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Diagnostic Value of Procalcitonin in ANCA-Associated Vasculitis (AAV) to Differentiate Between Disease Activity, Infection and Drug Hypersensitivity.

Herrmann K, Schinke S, Csernok E, Moosig F, Holle JU - Open Rheumatol J (2015)

Bottom Line: Procalcitonin (PCT) is considered to be a specific marker for severe bacterial infections and sepsis.In 53 AAV patients with elevated C-reactive protein (CRP) PCT was determined by the Thermo Scientific BRAHMS PCT sensitive KRYPTOR assay.Drug hypersensitivity seems to be an important differential diagnosis in the setting of elevated CRP and PCT in patients who receive azathioprine.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatology, Department of Medicine III, University Medical Center Carl Gustav Carus at the TU Dresden, Dresden, Germany ; Department of Rheumatology, Klinikum Bad Bramstedt, Germany.

ABSTRACT

Objective: Procalcitonin (PCT) is considered to be a specific marker for severe bacterial infections and sepsis. Elevated PCT levels have been reported in active autoimmune diseases without infection. The aim of this study was to assess the diagnostic value of PCT serum levels in ANCA-associated vasculitis (AAV) patients with respect to infection, disease activity and drug fever using a high sensitive PCT detection method.

Methods: In 53 AAV patients with elevated C-reactive protein (CRP) PCT was determined by the Thermo Scientific BRAHMS PCT sensitive KRYPTOR assay. Patients underwent standardized diagnostic procedures for evaluation of disease activity and infection.

Results: 53 patients with AAV and elevated CRP (7.7±6.9 mg/dl, PCT 0.34±1.02 ng/ml) were assessed, 10 had infection with elevated CRP levels of 11.2±10.2 mg/dl and PCT levels of 1.06±2.07 ng/dl. 43 patients had no evidence of infection, 36 of them were presented with AAV with normal or only slightly positive PCT levels in active disease (n=36) (PCT 0.06±0.06 ng/ml). 7 patients had increased PCT levels due to azathioprine hypersensitivity (0.76±1.01 ng/ml). For discrimination between infection and vasculitis activity PCT was more useful than CRP with the best cut-off at 0.1 ng/ml (sensitivity 60%, specificity 92%).

Conclusion: In contrast to previous studies using semiquantitative PCT assays, the KRYPTOR performs better with respect to discrimination of infection from active AAV. In all patients assessed with active AAV (and without infection) PCT levels remained below the PCT reference limit (0.5 ng/ml) for infections. Drug hypersensitivity seems to be an important differential diagnosis in the setting of elevated CRP and PCT in patients who receive azathioprine.

No MeSH data available.


Related in: MedlinePlus

A: Flowchart of analyzed AAV subgroups. CRP and PCT concentrations are represent as mean and standard deviation. Number of PCT positive samples is given for each subgroup. Additions to infection and causative pathogen: * -recurrent sepsis (blood culture: gram-negative rod-shaped bacteria; urin culture: klebsiella oxytoca);-respiratory sepsis, in course with multiorgan failure and exitus (bronchial lavage: multiresistent pseudomonas aeruginosa, candida albicans, aspergillus fumigatus; blood culture: enteroccus faecium) ** -atypical mycobacteriosis (bronchial lavage: M. avium, M. intracellulare complex);-pneumonia (bronchial lavage: staphylococcus aureus, haemophilus influenzae);-pneumonia (bronchial lavage: haemophilus influenzae); -pneumonia (sputum: escherichia coli, enterococcus faecalis, pseudomonas aeruginosa); -lacrimal duct abscess (MRSA); -serom of parotid gland (enteroccocus); -superinfection of pulmonal cavern (actinobacter and aspergillus); -superinfection of skin ulcus with concomitant lymphadenitis (proteus mirabilis, enterococcus faecalis, stenotrophomonas). B: PCT concentrations in AAV patients. Horizontal line indicates the defined limit for systemic infections at 0.5 ng/ml and functional assay sensitivity at 0.06 ng/ml. Bars are medians. 13 of 36 AAV patients were assessed regarding CRP and PCT levels during active disease and remission.
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Figure 1: A: Flowchart of analyzed AAV subgroups. CRP and PCT concentrations are represent as mean and standard deviation. Number of PCT positive samples is given for each subgroup. Additions to infection and causative pathogen: * -recurrent sepsis (blood culture: gram-negative rod-shaped bacteria; urin culture: klebsiella oxytoca);-respiratory sepsis, in course with multiorgan failure and exitus (bronchial lavage: multiresistent pseudomonas aeruginosa, candida albicans, aspergillus fumigatus; blood culture: enteroccus faecium) ** -atypical mycobacteriosis (bronchial lavage: M. avium, M. intracellulare complex);-pneumonia (bronchial lavage: staphylococcus aureus, haemophilus influenzae);-pneumonia (bronchial lavage: haemophilus influenzae); -pneumonia (sputum: escherichia coli, enterococcus faecalis, pseudomonas aeruginosa); -lacrimal duct abscess (MRSA); -serom of parotid gland (enteroccocus); -superinfection of pulmonal cavern (actinobacter and aspergillus); -superinfection of skin ulcus with concomitant lymphadenitis (proteus mirabilis, enterococcus faecalis, stenotrophomonas). B: PCT concentrations in AAV patients. Horizontal line indicates the defined limit for systemic infections at 0.5 ng/ml and functional assay sensitivity at 0.06 ng/ml. Bars are medians. 13 of 36 AAV patients were assessed regarding CRP and PCT levels during active disease and remission.

