Procalcitonin- Early-Warning System -...
Transcript of Procalcitonin- Early-Warning System -...
2017-10-08
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Procalcitonin-Early-Warning System
Irwin Reiss, MD PhD
Professor of Neonatology
Head, Division of Neonatology
Erasmus MC, Rotterdam
Weiss et al. AJRCM 2015
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Stoll BJ et al. JAMA 2004 Weiss SL et al Crit Care Med 2014
JAMA Pediatrics 2016
Vincent JL , PLoS Med 2016
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The inflammatory response Various possible courses of the immune response to severe sepsis and septic shock
Reinhart K. et al. 2012
The developing human preterm neonatal
immune system Sharma et al. Clin Immunol 2015
In this article we use the term ‘biomarker’in a very general sense to describe anymeasurable diagnostic indicator that is usedto assess the risk or presence of disease
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Biological marker (biomarker): A characteristicthat is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.
Lancet Infect Dis 2015
Infect Dis (London) 2015
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Potential Biomarkers and their sensitivity in Neonatal Sepsis Infections
Chauhan N et al. Microbial Path 2017
Ubiquitus Expression of the Calcitonin-I Gene in Multiple Tissues in response to Sepsis
Muller B et al. JCEM 2001
Procalcitonin as marker and therapeutic target ins sepsis
Becker KL et al. Br J Pharmacol 2010
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Dandona P et J Clin Endocrinol Metab 1994
Van Rossum et al. Lancet Infectious Dis 2004
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Lapillone A et al. Lancet 1998
Postnatal age-specifc percentile curve of serum PCT concentrations from birth to 12
weeks old in preterm infants
Fukuzumi N et al Sci Rep 2016
Healty Preterm infants
Confirmed SepsisSuspected sepsis
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J Perinatol 2005
Bouadma L et al. Lancet 2010
• Procalcitonin-guided decision making wassuperior to standard care in reducingantibiotic therapy in neonates withsuspected early-onset sepsis.
• Non-inferiority for re-infection or deathcould not be shown due to the lowoccurrence of re-infections and absence ofstudy-related death.
Stocker et al. Lancet 2017
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IL-6 42251 pg/mlCRP 139 mg/lPCT 18.06 ng/ml
CRP 6 mg/LPCT 11.47 ng/mlIL-6 13488 pg/ml
CRP 54 mg/lPCT 1.5 ng/mlIL-6 149pg/ml
Sepsis: a roadmap for future research
Lancet 2015
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Nature 2015
SepsisRiskFactors
SepsisImmune response
Neugebauer S et al. Crit Care Med. 2016
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Summary and Conclusion
• The use of PCT should be considered within the contextof the clinical workup and should take into account allpatient-and therapy related factors that may interferewith the initial magnitude and the course of thisparameter.
• Presently there is no single biomarker that fulfills all thecriteria’s for becoming an ideal biomarker in neonatalsepsis
• Combination of several biomarkers may be moreeffective than single biomarkers, but this requirefurther evaluation