Cutoff value of serum procalcitonin as a diagnostic biomarker of infection in end-stage renal disease patients.
OBJECTIVE
Serum procalcitonin (PCT) levels are low in healthy individuals but are elevated in patients with a serious bacterial infection or sepsis. In this study, we examined the ability of serum PCT concentration to diagnose infections in end-stage renal disease (ESRD) patients, and sought to determine an appropriate threshold level.


METHODS
Serum PCT levels were measured in ESRD patients on antibiotic therapy for a suspected bacterial infection (ESRD infection [iESRD] group, n = 21), and compared with those of ESRD patients on hemodialysis with no sign of infection (ESRD control [cESRD] group, n = 20).


RESULTS
The mean serum PCT concentration of the iESRD group was significantly higher than in the cESRD group (2.95 ± 3.67 ng/mL vs. 0.50 ± 0.49 ng/mL, p = 0.006), but serum PCT concentrations did not correlate with severity of infection. The optimized threshold level derived for serum PCT was 0.75 ng/mL, rather than the currently used 0.5 ng/mL; this threshold demonstrated a sensitivity and specificity of 76.2% and 80.0% for infection and 100% and 60.6% for systemic inflammatory response syndrome, respectively, compared with the cutoff of 0.5 ng/mL.


CONCLUSIONS
This study suggests that serum PCT at a cutoff value of 0.75 ng/mL is an appropriate indicator of infection in ESRD patients.
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Wan Soo
WS
Lee
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Dae Woong
DW
Kang
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Jong Hun
JH
Back
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Hyun Lee
HL
Kim
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Jong Hoon
JH
Chung
Department of Internal Medicine, Chosun University School of Medicine, Gwangju, Korea.
Byung Chul
BC
Shin
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001424:Bacterial Infections / Q000097:blood* / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D006435:Renal Dialysis; D015203:Reproducibility of Results; D015854:Up-Regulation
D015415:Biomarkers; C000606589:CALCA protein, human; D018836:Inflammation Mediators; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
Cut-off value; Infection; Kidney failure, chronic; Procalcitonin