Mentions: 53 patients with elevated CRP levels (7.7±6.9 mg/dl) were studied. These patients had a mean PCT level of 0.34±1.02 ng/ml. In 24 of 53 patients, PCT was increased (0.71±1.44 ng/ml). These patients were further assessed for the presence of infection: In 10 patients (CRP 11.2±10.2 mg/dl) an infection was documented, and PCT levels were elevated (1.06±2.07 mg/dl). Infections were local in 8 patients and systemic in 2 patients; interestingly, patients with systemic infections showed lower PCT levels than patients with local infections (Fig. 1). 43 patients had no evidence of infection, 7 of whom were diagnosed with azathioprine drug fever which as accompanied by marked PCT elevation (PCT 0.76±1.01 ng/ml). 36 patients were diagnosed with active AAV. All of these patients had normal or slightly elevated PCT levels (0.06±0.06 ng/ml).


Diagnostic Value of Procalcitonin in ANCA-Associated Vasculitis (AAV) to Differentiate Between Disease Activity, Infection and Drug Hypersensitivity.

Herrmann K, Schinke S, Csernok E, Moosig F, Holle JU - Open Rheumatol J (2015)

A: Flowchart of analyzed AAV subgroups. CRP and PCT concentrations are represent as mean and standard deviation. Number of PCT positive samples is given for each subgroup. Additions to infection and causative pathogen: * -recurrent sepsis (blood culture: gram-negative rod-shaped bacteria; urin culture: klebsiella oxytoca);-respiratory sepsis, in course with multiorgan failure and exitus (bronchial lavage: multiresistent pseudomonas aeruginosa, candida albicans, aspergillus fumigatus; blood culture: enteroccus faecium) ** -atypical mycobacteriosis (bronchial lavage: M. avium, M. intracellulare complex);-pneumonia (bronchial lavage: staphylococcus aureus, haemophilus influenzae);-pneumonia (bronchial lavage: haemophilus influenzae); -pneumonia (sputum: escherichia coli, enterococcus faecalis, pseudomonas aeruginosa); -lacrimal duct abscess (MRSA); -serom of parotid gland (enteroccocus); -superinfection of pulmonal cavern (actinobacter and aspergillus); -superinfection of skin ulcus with concomitant lymphadenitis (proteus mirabilis, enterococcus faecalis, stenotrophomonas). B: PCT concentrations in AAV patients. Horizontal line indicates the defined limit for systemic infections at 0.5 ng/ml and functional assay sensitivity at 0.06 ng/ml. Bars are medians. 13 of 36 AAV patients were assessed regarding CRP and PCT levels during active disease and remission.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4627387&req=5

