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Procalcitonin

Procalcitonin
Medical diagnostics

Procalcitonin (PCT) is a peptide precursor of the hormone calcitonin, the latter being involved with calcium homeostasis. It was first identified by Leonard J. Deftos and Bernard A. Roos in the 1970s.[1] It is composed of 116 amino acids and is produced by parafollicular cells (C cells) of the thyroid and by the neuroendocrine cells of the lung and the intestine.

The level of procalcitonin in the blood stream of healthy individuals is below the limit of detection (0.01 µg/L) of clinical assays.[2] The level of procalcitonin rises in a response to a proinflammatory stimulus, especially of bacterial origin. It is therefore often classed as an acute phase reactant.[3]:542 In this case, it is produced mainly by the cells of the lung and the intestine.... It does not rise significantly with viral or non-infectious inflammations. With the derangements that a severe infection with an associated systemic response brings, the blood levels of procalcitonin may rise to 100 µg/L. In serum, procalcitonin has a half-life of 25 to 30 hours. Remarkably the high procalcitonin levels produced during infections are not followed by a parallel increase in calcitonin or a decrease in serum calcium levels.

Medical uses

Sepsis

Measurement of procalcitonin can be used as a marker of severe sepsis caused by bacteria and generally grades well with the degree of sepsis,[4] although levels of procalcitonin in the blood are very low. PCT has the greatest sensitivity (85%) and specificity (91%) for differentiating patients with systemic inflammatory response syndrome (SIRS) from those with sepsis, when compared with IL-2, IL-6, IL-8, CRP and TNF-alpha.[5] Evidence is emerging that procalcitonin levels can reduce unnecessary antibiotic prescribing to people with lower respiratory tract infections.[6] Currently, procalcitonin assays are widely used in the clinical environment.[7]

A meta-analysis reported a sensitivity of 76% and specificity of 70% for bacteremia.[8]

Pneumonia

Procalcitonin levels may be useful to distinguish bacterial infections from nonbacterial infections.[9] This may help guide antibiotic use, which can help save on cost and drug resistance.[9]

Kidney disease

Patients with chronic kidney disease and end-stage renal disease are at higher risk for infections, and procalcitonin has been studied in these populations, who often have higher levels. Procalcitonin can be dialyzed, and so levels are dependent upon when patients receive hemodialysis. While there is no formally accepted cutoff value for patients undergoing HD, using a value of greater or equal to 0.5 ng/mL yielded a sensitivity of 97-98% and a specificity of 70-96%.[10]

Hepatitis

PCT, possibly together with CRP, is used to corroborate the MELD score.[11][12]

Research

Excessive overdose on amphetamine or its analogs can induce systemic inflammation; in a case of amphetamine overdose, sans bacterial infection, significant elevations in procalcitonin were observed.[13]

