Changes of Procalcitonin Kinetics According to Renal Clearance in Critically Ill Patients with Primary Gram-Negative Bloodstream Infections

Overview

Journal Infect Dis Clin Microbiol

Date 2024 Oct 14

PMID 39399744

Authors

Hasan Selcuk Ozger

Seref Kerem Corbacioglu

Nazlihan Boyaci-Dundar

Mehmet Yildiz

Ozant Helvaci

Fatma Betul Altin

Melda Turkoglu

Gulbin Aygencel

Murat Dizbay

Affiliations

Soon will be listed here.

Abstract

Objective: This study aimed to investigate the relationship between procalcitonin (PCT) kinetic and estimated glomerular filtration rates (eGFR) in critically ill patients who had Gram-negative primary bloodstream infection (GN-BSI) and responded to the antimicrobial therapy.

Materials And Methods: This single-centered study was retrospective and observational. Critically ill GN-BSI patients over 18 years old who had clinical and microbiological responses to antibiotic treatment were included in the study. Patients were divided into two groups according to eGFR (eGFR <30 mL/min/1.73m and ≥30 mL/min/1.73m) and compared for PCT kinetic at seven different measurement points as initial, first, third, fifth, seventh, tenth, and fourteenth days.

Results: The study included 138 patients. Initial PCT levels were higher in patients with eGFR <30 mL/min/1.73m (4.58 [1.36-39.4] ng/mL) than in eGFR ≥30 mL/min/1.73m (0.91 [0.32-10.2]) (<0.001). This elevation was present at all measurement points (<0.05). The decrease in PCT values by ≥30% (26.0% vs 47.9%; =0.024) on the third day and ≥50% (69.2% vs 76.6%; =0.411) on the fifth day was less in the low eGFR (<30 mL/min/1.73m) group. The effect of low GFR on serum PCT kinetic was present in both fermenter and non-fermenter GN-BSIs but was more prominent in the fermenter group.

Conclusion: Serum PCT levels during therapy were higher in patients with low eGFR. Early PCT (<5 days) response was not obtained in non-fermenter GN-BSI patients with low eGFR. Antibiotic revision decisions should be made more carefully in patients with low eGFR due to high initial PCT levels and slow PCT kinetic.

References

Zdziechowska M, Gluba-Brzozka A, Poliwczak A, Franczyk B, Kidawa M, Zielinska M . Serum NGAL, KIM-1, IL-18, L-FABP: new biomarkers in the diagnostics of acute kidney injury (AKI) following invasive cardiology procedures. Int Urol Nephrol. 2020; 52(11):2135-2143. PMC: 7575457. DOI: 10.1007/s11255-020-02530-x. View

Jiang L, Shao X, Xing W, Sun Y . Biomarkers and risk factors for sepsis in stage 5 chronic kidney disease: a retrospective case-control study. Int Urol Nephrol. 2019; 51(4):691-698. DOI: 10.1007/s11255-018-2035-2. View

Meisner M, Schmidt J, Huttner H, Tschaikowsky K . The natural elimination rate of procalcitonin in patients with normal and impaired renal function. Intensive Care Med. 2008; 26 Suppl 2:S212-6. DOI: 10.1007/BF02900740. View

Park J, Kim D, Jang H, Kim M, Jung S, Lee J . Clinical relevance of procalcitonin and C-reactive protein as infection markers in renal impairment: a cross-sectional study. Crit Care. 2014; 18(6):640. PMC: 4279682. DOI: 10.1186/s13054-014-0640-8. View

Cong S, Ma T, Di X, Tian C, Zhao M, Wang K . Diagnostic value of neutrophil CD64, procalcitonin, and interleukin-6 in sepsis: a meta-analysis. BMC Infect Dis. 2021; 21(1):384. PMC: 8072745. DOI: 10.1186/s12879-021-06064-0. View

Kim I, Kim S, Ye B, Kim M, Kim S, Lee D . Procalcitonin decrease predicts survival and recovery from dialysis at 28 days in patients with sepsis-induced acute kidney injury receiving continuous renal replacement therapy. PLoS One. 2022; 17(12):e0279561. PMC: 9794048. DOI: 10.1371/journal.pone.0279561. View

