CARDIOVASCULAR ENGINEERING Journal for Extracorporeal Circulation, Assist Devices,Transplantation and Artificial Organs
	Volume 1, 1996, No 1

Procalcitonin (PCT) - Indications for a New Diagnostic Parameter of Severe Bacterial Infection and Sepsis in Transplantation, Immunosuppression and Cardiac Assist Devices

P. G. Martin M. Meisner, K. Tschaikowsky, J. Schmidt, J. Schüttler

Abstract:
Procalcitonin (PCT), a 116 amino acid protein with identical sequence to the precursor protein of the human calcitonin hormone, is a new diagnostic parameter of bacterial infection and systemic inflammation. High plasma concentrations of PCT are induced in severe bacterial and fungal infection and in sepsis and multiorgan dysfunction syndrome (MODS). Unlike C-reactive protein (CRP), IL-6, or other parameters of the inflammatory response, PCT is generally not induced by viral infections, operation trauma, autoimmune or allergic disorders including allograft rejection and in the initial phase of circulatory failure. Hence, this parameter can be used for differential diagnosis of bacterial and non-bacterial inflammation and to assess the inflammatory reaction in sepsis and MODS. Increased PCT plasma concentrations are always found in sepsis and MODS, with high concentrations in the more severe states of disease. In circulatory failure and SIRS without bacterial infection, PCT values are less than in bacterial-induced septic shock, however, they may increase in the course of the disease. After major surgical procedures, only moderately increased PCT concentrations are observed. Presently PCT is regarded more suitable than CRP or other conventional indicators of inflammation to differentiate acute microbial infections from viral or allograft rejection following transplantation and immunosuppression. Since PCT initially shows only a weak induction during cardiac failure, it could be of prognostic value also in cardiac assist devices by indicating patients with septic hypotension and poor prognosis. To answer this question, prospective studies are warranted.

Keywords:
PCT, procalcitonin, bacterial inflammation, sepsis, infection, immunomonitoring, transplantation, immunosuppression, cardiac assist devices

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