PROCALCITONIN: THE BEST IS HERE
Michael Meisner
Clinic of Anaesthesiology and Intensive Care Therapy, University of Jena, Germany
Today, various therapeutic strategies are available to improve survival in patients with sepsis. However, diagnosis of sepsis is not always easy and clinical symptoms of sepsis are non-specific. The use of further diagnostic parameters thus is recommended. Among the various parameters evaluated during the last decade, procalcitonin (PCT) has emerged as a reliable tool for the diagnosis of sepsis, to estimate prognosis, and to describe severity of the systemic inflammatory response.
PCT plasma levels increase above the normal range in patients with sepsis (> 0.5 ->2 ng/ml). Especially high concentrations (> 10 ng/ml) are found when organ dysfunction is present due to systemic inflammation and infection (severe sepsis or septic shock). There are various reasons why PCT has proved a useful diagnostic tool: Induction is rather specific for sepsis, severe sepsis and septic shock; PCT plasma levels cover a wide range (0.05 to more than 1000 ng/ml) and are somewhat proportional to the severity of the inflammatory response; and PCT plasma concentrations are better related to the course and prognosis of the disease than for example C-reactive protein (CRP). Further, the protein is most stable in serum or plasma and has a medium induction and elimination time (induction after 6-8 hrs, clinical elimination half-life 25-30h). Given these features, the parameter is not only used for differential diagnosis, but also to monitor patients at risk of sepsis, and to guide therapy in patients with sepsis or a severe systemic inflammatory response. However, there are also limitations: PCT levels are low during local infection but may be increased during SIRS of various aetiology, e.g. early after multiple trauma or major surgery, or in the presence of high levels of circulating pro-inflammatory cytokines. Despite this, PCT is currently one of the best markers available for the diagnosis of sepsis and to describe the systemic inflammatory response.
Time of Presentation
Saturday 1 May 2004 - 1330-1500
