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Critical Care

, 23:215 | Cite as

Influence of pathogen and focus of infection on procalcitonin values in sepsis: are there additional confounding factors?

  • Patrick M. HonoreEmail author
  • David De Bels
  • Rachid Attou
  • Sebastien Redant
  • Andrea Gallerani
  • Kianoush Kashani
Open Access
Letter

Abbreviations

AKI

Acute kidney injury

CRRT

Continuous renal replacement therapy

HAM

Highly adsorptive membranes

PCT

Procalcitonin

RRT

Renal replacement therapy

SA-AKI

Sepsis-associated AKI

We read the study by Thomas-Rüddel et al. with great interest [1]. Authors showed serum procalcitonin (PCT) concentrations were higher in patients with Gram-negative bacteremia (26 ng/ml) than in those with Gram-positive bacteremia (7.1 ng/ml) or candidemia (P < .0001) [1]. They outlined some potential factors that could have impacted the PCT measurement outside to the type, location, and severity of the infection. In addition to their findings, it is essential to highlight that in patients with positive blood culture, septic shock is very common. Acute kidney injury (AKI) is prevalent among patients with sepsis, and a considerable proportion of patients with sepsis-associated AKI (SA-AKI) require renal replacement therapy (RRT) [2]. As PCT has an approximate molecular weight of 14.5 kDa [3], the contemporary continuous RRT membranes are able to remove it (CRRT cutoff is about 35 kDa) [4]. Also, using newer high adsorptive membranes (HAM) would make PCT removal even more prominent [4]. Accordingly, if in the study by Thomas-Rüddel et al., there was any imbalance between the uses of CRRT between the two groups, it could critically impact the observed results. We, therefore, suggest including the use of CRRT in the prediction model. In addition, the design of future studies to assess the performance of PCT among septic patients who are on CRRT seems to be necessary [5].

Notes

Acknowledgements

None.

Authors’ contributions

PMH and KK designed the paper. All authors participated in drafting the manuscript. All authors have read and approved the final version.

Funding

None.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

  1. 1.
    Thomas-Rüddel DO, Poidinger B, Kott M, Weiss M, Reinhart K, Bloos F; MEDUSA study group. Influence of pathogen and focus of infection on procalcitonin values in sepsis patients with bacteremia or candidemia. Crit Care 2018;22(1):128. doi:  https://doi.org/10.1186/s13054-018-2050-9.
  2. 2.
    Peters E, Antonelli M, Wittebole X, Nanchal R, François B, Sakr Y, et al. A worldwide multicentre evaluation of the influence of deterioration or improvement of acute kidney injury on clinical outcome in critically ill patients with and without sepsis at ICU admission: results from The Intensive Care Over Nations audit. Crit Care. 2018;22(1):188.  https://doi.org/10.1186/s13054-018-2112-z.CrossRefPubMedPubMedCentralGoogle Scholar
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    Level C, Chauveau P, Guisset O, Cazin MC, Lasseur C, Gabinsky C, et al. Mass transfer, clearance, and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure. Crit Care. 2003;6:R160–6.CrossRefGoogle Scholar
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    Honoré PM, De Bels D, Spapen HD. An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock. Curr Opin Crit Care. 2018;24(6):463–8.  https://doi.org/10.1097/MCC.0000000000000542.CrossRefPubMedGoogle Scholar
  5. 5.
    Honoré PM, Jacobs R, De Waele E, Van Gorp V, Spapen HD. Evaluating sepsis during continuous dialysis: are biomarkers still valid? Blood Purif. 2014;38(2):104–5.  https://doi.org/10.1159/000363497 Epub 2014 Oct 17.CrossRefPubMedGoogle Scholar

Copyright information

© The Author(s). 2019

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Patrick M. Honore
    • 1
    Email author
  • David De Bels
    • 1
  • Rachid Attou
    • 1
  • Sebastien Redant
    • 1
  • Andrea Gallerani
    • 1
  • Kianoush Kashani
    • 2
  1. 1.ICU DepartmentCentre Hospitalier Universitaire Brugmann-Brugmann University HospitalBrusselsBelgium
  2. 2.Division of Nephrology and Hypertension, Division of Pulmonary and Critical Care MedicineMayo ClinicRochesterUSA

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