Serum procalcitonin concentration in patients with Kawasaki disease

doi:10.1016/j.jinf.2003.08.002

Journal of Infection

Volume 48, Issue 2, February 2004, Pages 199-205

https://doi.org/10.1016/j.jinf.2003.08.002 Get rights and content

Abstract

Background. Procalcitonin (PCT) is a new parameter of inflammation, the clinical usefulness of which is currently being evaluated.

Materials and methods. We determined simultaneously the serum concentrations of PCT and C-reactive protein (CRP) as well as the white blood cell (WBC) count in 25 patients with Kawasaki disease (KD), 17 with bacterial infections, 10 with systemic autoimmune diseases, 17 with viral infections and 18 healthy children. The optimal cut-off value of each parameter for predicting coronary aneurysms was determined using receiver operating characteristic curves.

Results. Significantly higher serum concentrations of PCT were observed in patients with KD (2.3±3.0 ng/ml) and bacterial infections (2.2±2.9 ng/ml) than in patients with autoimmune diseases (0.4±0.4 ng/ml) or viral infections (0.4±0.3 ng/ml), or in healthy children (0.2±0.1 ng/ml). The serum PCT but not the WBC count or CRP, differentiated the KD patients from the patients with autoimmune diseases. The optimal cut-off value of 3.0 ng/ml of PCT increased the prediction rate of coronary aneurysms that subsequently occurred in 4 (16%) patients with KD.

Conclusions. The serum PCT may be clinically useful for determining the severity of KD and for narrowing the differential diagnosis of patients with inflammatory diseases.

Introduction

Procalcitonin (PCT) is a 116 amino acid protein with a molecular weight of approximately 13 kD.¹ PCT is a very stable protein in vivo and in vitro, and is not degraded to hormonally active calcitonin in plasma.² Because an increased serum concentration of PCT is seen in patients with bacterial infection,3., 4., 5. PCT is thought to behave as an acute phase reactant and is now recognized as a new marker of bacterial infectious diseases.3., 6. Kawasaki disease (KD), involves an acute systemic vasculitis and can induce serious coronary aneurysms.⁷ KD may be an infectious disease with abnormal immune responses to an unidentified bacterium or virus.⁸ Thus, KD involves an aspect of autoimmune disease in its pathogenesis.9., 10. An acute phase reactant protein, C-reactive protein (CRP), in the serum and the white blood cell (WBC) count are more likely to increase in response to a bacterial infection and autoimmune diseases than in response to a viral infection.11., 12. PCT, also an acute phase reactant, behaves in an unknown manner after the onset of KD. Accordingly, we determined simultaneously the serum concentration of PCT and CRP, and the WBC count in patients with several inflammatory diseases, including KD and autoimmune diseases.

Section snippets

Patients

A total of 87 Japanese children were studied (Table 1), including 25 patients with KD, 17 patients with bacterial infections (eight with pneumonia, four with pyelonephritis, three with sepsis, and two with bacterial enterocolitis), 10 patients with autoimmune diseases (six with juvenile rheumatoid arthritis, two with systemic lupus erythematosus, one with mixed connective tissue disease, and one with Takayasu disease), 17 patients with viral infection (seven with influenza, three with chicken

Results

Both the mean WBC count and the mean CRP were significantly greater in the patients with acute KD than in the patients with viral infections and the healthy controls, but did not differ from those in the patients with bacterial infections and autoimmune diseases (Table 1). The mean PCT was significantly higher in the patients with acute KD than in the patients with autoimmune diseases and viral infections and in the healthy controls, but did not differ from that in the patients with bacterial

Discussion

This may be the first report in which the serum PCT concentration was determined in patients with KD. In this study, the serum concentration of PCT increased in the acute-phase KD patients to a similar extent to that seen in patients during the acute phase of a bacterial infection. Although the extent of the increase in both the WBC count and the CRP was similar between the patients with KD and autoimmune diseases, the increase in the PCT differed between them: the PCT increased in the patients

