Skip to main content
SpringerLink
Log in

Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy

  • Original Paper
  • Published:
Urolithiasis Aims and scope Submit manuscript

Abstract

To evaluate the value of procalcitonin (PCT) as an early marker for diagnosis and differentiation of without urosepsis, urosepsis, severe urosepsis, and uroseptic shock following PCNL and the ability of PCT to assess the effectiveness of antibiotic therapy in patients with urosepsis. From June 2012 to August 2013, 267 patients undergoing PCNL for renal calculi, and who fulfilled selection criteria, were recruited into our study. The patients’ medical records were reviewed retrospectively. One of selection criteria was the scores of PCT and WBC were collected at operative day, postoperative day one, day two, day three, day five and day seven. The area under the ROC curve for the prediction of urosepsis was 0.960 for PCT and 0.634 for WBC. PCT concentrations were higher in patients with uroseptic shock versus severe urosepsis versus urosepsis versus without urosepsis following PCNL. WBC values showed no significant difference between patients with urosepsis, severe urosepsis and uroseptic shock following PCNL. With time, in patients with successfully treated urosepsis following PCNL, the PCT concentrations significantly declined and kept decreasing from postoperative day two to postoperative day seven and the WBC scores showed no significant change over the first postoperative 2 days and were decreased only after postoperative day three. PCT appears to be a useful early marker to diagnosis and discriminate urosepsis, severe urosepsis and uroseptic shock following PCNL. Daily PCT measurements may be a valuable tool in monitoring the effectiveness of antibiotic therapy in urosepsis following PCNL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Amer T, Ahmed K, Bultitude M, Khan S, Kumar P, De Rosa A, Khan MS, Hegarty N (2012) Standard versus tubeless percutaneous nephrolithotomy: a systematic review. Urol Int 88(4):373–382

    Article  PubMed  Google Scholar 

  2. Lingeman JE, Matlaga BR, Evan AP (2007) Surgical management of upper urinary calculi. In: Campbell-Walsh WAJ, Kavoussi LR, Novisk AC, Partin AW, Peters CA (eds) Campbell’s urology. Elsevier, Saunders, p 1500

  3. Charton M, Vallancien G, Veillon B, Brisset JM (1986) Urinary tract infection in percutaneous surgery for renal calculi. J Urol 135(1):15–17

    CAS  PubMed  Google Scholar 

  4. O’Keeffe NK, Mortimer AJ, Sambrook PA, Rao PN (1993) Severe sepsis following percutaneous or endoscopic procedures for urinary tract stones. Br J Urol 72(3):277–283

    Article  PubMed  Google Scholar 

  5. Rao PN, Dube DA, Weightman NC, Oppenheim BA, Morris J (1991) Prediction of septicemia following endourological manipulation for stones in the upper urinary tract. J Urol 146(4):955–960

    CAS  PubMed  Google Scholar 

  6. Bag S, Kumar S, Taneja N, Sharma V, Mandal AK, Singh SK (2011) One week of nitrofurantoin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study. Urology 77(1):45–49

    Article  PubMed  Google Scholar 

  7. Garnacho-Montero J, Ortiz-Leyba C, Herrera-Melero I, Aldabo-Pallas T, Cayuela-Dominguez A, Marquez-Vacaro JA, Carbajal-Guerrero J, Garcia-Garmendia JL (2008) Mortality and morbidity attributable to inadequate empirical antimicrobial therapy in patients admitted to the ICU with sepsis: a matched cohort study. J Antimicrob Chemother 61(2):436–441

    Article  CAS  PubMed  Google Scholar 

  8. Moyer MW (2012) New biomarkers sought for improving sepsis management and care. Nat Med 18(7):999

    Article  CAS  PubMed  Google Scholar 

  9. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. JAMA 273(2):117–123

    Article  CAS  PubMed  Google Scholar 

  10. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P (2013) Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 13(5):426–435