Figure 1: A: Flowchart of analyzed AAV subgroups. CRP and PCT concentrations are represent as mean and standard deviation. Number of PCT positive samples is given for each subgroup. Additions to infection and causative pathogen: * -recurrent sepsis (blood culture: gram-negative rod-shaped bacteria; urin culture: klebsiella oxytoca);-respiratory sepsis, in course with multiorgan failure and exitus (bronchial lavage: multiresistent pseudomonas aeruginosa, candida albicans, aspergillus fumigatus; blood culture: enteroccus faecium) ** -atypical mycobacteriosis (bronchial lavage: M. avium, M. intracellulare complex);-pneumonia (bronchial lavage: staphylococcus aureus, haemophilus influenzae);-pneumonia (bronchial lavage: haemophilus influenzae); -pneumonia (sputum: escherichia coli, enterococcus faecalis, pseudomonas aeruginosa); -lacrimal duct abscess (MRSA); -serom of parotid gland (enteroccocus); -superinfection of pulmonal cavern (actinobacter and aspergillus); -superinfection of skin ulcus with concomitant lymphadenitis (proteus mirabilis, enterococcus faecalis, stenotrophomonas). B: PCT concentrations in AAV patients. Horizontal line indicates the defined limit for systemic infections at 0.5 ng/ml and functional assay sensitivity at 0.06 ng/ml. Bars are medians. 13 of 36 AAV patients were assessed regarding CRP and PCT levels during active disease and remission.
Mentions: 53 patients with elevated CRP levels (7.7±6.9 mg/dl) were studied. These patients had a mean PCT level of 0.34±1.02 ng/ml. In 24 of 53 patients, PCT was increased (0.71±1.44 ng/ml). These patients were further assessed for the presence of infection: In 10 patients (CRP 11.2±10.2 mg/dl) an infection was documented, and PCT levels were elevated (1.06±2.07 mg/dl). Infections were local in 8 patients and systemic in 2 patients; interestingly, patients with systemic infections showed lower PCT levels than patients with local infections (Fig. 1). 43 patients had no evidence of infection, 7 of whom were diagnosed with azathioprine drug fever which as accompanied by marked PCT elevation (PCT 0.76±1.01 ng/ml). 36 patients were diagnosed with active AAV. All of these patients had normal or slightly elevated PCT levels (0.06±0.06 ng/ml).

Bottom Line: Procalcitonin (PCT) is considered to be a specific marker for severe bacterial infections and sepsis.In 53 AAV patients with elevated C-reactive protein (CRP) PCT was determined by the Thermo Scientific BRAHMS PCT sensitive KRYPTOR assay.Drug hypersensitivity seems to be an important differential diagnosis in the setting of elevated CRP and PCT in patients who receive azathioprine.

View Article: PubMed Central - PubMed

Affiliation: Division of Rheumatology, Department of Medicine III, University Medical Center Carl Gustav Carus at the TU Dresden, Dresden, Germany ; Department of Rheumatology, Klinikum Bad Bramstedt, Germany.

ABSTRACT

Objective: Procalcitonin (PCT) is considered to be a specific marker for severe bacterial infections and sepsis. Elevated PCT levels have been reported in active autoimmune diseases without infection. The aim of this study was to assess the diagnostic value of PCT serum levels in ANCA-associated vasculitis (AAV) patients with respect to infection, disease activity and drug fever using a high sensitive PCT detection method.

Methods: In 53 AAV patients with elevated C-reactive protein (CRP) PCT was determined by the Thermo Scientific BRAHMS PCT sensitive KRYPTOR assay. Patients underwent standardized diagnostic procedures for evaluation of disease activity and infection.

Results: 53 patients with AAV and elevated CRP (7.7±6.9 mg/dl, PCT 0.34±1.02 ng/ml) were assessed, 10 had infection with elevated CRP levels of 11.2±10.2 mg/dl and PCT levels of 1.06±2.07 ng/dl. 43 patients had no evidence of infection, 36 of them were presented with AAV with normal or only slightly positive PCT levels in active disease (n=36) (PCT 0.06±0.06 ng/ml). 7 patients had increased PCT levels due to azathioprine hypersensitivity (0.76±1.01 ng/ml). For discrimination between infection and vasculitis activity PCT was more useful than CRP with the best cut-off at 0.1 ng/ml (sensitivity 60%, specificity 92%).

Conclusion: In contrast to previous studies using semiquantitative PCT assays, the KRYPTOR performs better with respect to discrimination of infection from active AAV. In all patients assessed with active AAV (and without infection) PCT levels remained below the PCT reference limit (0.5 ng/ml) for infections. Drug hypersensitivity seems to be an important differential diagnosis in the setting of elevated CRP and PCT in patients who receive azathioprine.

No MeSH data available.


Related in: MedlinePlus