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Procalcitonin (PRCAL)

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EPIC Test Name

PROCALCITONIN

EPIC Code

LAB7082

Specimen Requirements

plasma
Minimum Volume:0.5 mL
Collection:Collect using standard laboratory procedures
Transport:Room Temperature ASAP
Stability:Room Temperature: 8 hours at 20-25 degrees C
Refrigerated: 24 hours at 2-8 degrees C
Frozen: 18 months at -20 degrees C
Container:LIT GRN
Processing/Storage:Centrifuge, pour off, and freeze plasma.
Rejection Causes:Hemolysis,
Insufficient Sample Volume

Methods

Chemiluminescent microparticle immunoassay

Turnaround Time

SpecimenTurnaround TimeFrequency
plasmaRoutine: 4 hours24/7

Reference Ranges

Chemiluminescent microparticle immunoassay
All RangeUnit
<0.10 ng/mLng/mL

Clinical Indications

Procalcitonin (ProCT, 116 aa) is the precursor of calcitonin, encoded by the CALC1 gene and secreted by the thyroid C cells and other neuroendocrine cells in the lung and bowel. Calcitonin involves in calcium homeostasis and its release is stimulated in response to increased calcium concentration in the circulation, e.g., in hypercalcemia. Calcitonin inhibits bone resorption by osteoclasts. Whereas, ProCT is mainly used, alone or in association with CRP and alpha 2-macroglobulin (A2M), in two areas: 1) as an early marker of sepsis (differentiating bacterial and non bacterial etiologies) and as a indicator in guiding the management of antibiotic therapy. ProCT shows particularly more sensitive to bacterial toxins than white blood cells (WBC) and CRP. In severe systemic inflammation, particularly bacterial infections, ProCT can increase by a magnitude of a thousand-fold. ProCT’s elevation level often correlates with the severity of disease, chances of developing to multi-organ dysfunction and with mortality.
Studies showed in trauma patients, ProCT reached the peak level on day 1 after trauma and declined immediately towards reference interval; however, in patients with subsequent developed sepsis, ProCT peak values were significantly higher than without sepsis. Initial ProCT levels were also significantly in patients who subsequently developed multi-organ dysfunction (MOD) than those without MOD. Other non-infectious systemic inflammatory response syndrome (SIRS) conditions causing ProCT elevations may include cardiac surgery and severe burns. Patients with burns >15−20% of total body area surface may have a SIRS that lasts for months after the wound is closed. To improve clinical criteria for sepsis detection in burned patients, American Burn Association suggested the modification of some cut-offs of the SIRS parameters and the concomitant documentation of infection (J Burn Care Res 2007;28:776-90).
ProCT increases occur more sooner than increases in CRP. ProCT Can be detectable in 2 - 4 hours upon occurrence of inflammatory event and peaks by 12 to 24 hours. ProCT secretion declines with resolution of illness. In the absence of an ongoing inflammatory stimulus, ProCT is eliminated with a half-life of 24 to 35 hours, therefore suitable for serial monitoring. Calcitonin concentration has not significant changes as occur to ProCT, likely due to that ProCT is more thermal stable and its half-life of approximately 24 h, unlike Calcitonin’s biphasic pattern.
When ProCT levels are below the cut-off or threshold values as defined for septic processes, it may suggest to discontinue antibiotic treatment, to avoid unnecessary therapy or antibiotic side effects.
ProCT was more reliable than CRP in diagnosing severe sepsis without shock, but it was not useful for diagnosing septic shock for cardiac surgery patients.

Additional Information

• Severe trauma, major burns, multiorgan failure, or major surgery can cause procalcitonin (ProCT) elevations in the absence of sepsis. After removal of the noxious stimulus, ProCT should start to decrease.
• Patients with untreated end-stage renal failure may have elevated ProCT levels in the absence of infection or severe inflammation, and should decrease to reference range level within 3 hemodialysis treatments. End-stage renal failure patients on stable hemodialysis or peritoneal dialysis treatments may have ProCT levels similar to healthy adults.
• Patients with medullary thyroid carcinoma or, very rarely, islet cell tumors may have significant elevations in ProCT in the absence of sepsis.
• Some infants and children may have slightly elevated ProCT levels for unknown reasons.