References

  1. ^ Deftos, L J; Roos, B A; Parthemore, J G (1975-12-01). "Calcium and skeletal metabolism..." Western Journal of Medicine. 123 (6): 447–458. ISSN 0093-0415. PMC 1130411Freely accessible. PMID 1105981. 
  2. ^ Dandona P, Nix D, Wilson MF, et al. (December 1994). "Procalcitonin Increase after Endotoxin Injection in Normal Subjects". Journal of Clinical Endocrinology and Metabolism. 79 (6): 1605–1608. doi:10.1210/jc.79.6.1605. PMID 7989463. 
  3. ^ Long, Sarah S.; Pickering, Larry K.; Prober, Charles G., eds. (2012), "Bacterial infections in the neonate", Principles and Practice of Pediatric Infectious Diseases (4th ed.), Elsevier, ISBN 978-1437727029. 
  4. ^ Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999). "Comparison of Procalcitonin (PCT) and C-reactive Protein (CRP) Plasma Concentrations at Different SOFA Scores During the Course of Sepsis and MODS". Critical Care. 3 (1): 45–50. doi:10.1186/cc306. PMC 29013Freely accessible. PMID 11056723. 
  5. ^ Balci C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoğlu B (February 2003). "Usefulness of Procalcitonin for Diagnosis of Sepsis in the Intensive Care Unit". Critical Care. 7 (1): 85–90. doi:10.1186/cc1843. PMC 154110Freely accessible. PMID 12617745. 
  6. ^ Schuetz P, Christ-Crain M, Thomann R, et al. (September 9, 2009). "Effect of Procalcitonin-based Guidelines vs Standard Guidelines on Antibiotic Use in Lower Respiratory Tract Infections: The ProHOSP Randomized Controlled Trial". JAMA. 302 (10): 1059–1066. doi:10.1001/jama.2009.1297. PMID 19738090. 
  7. ^ Yealy DM, Fine MJ (September 9, 2009). "Measurement of Serum Procalcitonin: A Step Closer to Tailored Care for Respiratory Infections?". JAMA. 302 (10): 1115–1116. doi:10.1001/jama.2009.1318. PMID 19738100. 
  8. ^ Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA (2007). "Procalcitonin Test in the Diagnosis of Bacteremia: a Meta-Analysis". Annals of Emergency Medicine. 50 (1): 34–41. doi:10.1016/j.annemergmed.2006.10.020. PMID 17161501. 
  9. ^ a b Schuetz, Philipp; Wirz, Yannick; Sager, Ramon; Christ-Crain, Mirjam; Stolz, Daiana; Tamm, Michael; Bouadma, Lila; Luyt, Charles E; Wolff, Michel; Chastre, Jean; Tubach, Florence; Kristoffersen, Kristina B; Burkhardt, Olaf; Welte, Tobias; Schroeder, Stefan; Nobre, Vandack; Wei, Long; Bucher, Heiner C; Annane, Djillali; Reinhart, Konrad; Falsey, Ann R; Branche, Angela; Damas, Pierre; Nijsten, Maarten; de Lange, Dylan W; Deliberato, Rodrigo O; Oliveira, Carolina F; Maravić-Stojković, Vera; Verduri, Alessia; Beghé, Bianca; Cao, Bin; Shehabi, Yahya; Jensen, Jens-Ulrik S; Corti, Caspar; van Oers, Jos A H; Beishuizen, Albertus; Girbes, Armand R J; de Jong, Evelien; Briel, Matthias; Mueller, Beat (October 2017). "Effect of procalcitonin-guided antibiotic treatment on mortality in acute respiratory infections: a patient level meta-analysis". The Lancet Infectious Diseases. doi:10.1016/S1473-3099(17)30592-3. 
  10. ^ Grace, E; Turner, RM (15 December 2014). "Use of Procalcitonin in Patients with Various Degrees of chronic Kidney Disease Including Renal Replacement Therapy". Clinical Infectious Diseases. 59 (12): 1761–1767. doi:10.1093/cid/ciu732. PMID 25228701. 
  11. ^ Zhou Q.; Tan D.; Yi Z.; Zheng Y.; Lu M. (Apr 9, 2013). "Prognostic value of procalcitonin, endotoxin and common inflammatory markers combining MELD score in patients with chronic severe hepatitis". doi:10.3969/j.issn.1672-7347.2013.04.009. 
  12. ^ Sakkarin Chirapongsathorn; Worawan Bunraksa; Dollapas Punpanich; Amnart Chaiprasert; Patrick S. Kamath (Nov 17, 2015). "Adding C-reactive Protein and Procalcitonin to the MELD Score Improves Mortality Prediction in Patients Admitted with Complications of Cirrhosis". 
  13. ^ Lovas A, Agoston Z, Késmárky K, Hankovszky P, Molnár Z (2014). "Extreme Procalcitonin Elevation without Proven Bacterial Infection Related to Amphetamine Abuse". Case Reports in Critical Care. 2014: 179313. doi:10.1155/2014/179313. PMC 4006559Freely accessible. PMID 24826347. 

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