Clinical value of serum procalcitonin in patients of chronic kidney disease with bacterial infection

doi:10.16150/j.1671-2870.2019.03.021

Abstract

Abstract:

Objective: Clinical data of chronic kidney disease(CKD) patients (n=354) of different disease stages were collected to analyze the median serum procalcitonin (PCT) level and diagnostic value of serum PCT in CKD patients with bacterial Infection. Methods: A total of 354 CKD patients admitted to the First Affiliated Hospital of China Medical University, including 153 patients with bacterial infection and antibiotics treatment and 201 patients without infection, were enrolled in this study. According to eGFR, patients were divided into stage 1, stage2, stage3, stage4, stage5 with nondialysis andstage5 with hemodialysis (HD) groups. Spearman correlation was used to analyze the relationship between PCT and serum creatinine and eGFR. ROC curve was used to analyze the diagnostic efficacy of serum PCT in different stage CKD patients with bacterial infection. Multivariate logistic regression analysis was used to assess the impact factors of infection. Results: The serum PCT level of CKD patients with infection was significantly higher than that of non-infected. The dynamic change of PCT was in parallel with recovery of clinical infection.PCT was positively correlated with serum creatinine, and negatively correlated with eGFR. Serum PCT cutoff values for differentiating infection and non-infection in overall CKD, stage 3, stage 4, stage 5 with nodialysis and with hemodialysis (HD) groups were 0.40 ng/mL,0.12 ng/mL, 0.23 ng/mL, 0.28 ng/mL and 0.60 ng/mL, respectively. Logistic regression analysis showed, WBC, PCT, CRP and serum albumin were independent risk factors for infection. Conclusions: PCT can be used as a useful clinical indicator of infection in different stages of CKD; the dynamic change of PCT has important diagnostic value in the diagnosis and treatment of CKD patients.

Key words: Procalcitonin, Chronic kidney disease, Bacterial Infection, C-reactive protein, Diagnosis

CLC Number:

R692.5

WANG Yuanyuan, FAN Qiuling. Clinical value of serum procalcitonin in patients of chronic kidney disease with bacterial infection[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(03): 353-359.

Figures/Tables 8

References 30

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特征	感染组 (n=134)	非感染组 (n=201)	P值
年龄（岁）	54	49	0.206
性别[n（%）]
男	84(62.7%)	111(55.2%)	0.067
女	50(37.3%)	90(44.8%)
住院天数（d）	17	12	<0.001
实验室参数
血清PCT（ng/mL）	0.52	0.10	<0.001
CRP（mg/L）	44.25	3.29	<0.001
白细胞计数（×10⁹/L)	8.39	6.40	<0.001
粒细胞与淋巴细胞比率	5.23	2.83	<0.001
血红蛋白(g/L)	101.59±28.65	105.67±31.23	0.232
血清肌酐(μmol/L)	298.50	292	0.449
eGFR[mL/（min·1.73 m²)]	18.7	17.9	0.892
血尿素氮(mmol/L)	17.88	16.08	0.104
血清胱抑素C（mg/L）	4.20	3.41	0.006
血清总蛋白(g/L)	54.70	59.55	<0.001
血清白蛋白(g/L)	27.70	35.30	<0.001
血清前白蛋白(mg/dL)	23.00	29.20	<0.001
血清铁(μmol/L)	8.71±5.48	12.24±6.61	0.127
铁蛋白(μg/L)	428.70	204.90	<0.001

组别	PCT（ng/mL）
组别	范围	均数	中位数
G1期
感染组	0.11~4.02	0.64	0.29
非感染组	0.02~0.24	0.04	0.04
G2期
感染组	0.14~1.13	0.32	0.24
非感染组	0.02~0.16	0.06	0.06
G3期
感染组	0.13~100.00	5.18	0.27
非感染组	0.02~0.19	0.07	0.06
G4期
感染组	0.17~35.44	2.18	0.45
非感染组	0.02~0.35	0.11	0.10
G5期
感染组	0.29~44.50	3.18	0.80
非感染组	0.05~0.45	0.18	0.16
中心静脉置管HD
感染组	0.45~100.00	7.42	1.28
非感染组	0.10~0.77	0.32	0.29

分组	血清肌酐		eGFR
分组	r值	P值	r值	P值
感染组PCT	0.565	<0.001	-0.561	<0.001
非感染组PCT	0.825	<0.000	-0.804	<0.000

分组	血清肌酐		eGFR
分组	r	P	r	P
感染组PCT	0.023	<0.001	-0.034	<0.001
非感染组PCT	0.126	0.076	-0.127	0.072

组别	参数	最佳临界值	灵敏度（%）	特异度（%）	AUC	95%CI	P值
总CKD	PCT	0.40	76.30	91.10	0.920	0.892~0.948	<0.001
	CRP	10.10	89.63	88.18	0.942	0.917~0.967	<0.001
G3期	PCT	0.12	100	96.43	0.994	0.985~1.000	<0.001
	CRP	7.76	85.71	100	0.895	0.804~0.987	<0.001
G4期	PCT	0.23	84.60	94.10	0.986	0.970~1.000	<0.001
	CRP	10.20	93.20	79.40	0.902	0.833~0.970	<0.001
G5期	PCT	0.28	100	91.50	0.992	0.984~1.000	<0.001
	CRP	12.20	89.70	94.90	0.929	0.889~0.970	<0.001
中心静脉置管	PCT	0.60	93.10	91.70	0.985	0.966~1.000	<0.001
	CRP	9.85	93.10	80.60	0.903	0.839~0.967	<0.001