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Procalcitonin in hemodialysis patients presenting with fever or chills to the emergency department

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Abstract

We sought to assess the role of procalcitonin in discriminating severe bacterial infections requiring antibiotic treatment from non-bacterial causes of fever or chills in chronic dialysis patients. Chronic hemodialysis patients who were admitted to the emergency room due to fever and/or chills were recruited to the study. The presence or absence of bacterial infection was defined after recruitment conclusion by an infectious disease specialist who was blinded to procalcitonin results. Procalcitonin levels were compared between infected and non-infected patients. Out of 54 patients recruited, 22 (41%) patients eventually diagnosed with infection. Mean (± SD) procalcitonin values were 4.3 (± 5.5) ng/ml among cases, 1.0 (± 2.0) ng/ml among controls with no infection (p = 0.02). A cutoff PCT value of 1 ng/ml or higher had 77% sensitivity and 59% specificity for the diagnosis of severe infection. Procalcitonin cannot usefully identify hemodialysis patient with bacterial infection.

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Abbreviations

HD:

hemodialysis

PCT:

procalcitonin

SD:

standard deviation

CRP:

C-reactive protein

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Acknowledgements

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Author notes

  1. R. Schneider and M. J. Cohen shared primary contribution.

Authors and Affiliations

  1. Division of Internal Medicine, Nephrology Service, Ein Kerem campus, 91120, Jerusalem, Israel

    R. Schneider, O. Duchin & M. Elhalel-Darnitski

  2. Department of Clinical Microbiology and Infectious Diseases, Hadassah–Hebrew University Medical Center, Ein Kerem campus, POB 12000, 91120, Jerusalem, Israel

    M. J. Cohen & S. Benenson

  3. Nephrology Department, Soroka Medical Center, Rager Boulevard, 85025, Beer Sheva, Israel

    Y. S. Haviv

  4. Intensive Care Unit Shaare-Zedek Medical Center, Shmuel Bait St., 9103102, Jerusalem, Israel

    P. D. Levin

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  1. R. Schneider
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  2. M. J. Cohen
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  4. O. Duchin
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  5. Y. S. Haviv
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Contributions

RS and MJC—study conception, design, analysis, manuscript preparation. OD—study design, patients’ recruitment, data collection, and analysis. SB—infection diseases analysis, manuscript preparation. YSH, ME-D, PDL—study overview, guidance, review of data and analyses, commentary and manuscript review.

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Correspondence to S. Benenson.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 0476-14-HMO).

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Informed consent was obtained from all individual participants included in the study.

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Schneider, R., Cohen, M.J., Benenson, S. et al. Procalcitonin in hemodialysis patients presenting with fever or chills to the emergency department. Intern Emerg Med 15, 257–262 (2020). https://doi.org/10.1007/s11739-019-02156-7

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  • DOI: https://doi.org/10.1007/s11739-019-02156-7

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