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Article: Procalcitonin fails to differentiate inflammatory status or predict long-term outcomes in peritoneal dialysis-associated peritonitis

TitleProcalcitonin fails to differentiate inflammatory status or predict long-term outcomes in peritoneal dialysis-associated peritonitis
Authors
KeywordsC-reactive protein
Inflammation
Peritonitis
Procalcitonin
Issue Date2008
PublisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.com
Citation
Peritoneal Dialysis International, 2008, v. 28 n. 4, p. 377-384 How to Cite?
Abstract◆ Background: Peritonitis is the major complication in patients undergoing maintenance peritoneal dialysis (PD) and is associated with a significant risk of mortality. Previously, we have shown that patients treated for peritonitis and having prolonged elevation of C-reactive protein (CRP) are associated with higher mortality. The underlying cause for the chronic systemic inflammation remains unknown. We studied serum procalcitonin (PCT), which has been reported as an accurate marker for infection and inflammation, with respect to being a diagnostic and prognostic indicator of persistent chronic inflammation after peritonitis in patients with PD-related peritonitis. ◆ Methods: We conducted a prospective study on PD patients that developed PD-related peritonitis. Blood samples obtained at routine check-up before the onset of peritonitis were taken as baseline (DO). When patients developed PD-related peritonitis, serial blood samples were obtained on day 1 (D1), day 7 (D7), and day 42 (D42) for PCT, CRP, and other inflammatory markers. Patients were followed up for at least 2 years, during which outcomes of peritonitis and causes of death were recorded. Serum levels of CRP and PCT at day 42 were analyzed to assess for long-term prognosis. ◆ Results: 35 patients [female 42.9%; mean age 63.8 ± 13.1 years; 12 (34.3%) diabetics] were recruited. The onset of peritonitis was 3.61 ± 3.56 years after PD initiation and median residual renal function at that time was 1.06 (range 0-6.1) mL/min. Median total white cell counts in PD effluent at days 1, 3, 7, and 42 were 3505/mm 3 (range 377-20 500/mm 3), 297 (8-5880)/mm 3, 34 (0-5290)/mm 3, and 10 (0-115)/mm 3, respectively. Twelve (34.3%) and 14 (40%) PD effluents grew gram-positive and gram-negative micro-organisms respectively; others were culture negative. Median PCT was increased significantly at day 1 [2.00 (0.12-58.7) ng/mL, p < 0.001], day 7 [0.76 (0.13-15.25) ng/mL, p < 0.001], and day 42 [0.30 (0.13-0.79) ng/ mL, p = 0.005] compared to baseline [0.20 (0.09-0.69) ng/mL]. Seven of 35 patients had false-negative results on day 1 (range 0.12-0.46) when PCT <0.5 ng/mL was used as the cutoff value for diagnosing peritonitis. For the long-term prognostic outcome, CRP at day 42 was significantly better than PCT in assessing overall prognosis (CRP: AUC 0.712, 95% CI 0.534-0.890 vs PCT: AUC 0.652, 95% CI 0.448-0.855). In Kaplan-Meier survival analysis, patients with elevated CRP (>3.0 mg/ L) were associated with poorer long-term survival (p = 0.04) but elevated PCT at the 25th, 50th, or 75th percentiles failed to provide prognostic value. ◆ Conclusions: PD patients after peritonitis may be associated with prolonged systemic inflammation. CRP was a better serum marker for monitoring inflammatory status and predicting long-term prognosis in our study. Although serum PCT is elevated in some patients at the time of peritonitis, its value in making a diagnosis and predicting long-term prognosis remains doubtful. Copyright © 2008 International Society for Peritoneal Dialysis.
Persistent Identifierhttp://hdl.handle.net/10722/59345
ISSN
2015 Impact Factor: 1.298
2015 SCImago Journal Rankings: 0.683
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLam, MFen_HK
dc.contributor.authorLeung, JCKen_HK
dc.contributor.authorLam, CWKen_HK
dc.contributor.authorTse, KCen_HK
dc.contributor.authorLo, WKen_HK
dc.contributor.authorLui, SLen_HK
dc.contributor.authorChan, TMen_HK
dc.contributor.authorTam, Sen_HK
dc.contributor.authorLai, KNen_HK
dc.date.accessioned2010-05-31T03:48:08Z-
dc.date.available2010-05-31T03:48:08Z-
dc.date.issued2008en_HK
dc.identifier.citationPeritoneal Dialysis International, 2008, v. 28 n. 4, p. 377-384en_HK
dc.identifier.issn0896-8608en_HK
dc.identifier.urihttp://hdl.handle.net/10722/59345-
