Procalcitonin Test in Rheumatologist's Practice
https://doi.org/10.37489/0235-2990-2020-65-3-4-34-38
Abstract
The aim of the work is to evaluate the diagnostic significance of the procalcitonin test (PCT) in the practice of a rheumatologist.
Material and methods. The study included 360 patients with various immuno-inflammatory rheumatic diseases (IIRD). Serum PCT concentration was determined by a quantitative electrochemiluminescent method on a Cobas E 411 analyzer (Roshe, Switzerland).
Results. The median (Me) level of PCT was 0.11 ng/ml [0.05; 0.16] in patients without infection (n=191). In patients with generalized infection (n=11), the Me level of PCT was 3.6 ng/ml [0.88; 11.3]. In cases of severe local infection (n=75), the Me level of PCT was 0.45 ng/ml [0.24; 1,2], while in case of mild local infection (n=83) — 0.12 ng/ml [0.05; 0.17]. ROC curve analysis showed that the diagnostic significance of determining PCT for generalized infection is very high, for severe local infection it is high, and for differentiation of generalized infection from local infection it is high.
Conclusion. PCT is a valuable diagnostic test that helps recognize generalized and severe local infections in patients with IIRD. However, when interpreting the values of PCT, the totality of data should be taken into account: specific rheumatic nosology, results of clinical laboratory, and instrumental examinations.
About the Authors
N. V. MuravyevaRussian Federation
Moscow
B. S. Belov
Russian Federation
Moscow
G. M. Tarasova
Moscow
References
1. Romasheva M.L., Proshin D.G. Diagnosis of sepsis in critically ill patients. Obschay Reanimatologia 2007; 3 (4): 34—36 [in Russian]
2. Schuetz P, Chiappa V., Briel V., Greenwald J.L. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med 2011; 171 (15): 1322-1331.
3. Uzzan B., Cohen R., Nicolas P. et al. Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit. Care Med 2006; 34 (7): 1996-2003.
4. Loban N.V, Fedotova N.Yu., Lysenko A.S. Experience in using a quantitative procalcitonin test to assess the effectiveness of antibiotic therapy in infants. Vopr Diagn Pediatr 2009; 1 (1): 37-40 [in Russian]
5. Becker K.L., Nylen E.S., White J.C. et al. Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004; 89 (4): 1512-1525.
6. Dahaba A.A., Metzler H. Procalcitonin's role in the sepsis cascade. Is procalcitonin a sepsis marker or mediator? Minerva Anestesiol 2009; 75 (7-8): 447-452.
7. Tavares E., Minano F.J. Immunoneutralization of the aminoprocalcitonin peptide of procalcitonin protects rats from lethal endotoxaemia: neuroendocrine and systemic studies. Clin Sci. 2010; 119 (12): 519-534. doi: 10.1042/CS20100007
8. Muller B., Christ-Crain M., Nylen E. et al. Limits to the use of the procalcitonin level as a diagnostic marker. Clin Infect Dis 2004; 39 (12): 1867-1868.
9. Meisner M. Procalcitonin. A new, innovative infection parameter. Biochemical and clinical aspects. Georg Thieme Verlag, Stuttgard-New York. 2000; 162-175.
10. Meisner M., Schmidt J., Huttner H., Tschaikowsky K. The natural elimination rate of procalcitonin in patients with normal and impared renal function. Intensive Care Med 2000; 26: 212-216.
11. Shaikh M.M., Hermans L.E., van Laar J.M. Is serum procalcitonin measurement a useful addition to a rheumatologist's repertoire? A review of its diagnostic role in systemic inflammatory diseases and joint infections. Rheumatology (Oxford) 2015; 54 (2): 231-240. doi: 10.1093/rheumatol-ogy/keu416
12. Meisner M. Pathobiochemistry and clinical use ofprocalcitonin. Clin Chim Acta 2002; 323 (1-2): 17-29. doi: 10.1016/S0009-9881(02)00101-8
13. Vel'kov V.V. Procalcitonin and C-reactive protein in modern laboratory diagnostics. Clinical laboratory Council of physicians 2008; 25 (6): 46-52. [in Russian].
14. Wu J.-Y., Shen C.-J., Hsieh Y.-C. et al. Use of serum procalcitonin to direct bacterial infection in patients with autoimmune diseases: a systematic review and meta-analysis. Arthritis Rheum 2012; 64 (9): 3034-3042. doi: 10.1002/art.34512
15. Moosig F., Csernok E., Reinhold-Keller E. et al. Elevated procalcitonin levels in active Wegener's granulomatosis. J Rheumatol 1998; 25 (8): 1531-1533.
16. Okada Y., Minakami H., Tomomasa T. et al. Serum procalcitonin con¬centration infection in patients with Kawasaki disease. J Infect 2004; 48 (2): 199-205. doi: 10.1016/j.jinf.2003.08.002
17. Scire C.A., Cavagna L., Perotti C. et al. Diagnostic value of procalcitonin measurement in febrile patients with systemic autoimmune diseases. Clin Exp Rheumatol 2006; 24 (2): 123-128.
18. Schwenger V., Sis J., Breitbart A., Andrassy K. CRP levels in autoimmune disease can be specified by measurement of procalcitonin. Infection. 1998; 26 (5): 274-276. doi: 10.1007/BF02962246
19. 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 (1): 114-119.
20. Chen D.Y., Chen Y.M., Ho W.L. et al. Diagnostic value of procalcitonin for differentiation between bacterial infection and non-infection inflammation in febrile patients with active adult-onset Still's disease. Ann Rheum Dis 2009; 68 (6): 1074-1075. doi: 10.1136/ard.2008.098335
21. Lapin S.V., Maslyanskiy A.L., Lazareva N.M., et al. The value of quantitative analysis of procalcitonin in diagnostics of septic complications in patients with systemic autoimmune diseases. Klinicheskaya Laboratornaya Diagnostika 2013; 1: 28-33. [in Russian]
Review
For citations:
Muravyeva N.V., Belov B.S., Tarasova G.M. Procalcitonin Test in Rheumatologist's Practice. Antibiot Khimioter = Antibiotics and Chemotherapy. 2020;65(3-4):34-38. (In Russ.) https://doi.org/10.37489/0235-2990-2020-65-3-4-34-38