calca-protein--human and Endocarditis--Bacterial

This review will highlight the potential application of procalcitonin, a novel marker of systemic bacterial infection, in two clinical settings relevant to cardiologists: infective endocarditis (IE) and lower respiratory tract infections (LRTI): The variability in the clinical presentation of infective endocarditis (IE) makes the diagnosis a clinical challenge. However, rapid diagnosis and initiation of effective treatment are essential to good patient outcome. Serum calcitonin precursor levels, including procalcitonin, are elevated in systemic bacterial infections and seem to be helpful in the diagnosis of IE. The utility of procalcitonin in clinical practice was examined in a prospective cohort of patients with the suspicion of IE. Procalcitonin was significantly higher in patients with IE (median 6.56 microg/L) as compared with patients with other final diagnoses (median 0.44 microg/L, p < 0.001). The area under the ROC curve using procalcitonin to predict infective endocarditis was 0.856, as compared to 0.657 for C-reactive protein. The optimum concentration of procalcitonin for the calculation of positive and negative predictive accuracy as obtained from the ROC curve was 2.3 microg/L. Using this cut-off, the test characteristics of procalcitonin were as follows: sensitivity 81%, specificity 85%, negative predictive value 92%, positive predictive value 72%. Although most LRTIs are due to viral infections, they are very often treated with antibiotics. This excessive use of antibiotics is believed to be the main cause of the spread of antibiotic-resistant bacteria. A procalcitonin-based therapeutic strategy has shown to reduce antibiotic usage in LRTI. Based upon serum procalcitonin levels, the use of antibiotics was more or less discouraged (<0.1 or <0.25 microg/L) or encouraged (> or =0.5 or > or =0.25 microg/L), respectively. Final diagnoses included pneumonia (36%), acute exacerbation of COPD (25%), and acute bronchitis (24%). Clinical and laboratory outcome was similar in both groups and favourable in 96.7%. In the procalcitonin group, the adjusted relative risk of antibiotic exposure was 0.49 (p < 0.001), as compared to the standard group. Thus, using a sensitive assay, procalcitonin-guidance substantially and safely reduced antibiotic usage in LRTI.

Topics: Anti-Bacterial Agents; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Clinical Medicine; Diagnosis, Differential; Early Diagnosis; Endocarditis, Bacterial; Glycoproteins; Humans; Protein Precursors; Respiratory Tract Infections

The aim of this study was to investigate the diagnostic values of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in infective endocarditis (IE) and to correlate them with the etiology of the disease and the prognosis of the patients.. Fifty patients who were diagnosed as having IE based on Duke criteria (major and/or minor) were included in the study at the Istanbul University Cardiology Institute and Florence Nightingale Hospital. Forty patients with bacteremia (non-IE) and 50 healthy blood donors were also included in the study as the control group. During the 45 days of medical follow-up, in those patients who had a response to medical therapy based on the results of left ventricular function tests, transesophageal echocardiography (TEE) and culture, among other factors, PCT and CRP levels were measured in 5-cm(3) blood samples obtained without anticoagulant when they were first admitted (day 0), as well as 24 h and 15, 30 and 45 days after admission. In the patients who had valve replacement, 5-cm(3) blood samples without anticoagulant were similarly obtained on the day of admission, after 24 h and/or on the 15th day, and 1 day before and on the 2nd and 5th days after the operation.. In this study, a significant difference (p < 0.001) was found between the IE group and the healthy control group with respect to their serum PCT and CRP levels at the time of admission. No significant difference was found between IE and non-IE groups (p > 0.05). The sensitivity of PCT in comparison to CRP was found to be lower (84 vs. 100%); however, its specificity was determined to be higher (88 vs. 72%). The median values of serum PCT in the nonoperated and operated cases at the time of admission, after 24 h and on the 15th day were 3.71, 5.35 and 0.44, and 2.45, 4.28 and 4.22 ng/ml, respectively, and those of CRP were 9.30, 10.95 and 10.65, and 9.5, 10.9 and 10.2 mg/dl, respectively. The median values of serum PCT were found to be higher in cases with IE and non-IE related to gram-negative bacteria than those related to gram-positive bacteria (p < 0.02). This was found to be insignificant for CRP (p > 0.05).. As a result, this study suggests that in the diagnosis of IE, it would be beneficial to use PCT, besides TEE, culture and other clinical criteria, for its high specificity and positive predictive value in comparison to CRP. This study also suggests that in determining the response to medical treatment in the follow-up period, PCT could be a more valuable parameter than CRP, as PCT has a high prognostic value and is a good indicator for valve replacement in addition to the major criteria. Furthermore, serum PCT levels may help the physician to decide on the antimicrobial therapy combination before obtaining the culture results, or in situations in which the agent could not be isolated yet.

