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How should procalcitonin and C‐reactive protein levels be interpreted in haemodialysis patients?
Author(s) -
Demir Nazlim A.,
Sumer Sua,
Celik Gulperi,
Afsar Rengin E.,
Demir Lutfi S.,
Ural Onur
Publication year - 2018
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13952
Subject(s) - procalcitonin , medicine , c reactive protein , gastroenterology , predictive value , sepsis , inflammation
Background Procalcitonin (PCT) and C‐reactive protein (CRP) are used most widely in the diagnosis/treatment of bacterial infections. These are not infection‐specific and may also show increases in other inflammation‐causing cases. Aim To establish a new cut‐off value for PCT and CRP to eliminate confusion in the diagnosis and treatment of bacterial infections in haemodialysis (HD) patients. Methods A total of 1110 patients, 802 with undocumented infection and 308 with documented infection, was included in the study. Results A total of 802 patients with undocumented infection had a mean CRP value of 12.2 ± 9.6 mg/dL and a mean PCT value of 0.51 ± 0.96 ng/mL and the 308 patients with documented infection had a mean CRP value of 125.9 ± 83.3 mg/dL and a mean PCT value of 13.9 ± 26.9 ng/mL at the time of admittance. In HD patients, the cut‐off values for CRP was determined as 19.15 mg/dL and for PCT as 0.685 ng/mL in the presence of infection. The use of these two parameters in combination (CRP ≥19.15 mg/dL and PCT ≥ 0.685 ng/mL) was found to have 95% positive predictive value (PPV) and 93% negative predictive value (NPV) for the diagnosis of infectious diseases in HD patients. When CRP ≥100 mg/dL and PCT ≥5 ng/mL, this was found to have 100% PPV and 94% NPV for the diagnosis of sepsis in HD patients. Conclusion We specified PCT and CRP cut‐off values with high PPV and NPV for revealing the presence of bacterial infection and sepsis in HD patients.