dc.description.abstract◆ Background: Peritonitis is the major complication in patients undergoing maintenance peritoneal dialysis (PD) and is associated with a significant risk of mortality. Previously, we have shown that patients treated for peritonitis and having prolonged elevation of C-reactive protein (CRP) are associated with higher mortality. The underlying cause for the chronic systemic inflammation remains unknown. We studied serum procalcitonin (PCT), which has been reported as an accurate marker for infection and inflammation, with respect to being a diagnostic and prognostic indicator of persistent chronic inflammation after peritonitis in patients with PD-related peritonitis. ◆ Methods: We conducted a prospective study on PD patients that developed PD-related peritonitis. Blood samples obtained at routine check-up before the onset of peritonitis were taken as baseline (DO). When patients developed PD-related peritonitis, serial blood samples were obtained on day 1 (D1), day 7 (D7), and day 42 (D42) for PCT, CRP, and other inflammatory markers. Patients were followed up for at least 2 years, during which outcomes of peritonitis and causes of death were recorded. Serum levels of CRP and PCT at day 42 were analyzed to assess for long-term prognosis. ◆ Results: 35 patients [female 42.9%; mean age 63.8 ± 13.1 years; 12 (34.3%) diabetics] were recruited. The onset of peritonitis was 3.61 ± 3.56 years after PD initiation and median residual renal function at that time was 1.06 (range 0-6.1) mL/min. Median total white cell counts in PD effluent at days 1, 3, 7, and 42 were 3505/mm 3 (range 377-20 500/mm 3), 297 (8-5880)/mm 3, 34 (0-5290)/mm 3, and 10 (0-115)/mm 3, respectively. Twelve (34.3%) and 14 (40%) PD effluents grew gram-positive and gram-negative micro-organisms respectively; others were culture negative. Median PCT was increased significantly at day 1 [2.00 (0.12-58.7) ng/mL, p < 0.001], day 7 [0.76 (0.13-15.25) ng/mL, p < 0.001], and day 42 [0.30 (0.13-0.79) ng/ mL, p = 0.005] compared to baseline [0.20 (0.09-0.69) ng/mL]. Seven of 35 patients had false-negative results on day 1 (range 0.12-0.46) when PCT <0.5 ng/mL was used as the cutoff value for diagnosing peritonitis. For the long-term prognostic outcome, CRP at day 42 was significantly better than PCT in assessing overall prognosis (CRP: AUC 0.712, 95% CI 0.534-0.890 vs PCT: AUC 0.652, 95% CI 0.448-0.855). In Kaplan-Meier survival analysis, patients with elevated CRP (>3.0 mg/ L) were associated with poorer long-term survival (p = 0.04) but elevated PCT at the 25th, 50th, or 75th percentiles failed to provide prognostic value. ◆ Conclusions: PD patients after peritonitis may be associated with prolonged systemic inflammation. CRP was a better serum marker for monitoring inflammatory status and predicting long-term prognosis in our study. Although serum PCT is elevated in some patients at the time of peritonitis, its value in making a diagnosis and predicting long-term prognosis remains doubtful. Copyright © 2008 International Society for Peritoneal Dialysis.en_HK
dc.languageengen_HK
dc.publisherMultimed, Inc. The Journal's web site is located at http://pdiconnect.comen_HK
dc.relation.ispartofPeritoneal Dialysis Internationalen_HK
dc.subjectC-reactive proteinen_HK
dc.subjectInflammationen_HK
dc.subjectPeritonitisen_HK
dc.subjectProcalcitoninen_HK
dc.subject.meshAgeden_HK
dc.subject.meshAnti-Bacterial Agents - therapeutic useen_HK
dc.subject.meshBiological Markers - blooden_HK
dc.subject.meshC-Reactive Protein - analysis - metabolismen_HK
dc.subject.meshCalcitonin - blood - metabolismen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshKaplan-Meier Estimateen_HK
dc.subject.meshKidney Failure, Chronic - blood - mortality - therapyen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPeritoneal Dialysis - adverse effectsen_HK
dc.subject.meshPeritonitis - blood - therapyen_HK
dc.subject.meshPrognosisen_HK
dc.subject.meshProspective Studiesen_HK
dc.subject.meshProtein Precursors - blood - metabolismen_HK
dc.subject.meshSensitivity and Specificityen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleProcalcitonin fails to differentiate inflammatory status or predict long-term outcomes in peritoneal dialysis-associated peritonitisen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0896-8608&volume=28&spage=377&epage=84&date=2008&atitle=Procalcitonin+fails+to+differentiate+inflammatory+status+or+predict+long-term+outcomes+in+peritoneal+dialysis-associated+peritonitisen_HK
dc.identifier.emailLeung, JCK: jckleung@hku.hken_HK
dc.identifier.emailChan, TM: dtmchan@hku.hken_HK
dc.identifier.emailLai, KN: knlai@hku.hken_HK
dc.identifier.authorityLeung, JCK=rp00448en_HK
dc.identifier.authorityChan, TM=rp00394en_HK
dc.identifier.authorityLai, KN=rp00324en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid18556380-
dc.identifier.scopuseid_2-s2.0-48749115316en_HK
dc.identifier.hkuros149219en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-48749115316&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume28en_HK
dc.identifier.issue4en_HK
dc.identifier.spage377en_HK
dc.identifier.epage384en_HK
dc.identifier.isiWOS:000256889800012-
dc.publisher.placeCanadaen_HK
dc.identifier.scopusauthoridLam, MF=35300050600en_HK
dc.identifier.scopusauthoridLeung, JCK=7202180349en_HK
dc.identifier.scopusauthoridLam, CWK=7402527629en_HK
dc.identifier.scopusauthoridTse, KC=7102609864en_HK
dc.identifier.scopusauthoridLo, WK=7201502414en_HK
dc.identifier.scopusauthoridLui, SL=7102379130en_HK
dc.identifier.scopusauthoridChan, TM=7402687700en_HK
dc.identifier.scopusauthoridTam, S=7202037323en_HK
dc.identifier.scopusauthoridLai, KN=7402135706en_HK

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