Topics: Adolescent; Adult; Aged; Bacteremia; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Endocarditis, Bacterial; Female; Follow-Up Studies; Hospitalization; Humans; Male; Middle Aged; Predictive Value of Tests; Prognosis; Protein Precursors; Reference Values; Serum; Severity of Illness Index; Statistics as Topic

diagnostic delay contributes to high morbidity and mortality in infective endocarditis. A readily available diagnostic marker of infective endocarditis is desirable. S-procalcitonin has been proposed as a candidate, but data on its yield are conflicting. We tested its diagnostic value in a large population of patients seen in a tertiary center.. this prospective study included 759 consecutive patients referred for echocardiographic examination on clinical suspicion of infective endocarditis. Transthoracic echocardiography was followed by immediate transesophageal examination, and a blood sample was obtained for procalcitonin analysis. Infective endocarditis was diagnosed by an interdisciplinary team and confirmed according to the Duke criteria. The team was unaware of the results of procalcitonin analyses.. infective endocarditis was present in 147 patients (19%). Procalcitonin was higher in these patients than in those in whom infective endocarditis was rejected (median, 0.21 ng/mL vs. 0.13 ng/mL; P <.0005). Multivariate analysis identified significant independent determinants of high procalcitonin: blood culture with endocarditis-typical microorganisms (odds ratio [OR], 2.81), temperature ≥ 38°C (OR, 2.61), symptoms ≤ 5 days (OR, 2.39), immunocompromised status (OR, 1.74), and male gender (OR, 1.61). Tests at various procalcitonin thresholds yielded an acceptable sensitivity of 95% at 0.04 ng/mL, but specificity was only 14%. Only 12% had procalcitonin below this threshold, which might justify postponement of further examinations for infective endocarditis.. procalcitonin was significantly higher in patients with infective endocarditis than in patients without infective endocarditis and bacteremia with endocarditis-typical organisms was the strongest independent determinant of high procalcitonin. The clinical importance of this is questionable, because a suitable procalcitonin threshold for diagnosing or excluding infective endocarditis was not established.

Topics: Adult; Aged; Aged, 80 and over; Bacteremia; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Candida; Echocardiography; Echocardiography, Transesophageal; Endocarditis; Endocarditis, Bacterial; Female; Fungemia; Humans; Male; Middle Aged; Odds Ratio; Predictive Value of Tests; Prospective Studies; Protein Precursors; Research Design; Risk Factors; Sensitivity and Specificity; Sex Factors; Staphylococcus aureus; Streptococcus pneumoniae; Time Factors; Viridans Streptococci

This work was designed to analyse dynamics of inflammation markers (C-reactive protein, TNF-alpha) and procalcitonin in 66 patients with infectious endocarditis (IE) followed up during 6 months. Comparison of clinical observations and laboratory data revealed specific trends in these parameters in patients with different clinical course of IE and at its different stages. Some of the changes are shown to be responsible for the unfavourable prognosis of IE. TNF-alpha levels are considered to be a sensitive and informative index of the patients" clinical conditions throughout the entire period of IE evolvement.

Topics: Adult; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Disease Progression; Endocarditis, Bacterial; Female; Follow-Up Studies; Glycoproteins; Humans; Inflammation; Male; Middle Aged; Prognosis; Protein Precursors; Retrospective Studies; Tumor Necrosis Factor-alpha; Young Adult

The role of procalcitonin (PCT) in the diagnosis of infective endocarditis (IE) remains unclear. The aim of our study was to test the accuracy of PCT in the early diagnosis of IE and analyse if the accuracy of PCT is dependent on the type of pathogen causing IE. We carried out a prospective analysis of hospitalised patients referred for transthoracic echocardiography to search for an IE. The plasma PCT value was measured at the time of echocardiography. The diagnosis of IE was made using the modified Duke criteria. A total of 77 patients were included. IE was confirmed in 15 patients. The mean PCT values were 6.9 (+/-21.6) ug/l in patients without IE and 6.4 (+/-11.7) ug/l in patients with confirmed IE (p=0.92). IE patients with Staphylococcus aureus bacteraemia (n=7) had significantly higher PCT values compared to IE patients with other types of bacteraemia (n=8) (13.1 vs. 0.435, p=0.0299). This study demonstrates that PCT levels markedly differ at the time when IE is diagnosed. While PCT values are very high in patients with S. aureus bacteraemia, they are surprisingly low in patients with Streptococcus viridans bacteraemia, which are common offenders of endocarditis. We conclude that serum PCT has the potential to be used in the early diagnosis of S. aureus endocarditis.

