Procalcitonin for accurate detection of infection in haemodialysis

Background. Infection results in considerable morbidity and mortality in ha emodialysis patients. Diagnosis of infection can be difficult because curre ntly applied laboratory parameters may be non-specifically altered due to u raemia or haemodialysis (HD). This study investigated the diagnostic value and kinetics of serum procalcitonin (PCT). a low-molecular-weight protein, in patients receiving intermittent HD. Methods. Sixty-eight patients receiving intermittent HE for end-stage renal disease (n = 48) or acute renal failure (n = 20) were prospectively studie d, 47 treated with high-flux and 21 with low-flux membranes. Of 36 patients with severe infections or sepsis, 27 were treated with high-flux and nine with low-flux membranes. WBC, serum PCT and C-reactive protein (CRP) concen trations were measured immediately before HD, and PCT repeatedly during the following 48 h. Results. When determined immediately before IIB, PCT demonstrated a sensiti vity of 89%,, a specificity of 81%, and positive and negative predictive va lues of 84 and 87%, indicating severs infection or sepsis. These levels wer e higher than the respective values for CRP (89, 48, 68 and 78%) and WBC (5 8. 75, 71 and 59%). After 4 h of HD with high-flux membranes, PCT decreased significantly to 83 +/- 25% and did not return to predialysis concentratio ns before 48 h. This decrease in serum PCT resulted in markedly reduced sen sitivity (65%) and negative predictive value (54%). In contrast, no marked change in PCF concentration occurred during or after HD with low-flux membr anes. Conclusion. Serum PCT is an accurate indicator of severe infection and seps is in patients receiving intermittent HD. High-flux, membranes substantiall y decrease PCT. When utilizing high flux membranes, serum PCT concentration s should be determined prior to the start of I-IB.