Performed

Lab
Chemistry - Downtown

Interpretative Information

• ProCT levels should always be interpreted in the clinical context of the patient. Therefore, clinicians should use the PCT results in conjunction with other laboratory findings and clinical signs of the patient.
• A ProCT level above the cut-off vale on the first day of ICU admission is associated with a high risk for progression to severe sepsis and/or septic shock.
• ProCT levels above the cut-off value highly suggests systemic bacterial infection/sepsis or severe localized bacterial infection, e.g., severe pneumonia, meningitis, or peritonitis.
• Elevated ProCT can also occur to patients with severe noninfectious SIRS, e.g., burns, severe trauma, acute multi-organ failure, or major abdominal or cardiothoracic surgery; in such cases, ProCT levels shall fall after 24 to 48 hours.
• If the ProCT measurement is done very early after the systemic infection process has started (usually < 6 hours), these ProCT values may still be low.
• For patients having low ProCT values but with or suspected to have non-infectious SIRS, a separate sample within following 6-24 hours for retesting ProCT is recommended.
• ProCT level declines ≤ 80% from the day that severe sepsis or septic shock was clinically diagnosed (Day 0) to the 4th day is associated with higher cumulative 28-day risk of all-cause mortality than a decline > 80%.
• For neonates patients, it needs to consideration that ProCT values increase from birth to peak in about the first 24 hours of life and decrease gradually in the next 48 hours, suggesting to apply a different cut off values from adult or after the first 72 hours of birth.
• With successful antibiotic therapy, ProCT levels should fall with a half-life to 24 to 35 hours.

CPT

84145

LOINC

33959-8

References

1. Schneider HG, Lam QT: Procalcitonin for the clinical laboratory: a review. Pathology 2007;39: 383-90.
2. Maruna P, Nedelníková K, Gürlich R: Physiology and genetics of procalcitonin. Physiol Res 2000;49:S57-61.
3. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341:515-8.
4. Muller B, Becker KL, Schachinger H, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977-83.
5. Whang KT, Steinwald PM, White JC, et al. Serum calcitonin precursors in sepsis and systemic inflammation. J Clin Endocrinol Metab. 1998;83:3296-301.
6. Sakran JV, Michetti CP, Sheridan MJ, et al. The utility of procalcitonin in critically ill trauma patients. J Trauma Acute Care Surg 2012;73:413-8.
7. Balci C, Sivaci R, Akbulut G, et al. Procalcitonin levels as early marker in patients with multiple trauma under intensive care. J Int Med Res 2009;37:1709-17.
8. Greenhalgh DG. Sepsis in the burn patient: a different problem than sepsis in the general population. Burns Trauma 2017;5:23.
9. Zhao D, Zhou J, Haraguchi G, Arai H, Mitaka C. Procalcitonin for the differential diagnosis of infectious and non-infectious systemic inflammatory response syndrome after cardiac surgery. J Intensive Care. 2014;2:35. doi: 10.1186/2052-0492-2-35. PMID: 25960877; PMCID: PMC4424708.
10. Greenhalgh DG, Saffle JR, Holmes JH, et al. American Burn Association consensus conference to define sepsis and infection in burns. J Burn Care Res 2007;28:776-90.
11. Karagiannis AK, Girio-Fragkoulakis C, Nakouti T. Procalcitonin: A New Biomarker for Medullary Thyroid Cancer? A Systematic Review. Anticancer Res. 2016;36:3803-10. PMID: 27466480.
12. Chiesa C, Panero A, Rossi N, et al: Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 1998;26:664-72. https://doi.org/10.1086/514576
13. Chiesa C, Natale F, Pascone R, et al: C reactive protein and procalcitonin: Reference intervals for preterm and term newborns during the early neonatal period. Clin Chim Acta 2011;412:1053-9. https://doi.org/10.1016/j.cca.2011.02.020
14. Sitter T, Schmidt M, Schneider S, Schiffle H: Differential diagnosis of bacterial infection and inflammatory response in kidney disease using procalcitonin. J Nephrol 2002;15:297-301. PMID: 12113602
15. Becker KL, Nylén ES, White JC, Müller B, Snider RH, Jr., Procalcitonin and the Calcitonin Gene Family of Peptides in Inflammation, Infection, and Sepsis: A Journey from Calcitonin Back to Its Precursors. J Clin Endocrinol Metab 2004;89:1512-25. https://doi.org/10.1210/jc.2002-021444
16. Van Rossum AMC, Wulkan RW, Oudesluys-Murphy AM: Procalcitonin as an early marker of infection in neonates and children. Lancet Infect Dis 2004;4:620-30. https://doi.org/10.1016/S1473-3099(04)01146-6
17. Uzzan B, Cohen R, Nicolas P, et al: Procalcitonin as a diagnostic test for sepsis in critically ill adults and after surgery or trauma: a systematic review and meta-analysis. Crit Care Med 2006;34(7):1996-2003

Contact Information

Chemistry - Downtown: (315)464-4460
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