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A pregnancy-specific reference interval for procalcitonin
2021, Clinica Chimica Acta
Citation Excerpt :
A total of 328 women were potentially eligible for inclusion. Five women (1.5%) were excluded as outliers; the reasons for these high levels of PCT are uncertain but may include undiagnosed or unreported thyroid cancer [17], or Kawasaki disease [18]. The distribution of PCT in each trimester is presented in Fig. 1: Procalcitonin values by trimester, and details on outliers are presented in Appendix A: Procalcitonin outliers.
Sepsis is a leading cause of maternal death, and developing diagnostic tests for infection is increasingly important to reduce maternal mortality. The existing inflammatory markers, like C-reactive protein, are not specific for infection, which introduces diagnostic uncertainty. Procalcitonin (PCT) is used to accurately diagnose bacterial sepsis and differentiate it from other conditions, which is now particularly important given the vulnerability to COVID-19 in pregnancy. There are few studies of PCT in pregnancy as the reference interval for pregnant women is unknown. This study aimed to define the pregnancy-specific reference interval for PCT.
Cross-sectional study of 323 healthy pregnant women, with longitudinal sampling in each trimester.
The upper reference limit for PCT was 0.05 ng/mL and did not vary materially between any observed group of gestational age, body mass index, maternal age, mean arterial blood pressure or fetal sex.
Our study has shown that levels of PCT are similar in pregnant and non-pregnant populations despite the physiological changes of normal pregnancy. Therefore, pregnancy should not preclude the use of PCT in pregnant women with suspected sepsis, or for guiding antibiotic therapy in women with a diagnosed bacterial infection at any stage of pregnancy.
Procalcitonin levels predicting the infliximab response of immunoglobulin resistant Kawasaki disease
2019, Cytokine
Citation Excerpt :
Serum procalcitonin levels are widely used in practice for distinguishing bacterial infection from viral infection [23], although the precise source of the circulating molecule remains elusive. The procalcitonin levels also increase in cases of non-infectious conditions including surgery, burn, heart failure as well as vasculitis syndrome including KD [24–29]. Several proinflammatory cytokines including TNF-α and IL-6 are known to induce the production of procalcitonin [30].
To search the predictive factors of infliximab resistance in intravenous immunoglobulin (IVIG)-resistant Kawasaki disease (KD) patients.
Study design.
Twenty-seven patients with KD who received infliximab after 4–5 g/kg of IVIG therapy from 2013 to 2015 were consecutively recruited in this study. They were divided into two groups: patients who responded to infliximab (infliximab-responsive group, n = 15) and patients who required additional therapy for the disease control (infliximab-resistant group, n = 12). We analyzed the clinical and laboratory parameters just before the infliximab treatment including serum levels of procalcitonin and cytokines with respect to the infliximab response.
Serum procalcitonin concentration (P = 0.017), neutrophils to lymphocytes ratio (P = 0.013), and % neutrophils (P = 0.004) were higher, and serum sodium concentration (P = 0.017) was lower in infliximab-resistant group than those of infliximab-responsive group, respectively. Multivariate logistic regression analyses indicated that higher procalcitonin concentration (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.00–5.00, P = 0.046) and lower sodium levels (OR 0.64, 95% CI 0.32–1.00, P = 0.047), but not other variables, were associated with infliximab-resistance. Serum procalcitonin concentrations positively correlated with the serum levels of interleukin-6, soluble tumor necrosis factor receptor type 1 and type 2, respectively. Analyses of the receiver operating characteristic (ROC) curve showed that the cut-off value of procalcitonin 2.0 ng/ml had 58.3% of sensitivity and 93.3% of specificity. ROC analysis yielded an area under the curve (AUC) of 0.739 to predict infliximab-resistance.
Serum procalcitonin might be an effective biomarker to predict infliximab resistance in severe KD patients who are refractory to IVIG treatment.
Role of procalcitonin in infected diabetic foot ulcer
2017, Diabetes Research and Clinical Practice
Citation Excerpt :
It has been noted that PCT levels are greatly elevated in patients with infections associated with Gram-negative bacteria, compared to Gram-positive bacteria [32]. Non-infectious conditions, such as stress response (i.e., after surgery, trauma, shock, burns), Kawasaki disease, and adult onset Still’s disease also can cause elevated PCT levels [18,33–35]. Even though PCT may incur extra costs in addition to the costs of conventional laboratory markers in patients with IDFU, it has been demonstrated to be cost-effective in a hospital setting to guide antibiotic usage in septic patients, when decreased length of stay and quality-of-life-years are considered [36–38].
Procalcitonin (PCT) has been recently accepted as a marker for diagnosing infection. The aim of the present study was to determine whether PCT levels are associated with infection severity of diabetic foot ulcers and whether PCT levels would be helpful to differentiate infected diabetic foot ulcer (IDFU) from IDFU associated with other infectious diseases (IDFU + O).
We prospectively included 123 diabetic patients hospitalized for IDFU. Infection severity of diabetic foot ulcers was graded according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot clinical classification of diabetic foot infection. Chest radiograph, urinalysis, urine microscopy, urine culture, and blood cultures (if fever was present) were performed for all patients to diagnose other infectious diseases. Laboratory parameters were measured from blood venous samples.
PCT (Spearman’s ρ = 0.338, P < 0.001) and C-reactive protein (Spearman’s ρ = 0.477, P < 0.001) levels were significantly associated with infection severity of diabetic foot ulcers. However, only PCT levels could differentiate patients with associated infectious diseases from patients with no concomitant infection (area under the receiver-operator characteristic curve 0.869, P < 0.0001; cut-off value 0.59; sensitivity 94.7; specificity 88.5).
PCT and CRP levels positively correlated with infection severity of diabetic foot ulcers and PCT levels > 0.59 ng/mL in patients with IDFU may be associated with other systemic bacterial infection.
Determination of Serum Procalcitonin Level in Kawasaki Disease
2024, Journal of Comprehensive Pediatrics
Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans–A potential marker for disease severity
2023, PLoS ONE
Clinical indications for Kawasaki disease in febrile infants aged less than three months
2022, Rheumatology International

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Serum procalcitonin concentration in patients with Kawasaki disease

Abstract

Introduction

Section snippets

Patients

Results

Discussion

FEBS Lett

J Pediatr

Am J Cardiol

J Pediatr

High serum procalcitonin concentrations in patients with sepsis and infection

Lancet

Procalcitonin, a marker of bacterial infection

Infection

Procalcitonin increase after endotoxin injection in normal subjects

J Clin Endocrinol Metab

Mortality is increased by procalcitonin and decreased by antiserum reactive to procalcitonin in experimental sepsis

Crit Care Med

Comparison of procalcitonin with C-reactive protein, interleukin 6 and interferon-alpha for differentiation of bacterial vs. viral infections

Pediatr Infect Dis J

A new infantile acute febrile mucocutaneous lymph node syndrome (MLNS) prevailing in Japan