Abstract
Objective
Patients in cardiogenic shock (CS) often present with signs of systemic inflammation that mimic infection, especially in the setting of multiple organ failure (MOF). To clarify the usefulness of procalcitonin (PCT) for diagnosing complicating sepsis in patients with CS, especially in the presence of MOF we compared PCT concentrations in patients with CS with and without MOF to those in patients with septic shock (SS).
Design and setting
Retrospective analysis in the cardiovascular ICU at a university hospital.
Patients
40 patients with CS, 15 patients with SS, and 11 noncritically ill patients without infection.
Measurements and results
Infection was excluded by clinical and microbiological examination in all CS patients at the time of blood sampling. Nevertheless 35% exhibited CRP concentrations higher than 10 mg/dl and 25% PCT concentrations higher than 2 ng/ml. Median PCT concentrations were higher in CS patients than in controls but lower than in patients with SS. CS patients with MOF at the time of blood sampling exhibited higher PCT concentrations than patients without organ failure. In the pooled population of patients with CS and SS PCT had a higher area under the receiver operating characteristic curve (0.86 vs. 0.83) than CRP and a PCT concentration of 10 ng/ml or higher had greater specificity for sepsis than a PCT concentration of 2 ng/ml or higher but lower negative predictive value.
Conclusions
PCT concentrations above 2 ng/ml are frequently found in CS patients with MOF and do not necessarily indicate infection. PCT was slightly better than CRP for diagnosing sepsis in our study, but a PCT concentration of 10 ng/ml or higher seems to be more appropriate for diagnosing this complication in CS patients than 2 ng/ml.
References
Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634
Christ G, Zehetgruber M, Mundigler G, Coraim F, Laufer G, Wolner E, Maurer G, Siostrzonek P (1997) Emergency aortic valve replacement for critical aortic stenosis. A lifesaving treatment for patients with cardiogenic shock and multiple organ failure. Intensive Care Med 23:297–300
Brunkhorst FM, Clark AL, Forycki ZF, Anker SD (1999) Pyrexia, procalcitonin, immune activation and survival in cardiogenic shock: the potential importance of bacterial translocation. Int J Cardiol 72:3–10
Geppert A, Steiner A, Zorn G, Delle-Karth G, Koreny M, Haumer M, Siostrzonek P, Huber K, Heinz G (2002) Multiorgan failure in patients with cardiogenic shock is associated with high plasma levels of interleukin-6. Crit Care Med 30:1987–1994
Ugarte H, Silva E, Mercan D, De Mendonca A, Vincent JL (1999) Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 27:498–504
Müller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, Ritz R (2000) Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 28:977–983
Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, Celard M, Vandenesch F, Rousson R, Lehot JJ (2000) Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 28:3171–3176
Califf RM, Bengtson JR (1994) Cardiogenic shock. N Engl J Med 330:1724–1730
Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710
Pugin J (2002) Biomarkers of sepsis: is procalcitonin ready for prime time? Intensive Care Med 28:1203–1204
Kornberg A, Grube T, Wagner T, Voigt R, Homman M, Schotte U, Schmidt K, Scheele J (2000) Differentiated therapy with prostaglandin E1 (alprostadil) after orthotopic liver transplantation: the usefulness of procalcitonin (PCT) and hepatic artery resistive index (RI) for the evaluation of early graft function and clinical course. Clin Chem Lab Med 38:1177–1180
Sabat R, Hoflich C, Docke WD, Oppert M, Kern F, Windrich B, Rosenberger C, Kaden J, Volk HD, Reinke P (2001) Massive elevation of procalcitonin plasma levels in the absence of infection in kidney transplant patients treated with pan-T-cell antibodies. Intensive Care Med 27:987–991
Wagner FD, Jonitz B, Potapov EV, Qedra N, Wegscheider K, Abraham K, Ivanitskaia EA, Loebe M, Hetzer R (2001) Procalcitonin, a donor-specific predictor of early graft failure-related mortality after heart transplantation. Circulation 104:I192–I196
Hammer S, Meisner F, Dirschedl P, Hobel G, Fraunberger P, Meiser B, Reichardt B, Hammer C (1998) Procalcitonin: a new marker for diagnosis of acute rejection and bacterial infection in patients after heart and lung transplantation. Transpl Immunol 6:235–241
Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999) Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 3:45–50
Giamarellos-Bourboulis EJ, Mega A, Grecka P, Scarpa N, Koratzanis G, Thomopoulos G, Giamarellou H (2002) Procalcitonin: a marker to clearly differentiate systemic inflammatory response syndrome and sepsis in the critically ill patient? Intensive Care Med 28:1351–1356
Vincent JL, Mercan D (2000) Dear Sirs, what is your PCT? Intensive Care Med 26:1170–1171
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273:117–123
Meisner M, Lohs T, Huettemann E, Schmidt J, Hueller M, Reinhart K (2001) The plasma elimination rate and urinary secretion of procalcitonin in patients with normal and impaired renal function. Eur J Anaesthesiol 18:79–87
Meisner M, Huttemann E, Lohs T, Kasakov L, Reinhart K (2001) Plasma concentrations and clearance of procalcitonin during continuous veno-venous hemofiltration in septic patients. Shock 15:171–175
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Geppert, A., Steiner, A., Delle-Karth, G. et al. Usefulness of procalcitonin for diagnosing complicating sepsis in patients with cardiogenic shock. Intensive Care Med 29, 1384–1389 (2003). https://doi.org/10.1007/s00134-003-1827-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-003-1827-7