Pro-calcitonin and inflammation in chronic hemodialysis / Pro-calcitonina e inflamación en hemodiálisis crónica

ABSTRACT

Procalcitonin (PCT) has emerged as a marker of infection, a frequent complication in hemodialysis (HD). We analyzed PCT levels in chronic non-acutely infected HD subjects, assessed its correlation with inflammatory and nutritional markers and propose a PCT reference value for non-infected HD patients.In an observational cross-sectional study, 48 chronic HD patients and 36 controls were analyzed. Variables age, gender, time on HD; diabetes; vascular access, PCT, C-reactive protein (CRP), albumin, malnutrition inflammatory score (MIS), hematocrit, leukocyte count, and body mass index (BMI). Subsequently, control (G1, n = 36, 43%) vs. non-infected patients (G2, n = 48, 57%) groups were compared. In control subjects (G1), age 54.3 ± 13.7 years, range (r) 30-81; males 19 (53%); median PCT 0.034 ng/ml (r 0.02-0.08); median CRP 0.80 mg/dl (r 0.36-3.9); p95 PCT level 0.063 ng/ml. In G2, age 60.2 ± 15.2 years; males 32 (67%), time on HD 27.0 ± 24.4; diabetics 19 (32%); median PCT 0.26 ng/ml (r 0.09-0.82); CRP 1.1 mg/dl (r 0.5-6.2); p95 PCT level 0.8 ng/ml. In control subjects, PCT and CRP were significantly lower than in G2 PCT 0.034 vs. 0.26 ng/ml, p = 0.0001; CRP 0.8 vs. 1.1 mg/dl, p = 0.0004. PCT-CRP correlation in G2 ρ = 0.287, p = 0.048. PCT and CRP concentrations are elevated in chronic non-acutely infected HD subjects, independently of infection, diabetes and vascular access. A p95 PCT level of 0.8 ng/ml may be considered as the upper normal reference value in non-acutely infected HD subjects. The PCT cut-off level in HD is yet to be determined in HD.

RESUMEN

La procalcitonina (PCT) puede ser un marcador de infección en la hemodiálisis (HD). Analizamos los niveles de PCT en sujetos sin infección aguda en HD crónica, su correlación con marcadores inflamatorios y nutricionales y, de acuerdo a ello, proponemos niveles de referencia de PCT. En un estudio observacional transversal se estudiaron 48 pacientes en HD y 36 controles. Variables edad; sexo, tiempo en HD; diabetes; acceso vascular, PCT, proteína C-reactiva (PCR), albúmina, score de malnutrición-inflamación, hematocrito, recuento leucocitario, e índice de masa muscular (IMC). En los controles se determinaron PCT y PCR. Se comparó grupo control (G1, n = 36, 43%) vs. pacientes (G2, n = 48, 57%). G1 edad, 54.3 ± 13.7, rango (r) 30-81 años; hombres 19 (53%); PCT mediana 0.034 ng/ml (r 0.020-0.080); PCR mediana 0.8 mg/dl (r 0.36-3.9); el nivel p95 de PCT 0.063 ng/ml. En el G2, edad media 60.2 ± 15.2 años, hombres 32 (66%), tiempo en HD 27.0 2 4.4; diabéticos 19 (32%); PCT 0.26 ng/ml (r 0.09-0.82); PCR 1.1 mg/dl (r 0.5-6.2); p95 PCT 0.8 ng/ml. En G1 los niveles de PCT y PCR fueron significativamente más bajos que en G2 PCT 0.034 vs. 0.26 ng/ml, p = 0.0001; PCR 0.8 vs 1.1 mg/dl, p = 0.0004. Correlación PCT- PCR en G2 ρ = 0.287, p = 0.048. La PCT y la PCR están elevadas en HD crónica independientemente de infección, diabetes y acceso vascular. Se propone p95 de PCT de 0.8 ng/ml como límite superior del intervalo de referencia en sujetos sin infección aguda en HD. El valor de PCT en HD está por determinarse.