Topics: Adult; Aged; Aged, 80 and over; Bacteremia; Calcitonin; Calcitonin Gene-Related Peptide; Endocarditis, Bacterial; Humans; Middle Aged; Prospective Studies; Protein Precursors; Serum; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Viridans Streptococci

Variability in the clinical presentation of infective endocarditis (IE) makes the diagnosis a clinical challenge. We hypothesized that serum procalcitonin, a marker of systemic bacterial infection, might be helpful in its diagnosis.. We conducted a prospective cohort study in 67 consecutive patients admitted to the hospital with the suspicion of IE or in whom the suspicion arose during the hospital course. IE was diagnosed by an interdisciplinary team that included an infectious disease specialist and a cardiologist who applied the Duke criteria. IE was confirmed in 21 patients. Procalcitonin was significantly higher in patients with IE (median 6.56 ng/mL) than in those with other final diagnoses (median 0.44 ng/mL, P<0.001). The area under the receiver operating characteristic curve that used procalcitonin to predict IE was 0.856 (95% CI 0.750 to 0.962), compared with 0.657 (95% CI 0.511 to 0.802) for C-reactive protein. The optimum concentration of procalcitonin for the calculation of positive and negative predictive accuracy as obtained from the receiver operating characteristic curve was 2.3 ng/mL. With this cutoff, the test characteristics of procalcitonin were as follows: sensitivity 81%, specificity 85%, negative predictive value 92%, and positive predictive value 72%. Multiple logistic regression analysis revealed that procalcitonin was the only significant independent predictor of IE on admission (OR 1.52, 95% CI 1.07 to 2.15, P=0.018).. Procalcitonin may be a valuable additional diagnostic marker in patients with suspected IE.

Topics: Adult; Aged; Area Under Curve; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Cohort Studies; Comorbidity; Early Diagnosis; Endocarditis, Bacterial; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Risk Factors; ROC Curve; Sensitivity and Specificity

Topics: Abciximab; Antibodies, Monoclonal; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cardiology; Cholesterol, HDL; Combined Modality Therapy; Endocarditis, Bacterial; Humans; Immunoglobulin Fab Fragments; Myocardial Infarction; Protein Precursors; Quinolines; Stents

PCT is a new highly sensitive and specific marker of bacterial and fungi infection--to be used in differential diagnosis at Infectious Diseases Departments. Author in this paper presents structure and mechanism of stimulation of PCT as a factor of "early infection's fase" for many infectious agents: bacteria, fungi, viruses and parasites. PCT may be found useful in diagnosing diseases; for ex.: sepsis, meningitis, inflammation of respiratory system, spontaneous bacterial peritonitis (SPB) and other local inflammatory foci (otitis media, endocarditis). PCT level is low in systemic inflammatory response syndrome (SIRS) and multiorgan dysfunction syndrome (MODS) of non-infectious origin (< 0.5 ng/ml), medium in case of localized infections (1.0-2.0 ng/ml) and in severe cases of disseminated infections (sepsis-->SIRS-->MODS) high (approximately 20 ng/ml).

Topics: Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Central Nervous System Infections; Diagnosis, Differential; Endocarditis, Bacterial; Humans; Multiple Organ Failure; Mycoses; Parasitic Diseases; Peritonitis; Protein Precursors

Infective endocarditis especially where blood culture is negative frequently causes problems in diagnosis despite of many nonspecific inflammation parameters. Procalcitonin (PCT) concentration is a new marker of severe bacterial and fungal infection. The aim of this study was to evaluate the usefulness of PCT concentration assessment in the diagnosis of uncomplicated infective endocarditis of bacterial etiology. The study group consisted of 30 patients with ongoing infective endocarditis in the course of acquired valvular heart disease. The diagnosis of bacterial endocarditis was established according to the Duke criteria on the basis of: clinical examination, laboratory investigations (inflammatory parameters, transthoracic and transesophageal echocardiography) and positive blood cultures. Patients with sepsis, concomitant infections and in an early postoperative period were excluded. Two control groups consisted of: 10 patients without endocarditis and other infections and another 10 patients without endocarditis and with an urinary tract infection. Serum procalcitonin concentrations were measured by an immunoluminometric assay (LUMItest PCT set). Mean serum PCT concentrations in patients with endocarditis (0.12 +/- 0.13, range 0-0.4 ng/ml) were significantly higher than in control group without infection (0.03 +/- 0.05, range 0-0.1 ng/ml) and higher than in control group with an urinary tract infection (0.02 +/- 0.04, range 0-0.1 ng/ml). However in 12 patients (of 30) were below sensitivity of the method and in the rest were within normal range (< 0.5 ng/ml).. Serum PCT concentration assessment seems to have no value in the diagnosis of uncomplicated infective endocarditis.

Topics: Adult; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Gram-Positive Bacterial Infections; Heart Valve Diseases; Humans; Male; Middle Aged; Protein Precursors; Sensitivity and Specificity; Urinary Tract Infections