–43.
14. Selberg O, Hecker H, Martin M, et al. Discrimination of sepsis and systemic inflammatory response syndrome by determination of circulating plasma concentrations of procalcitonin, protein komplement 3a, and interleukin-6. Crit Care Med 2000; 28: 2793–8.
15. Gendrel D, Bohuon C. Procalcitonin as a marker of bacterial infection. Pediatr Infect Dis J 2000; 19: 679–687.
16. Husová L, Husa P, Šenkyřík M, et al. Prokalcitonin jako indikátor infekce u pacientů s jaterní cirhózou. Vnitř Lék 2004; 50: 153–6.
17. Sitter T, Schmidt M, Schneider S, et al. Differential diagnosis of bacterial infection and inflammatory response in kidney diseases using procalcitonin. J Nephrol 2002; 15: 297–301.
18. Uzun G, Solmazgul E, Curuksulu H, et al. Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 2007; 213(4): 305–12.
19. Martinot M, Sordet C, Soubrier M, et al. Diagnostic value of serum and synovial procalcitonin in acute arthritis: a prospective study of 42 patiens. Clin Exp Rheumatol 2005; 23: 303–10.
20. Quintana G, Medina YF, Rojas C, et al. The use of procalcitonin determinations in evaluation of systemic lupus erythematosus. J Clin Rheumatol 2008; 14(3): 138–42.
21. Charles PE, Ladoire S, AHO S, et al. Serum procalcitonin elevation in critically ill patiens at the onset of bacteremia caused by either Gram negative or Gram positive bacteria. BMC Infect Dis 2008; 26: 8: 38.
22. Perrotti C, et al. Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clin Exp Rheumatol 2006; 24(2): 123–8.
23. Eberhard OK, Haubitz M, Brunkhorst FM, et al. Usefulness of procalcitonin for differentiation between activity of systemic autoimmune disease (systemic lupus erythematosus/systemic antineutrophil cytoplasmic antibody-associated vasculitis) and invasive bacterial infection. Arthritis Rheum 1997; 40(7): 1250–6.
24. Brunkhorst R, Eberhardt OK, Haubitz M, et al. Procalcitonin for discrimination between activity of systemic autoimmune disease and systemic bacterial infection. Intensive Care Med 2000; 26 Suppl 2: S199–201.
25. Scire CA, Cavagna L, Perotti C, et al. Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clin Exp Rheumatol 2006; 24(2): 123–8.
26. Tamaki K, Kogata Y, Sugiyama D, et al. Diagnostic accuracy of serum procalcitonin concentrations for detecting systemic bacterial infection in patients with systemic autoimmune diseases. J Rheumatol 2008; 35: 114–9.
27. Jensen JU, Lundgren B, Hein L, et al. The Procalcitonin and Survival Study (PASS)- a randomised multi-center investigator-initiated trial to investigate whether daily measurements biomarker Procalcitonin and pro-active diagnostic and therapeutic response to abnormal Procalcitonin levels, can improve survival in intensive care unit patients. Calculated sample size(target population): 1 000 patients. BMC Infect Dis 2008: 91. online 2008 July 13. doi:10.1186/1471-2334-8-91.
Labels
Dermatology & STDs Paediatric rheumatology RheumatologyArticle was published in
Czech Rheumatology
2009 Issue 2
Most read in this issue
- HLA-Cw*0602 is a predisposing allele to develop psoriatic arthritis
- Limited significance of procalcitonin in differentiation between sepsis and flare of a rheumatic disease
- Secondary immunodeficiency with infectious complications following immunosuppressive therapy in a female patient with systemic lupus erythematosus
- Utilization of health care and the costs for patients with rheumatoid arthritis treated with TNF-α inhibitors in the Czech Republic