Wu S, Liang C, Zhang Y, Hu W . Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case-control study. J Clin Lab Anal. 2019; 34(2):e23065. PMC: 7031592. DOI: 10.1002/jcla.23065. View

de Azevedo J, Torres O, Beraldi R, Ribas C, Malafaia O . Prognostic evaluation of severe sepsis and septic shock: procalcitonin clearance vs Δ Sequential Organ Failure Assessment. J Crit Care. 2014; 30(1):219.e9-12. DOI: 10.1016/j.jcrc.2014.08.018. View

Peng F, Chang W, Xie J, Sun Q, Qiu H, Yang Y . Ineffectiveness of procalcitonin-guided antibiotic therapy in severely critically ill patients: A meta-analysis. Int J Infect Dis. 2019; 85:158-166. DOI: 10.1016/j.ijid.2019.05.034. View

10.

Han S, Kim M, Ko H, Lee E, Kim H, Jeon J . Diagnostic and Prognostic Roles of C-Reactive Protein, Procalcitonin, and Presepsin in Acute Kidney Injury Patients Initiating Continuous Renal Replacement Therapy. Diagnostics (Basel). 2023; 13(4). PMC: 9955569. DOI: 10.3390/diagnostics13040777. View

11.

Grace E, Turner R . Use of procalcitonin in patients with various degrees of chronic kidney disease including renal replacement therapy. Clin Infect Dis. 2014; 59(12):1761-7. DOI: 10.1093/cid/ciu732. View

12.

Sun Y, Jiang L, Shao X . Predictive value of procalcitonin for diagnosis of infections in patients with chronic kidney disease: a comparison with traditional inflammatory markers C-reactive protein, white blood cell count, and neutrophil percentage. Int Urol Nephrol. 2017; 49(12):2205-2216. DOI: 10.1007/s11255-017-1710-z. View

13.

Arora S, Singh P, Singh P, Trikha A . Procalcitonin Levels in Survivors and Nonsurvivors of Sepsis: Systematic Review and Meta-Analysis. Shock. 2014; 43(3):212-21. DOI: 10.1097/SHK.0000000000000305. View

14.

Giamarellos-Bourboulis E, Kotsaki A, Routsi C, Graziano E, Righi E, Bassetti M . A prognostic score for the resolution of bacteremia by Gram-negative bacteria resistant to carbapenems. Eur J Clin Microbiol Infect Dis. 2018; 37(11):2083-2089. DOI: 10.1007/s10096-018-3342-3. View

15.

Schuetz P, Birkhahn R, Sherwin R, Jones A, Singer A, Kline J . Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017; 45(5):781-789. PMC: 5389588. DOI: 10.1097/CCM.0000000000002321. View

16.

Scott J, Deresinski S . Use of biomarkers to individualize antimicrobial therapy duration: a narrative review. Clin Microbiol Infect. 2022; 29(2):160-164. DOI: 10.1016/j.cmi.2022.08.026. View

17.

Thomas-Ruddel D, Poidinger B, Kott M, Weiss M, Reinhart K, Bloos F . Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care. 2018; 22(1):128. PMC: 5949148. DOI: 10.1186/s13054-018-2050-9. View

18.

Zhang B, Song Y, Ma Q, Yang J, Bai L . Expression and Significance of KIM-1, NGAL, and HO-1 in Patients with Acute Kidney Injury After Cardiac Valve Replacement. J Inflamm Res. 2023; 16:2755-2761. PMC: 10319345. DOI: 10.2147/JIR.S410338. View

19.

Heilmann E, Gregoriano C, Wirz Y, Luyt C, Wolff M, Chastre J . Association of kidney function with effectiveness of procalcitonin-guided antibiotic treatment: a patient-level meta-analysis from randomized controlled trials. Clin Chem Lab Med. 2020; 59(2):441-453. DOI: 10.1515/cclm-2020-0931. View

20.

Huang Y, Chen C, Shao S, Li C, Hsiao C, Niu K . Comparison of the Diagnostic Accuracies of Monocyte Distribution Width, Procalcitonin, and C-Reactive Protein for Sepsis: A Systematic Review and Meta-Analysis. Crit Care Med. 2023; 51(5):e106-e114. PMC: 10090344. DOI: 10.1097/CCM.0000000000005820. View