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Abstract: FR-PO773

Procalcitonin as a Predictor of Sepsis in Patients with ESRD

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Dhillon, Raman, St. Joseph''s University Medical Center, Clifton, New Jersey, United States
  • Doroudi, Shideh, St. Joseph''s University Medical center, Clifton, New Jersey, United States
  • Patel, Puja, St. Joseph''s University Medical Center, Clifton, New Jersey, United States
Background

Procalcitonin is a helpful biomarker in the diagnosis of sepsis in critically ill patients, especially in identifying occult bacterial infections. Procalcitonin levels rise 3-6 hours after onset of sepsis, and peak at 24-48 hours. It has been found that renal clearance of procalcitonin is low, and the use of procalictonin in kidney disease has not been widely studied.

Methods

A Retrospective chart review of patient admitted with diagnosis of Sepsis and End Stage Renal disease was reviewed for 57 months. All patients with end stage renal disease and sepsis with procalcitonin measured at admission or during hospitalization were included. We used two-way ANOVA table to explore the relationships between procalcitonin, lactic acid levels, hemodialysis, and cultures.

Results

Of 362 patients, 190 were male and 172 were female with ages ranging from 30-100 years. 158 of 362 patients were on hemodialysis. 210 of 362 had procalcitonin levels measured during hospitalization. Procalcitonin of these patients ranged from less than 0.05 to 235.94 ng/mL. 148 of 362 patients had lactic acid measured, with 62 having lactic acid > 2 mmol/L. Of the 362 patients, 41 had positive cultures. By using our method of statistical analysis, we found that only age was statistically significant, with a P-value 0.0107, meaning that procalcitonin levels were increased with increasing age. We also found that lactic acid and culture growth when compared with procalcitonin levels, were not statistically significant, with P-values of 0.4095 & 0.9148, respectively.

Conclusion

Procalcitonin's role has not been well studied in patients with end stage renal disease on hemodialysis, although it has been found that it is the best predictor of infection in hemodialysis patients. Previous studies have found that higher cutoff levels of procalcitonin should be used to rule in or rule out infection, and it has been found that a procalcitonin of >0.5 ng/mL can be used to rule in infection in patients on hemodialysis. Our study looked at patients with end stage renal disease on hemodialysis and sepsis comparing procalcitonin, lactic acid and culture growth. We found that lactic acid and culture results were not statistically significant, meaning that those values may be negative despite positive procalcitonin levels. Therefore, clinical judgment should be used when a patient has sepsis.