Abstract
The role of procalcitonin (PCT) in the diagnosis of infective endocarditis (IE) remains unclear. The aim of our study was to test the accuracy of PCT in the early diagnosis of IE and analyse if the accuracy of PCT is dependent on the type of pathogen causing IE. We carried out a prospective analysis of hospitalised patients referred for transthoracic echocardiography to search for an IE. The plasma PCT value was measured at the time of echocardiography. The diagnosis of IE was made using the modified Duke criteria. A total of 77 patients were included. IE was confirmed in 15 patients. The mean PCT values were 6.9 (±21.6) ug/l in patients without IE and 6.4 (±11.7) ug/l in patients with confirmed IE (p=0.92). IE patients with Staphylococcus aureus bacteraemia (n=7) had significantly higher PCT values compared to IE patients with other types of bacteraemia (n=8) (13.1 vs. 0.435, p=0.0299). This study demonstrates that PCT levels markedly differ at the time when IE is diagnosed. While PCT values are very high in patients with S. aureus bacteraemia, they are surprisingly low in patients with Streptococcus viridans bacteraemia, which are common offenders of endocarditis. We conclude that serum PCT has the potential to be used in the early diagnosis of S. aureus endocarditis.
References
Hoen B, Alla F, Selton-Suty C, Béguinot I, Bouvet A, Briançon S, Casalta JP, Danchin N, Delahaye F, Etienne J, Le Moing V, Leport C, Mainardi JL, Ruimy R, Vandenesch F; Association pour l’Etude et la Prévention de l’Endocardite Infectieuse (AEPEI) Study Group (2002) Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 288(1):75–81
Delahaye F, Goulet V, Lacassin F, Ecochard R, Selton-Suty C, Hoen B, Etienne J, Briançon S, Leport C (1995) Characteristics of infective endocarditis in France in 1991. A 1-year survey. Eur Heart J 16(3):394–401
King JW, Nguyen VQ, Conrad SA (1988) Results of a prospective statewide reporting system for infective endocarditis. Am J Med Sci 295(6):517–527
Hogevik H, Olaison L, Andersson R, Lindberg J, Alestig K (1995) Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore) 74(6):324–339
Durack DT, Lukes AS, Bright DK (1994) New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 96(3):200–209
Lukes AS, Bright DK, Durack DT (1993) Diagnosis of infective endocarditis. Infect Dis Clin North Am 7(1):1–8
Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA; Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease; Council on Cardiovascular Disease in the Young; Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia; American Heart Association; Infectious Diseases Society of America (2005) Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 111(23):e394–e434
Li JS, Sexton DJ, Mick N, Nettles R, Fowler VG Jr, Ryan T, Bashore T, Corey GR (2000) Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 30(4):633–638
Wallace SM, Walton BI, Kharbanda RK, Hardy R, Wilson AP, Swanton RH (2002) Mortality from infective endocarditis: clinical predictors of outcome. Heart 88(1):53–60
Cabell CH, Jollis JG, Peterson GE, Corey GR, Anderson DJ, Sexton DJ, Woods CW, Reller LB, Ryan T, Fowler VG Jr (2002) Changing patient characteristics and the effect on mortality in endocarditis. Arch Intern Med 162(1):90–94
Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C (1993) High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 341(8844):515–518
Christ-Crain M, Müller B (2005) Procalcitonin in bacterial infections—hype, hope, more or less. Swiss Med Wkly 135(31–32):451–460
Whang KT, Steinwald PM, White JC, Nylen ES, Snider RH, Simon GL, Goldberg RL, Becker KL (1998) Serum calcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab 83(9):3296–3301
Mueller C, Huber P, Laifer G, Mueller B, Perruchoud AP (2004) Procalcitonin and the early diagnosis of infective endocarditis. Circulation 109(14):1707–1710
Kocazeybek B, Küçükoğlu S, Oner YA (2003) Procalcitonin and C-reactive protein in infective endocarditis: correlation with etiology and prognosis. Chemotherapy 49(1–2):76–84
Watkin RW, Harper LV, Vernallis AB, Lang S, Lambert PA, Ranasinghe AM, Elliott TS (2007) Pro-inflammatory cytokines IL6, TNF-alpha, IL1beta, procalcitonin, lipopolysaccharide binding protein and C-reactive protein in infective endocarditis. J Infect 55(3):220–225
Tang BM, Eslick GD, Craig JC, McLean AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7(3):210–217
[No authors listed] (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20(6):864–874
Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA (2007) Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Ann Emerg Med 50(1):34–41
Cecchi E, Forno D, Imazio M, Migliardi A, Gnavi R, Dal Conte I, Trinchero R; Piemonte Infective Endocarditis Study Group (2004) New trends in the epidemiological and clinical features of infective endocarditis: results of a multicenter prospective study. Ital Heart J 5(4):249–256
Kuruppu JC, Corretti M, Mackowiak P, Roghmann MC (2002) Overuse of transthoracic echocardiography in the diagnosis of native valve endocarditis. Arch Intern Med 162(15):1715–1720
Chan YL, Tseng CP, Tsay PK, Chang SS, Chiu TF, Chen JC (2004) Procalcitonin as a marker of bacterial infection in the emergency department: an observational study. Crit Care 8(1):R12–R20
Suprin E, Camus C, Gacouin A, Le Tulzo Y, Lavoue S, Feuillu A, Thomas R (2000) Procalcitonin: a valuable indicator of infection in a medical ICU? Intensive Care Med 26(9):1232–1238
Delèvaux I, André M, Colombier M, Albuisson E, Meylheuc F, Bègue RJ, Piette JC, Aumaître O (2003) Can procalcitonin measurement help in differentiating between bacterial infection and other kinds of inflammatory processes. Ann Rheum Dis 62(4):337–340
Boeken U, Feindt P, Micek M, Petzold T, Schulte HD, Gams E (2000) Procalcitonin (PCT) in cardiac surgery: diagnostic value in systemic inflammatory response syndrome (SIRS), sepsis and after heart transplantation (HTX). Cardiovasc Surg 8(7):550–554
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Cuculi, F., Toggweiler, S., Auer, M. et al. Serum procalcitonin has the potential to identify Staphylococcus aureus endocarditis. Eur J Clin Microbiol Infect Dis 27, 1145–1149 (2008). https://doi.org/10.1007/s10096-008-0541-3
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DOI: https://doi.org/10.1007/s10096-008-0541-3