Serum procalcitonin predicts development of acute kidney injury in patients with suspected infection

Xin Nie, Bin Wu, Yong He, Xunbei Huang, Zhongqiu Dai, Qiang Miao, Haolan Song, Tongxing Luo, Baoxiu Gao, Lanlan Wang, Guixing Li
Clinical Chemistry and Laboratory Medicine: CCLM 2013, 51 (8): 1655-61

BACKGROUND: Procalcitonin (PCT) is an early, sensitive, and accurate marker for diagnosing infection and sepsis. As sepsis and septic shock are dominant causes of acute kidney injury (AKI), we investigated whether PCT is an early predictor of AKI in patients with symptoms of infection.

METHODS: Between January 2011 and October 2011, 1361 inpatients in West China Hospital who displayed infection symptoms were enrolled in our study. Levels of PCT, serum amyloid A (SAA), C-reactive protein (CRP), interleukin-6 (IL-6), and white blood cell count (WBC) were determined and participants' renal function was monitored for 3 consecutive days.

RESULTS: The rate of AKI occurrence 3 days after enrollment was 14.6%. Higher PCT levels were correlated with higher AKI occurrence rates and higher levels of serum urea, creatinine, and cystatin C (p<0.05). The area under the receiver-operating characteristic (ROC) curve (AUC) for PCT was 0.823, making it more predictive (p<0.0001) than SAA, CRP, IL-6, or WBC. The cut-off value of 1.575 ng/mL for PCT had the highest validity for predicting AKI in patients with infection symptoms. The sensitivity, specificity, negative-predictive value (NPV), positive-predictive value (PPV), negative-likelihood ratio (LR-), and positive-likelihood ratio (LR+) for this cut-off value were 61.7%, 84.6%, 93.6%, 37.5%, 0.415, and 4.98, respectively.

CONCLUSIONS: PCT can be used as a predictive marker for sepsis-induced acute kidney injury in patients with symptoms of infection.

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