    Article  CAS  PubMed  Google Scholar 

  11. Schuetz P, Christ-Crain M, Thomann R, Falconnier C, Wolbers M, Widmer I, Neidert S, Fricker T, Blum C, Schild U, Regez K, Schoenenberger R, Henzen C, Bregenzer T, Hoess C, Krause M, Bucher HC, Zimmerli W, Mueller B (2009) Effect of procalcitonin-based guidelines versus standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 302(10):1059–1066

    Article  CAS  PubMed  Google Scholar 

  12. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, Schortgen F, Lasocki S, Veber B, Dehoux M, Bernard M, Pasquet B, Regnier B, Brun-Buisson C, Chastre J, Wolff M (2010) Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 375(9713):463–474

    Article  CAS  PubMed  Google Scholar 

  13. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 31(4):1250–1256

    Article  PubMed  Google Scholar 

  14. Brunkhorst FM, Wegscheider K, Forycki ZF, Brunkhorst R (2000) Procalcitonin for early diagnosis and differentiation of SIRS, sepsis, severe sepsis, and septic shock. Intensive Care Med 26(Suppl 2):S148–S152

    Article  PubMed  Google Scholar 

  15. Fioretto JR, Martin JG, Kurokawa CS, Carpi MF, Bonatto RC, de Moraes MA, Ricchetti SM (2010) Comparison between procalcitonin and C-reactive protein for early diagnosis of children with sepsis or septic shock. Inflamm Res 59(8):581–586

    Article  CAS  PubMed  Google Scholar 

  16. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J (1999) Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 3(1):45–50

    Article  PubMed Central  PubMed  Google Scholar 

  17. Ivancevic N, Radenkovic D, Bumbasirevic V, Karamarkovic A, Jeremic V, Kalezic N, Vodnik T, Beleslin B, Milic N, Gregoric P, Zarkovic M (2008) Procalcitonin in preoperative diagnosis of abdominal sepsis. Langenbecks Arch Surg 393(3):397–403

    Article  PubMed  Google Scholar 

  18. Geppert A, Steiner A, Delle-Karth G, Heinz G, Huber K (2003) Usefulness of procalcitonin for diagnosing complicating sepsis in patients with cardiogenic shock. Intensive Care Med 29(8):1384–1389

    Article  PubMed  Google Scholar 

  19. Guven H, Altintop L, Baydin A, Esen S, Aygun D, Hokelek M, Doganay Z, Bek Y (2002) Diagnostic value of procalcitonin levels as an early indicator of sepsis. Am J Emerg Med 20(3):202–206

    Article  PubMed  Google Scholar 

  20. Ruiz-Alvarez MJ, Garcia-Valdecasas S, De Pablo R, Sanchez Garcia M, Coca C, Groeneveld TW, Roos A, Daha MR, Arribas I (2009) Diagnostic efficacy and prognostic value of serum procalcitonin concentration in patients with suspected sepsis. J Intensive Care Med 24(1):63–71

    Article  CAS  PubMed  Google Scholar 

  21. Abdollahi A, Shoar S, Nayyeri F, Shariat M (2012) Diagnostic value of simultaneous measurement of procalcitonin, Interleukin-6 and hs-CRP in prediction of early-onset neonatal sepsis. Mediterr J Hematol Infect Dis 4(1):e2012028

    Article  PubMed Central  PubMed  Google Scholar 

  22. Heper Y, Akalin EH, Mistik R, Akgoz S, Tore O, Goral G, Oral B, Budak F, Helvaci S (2006) Evaluation of serum C-reactive protein, procalcitonin, tumor necrosis factor alpha, and interleukin-10 levels as diagnostic and prognostic parameters in patients with community-acquired sepsis, severe sepsis, and septic shock. Eur J Clin Microbiol Infect Dis 25(8):481–491

    Article  CAS  PubMed  Google Scholar 

  23. Aikawa N, Fujishima S, Endo S, Sekine I, Kogawa K, Yamamoto Y, Kushimoto S, Yukioka H, Kato N, Totsuka K, Kikuchi K, Ikeda T, Ikeda K, Harada K, Satomura S (2005) Multicenter prospective study of procalcitonin as an indicator of sepsis. J Infect Chemother 11(3):152–159

    Article  CAS  PubMed  Google Scholar 

  24. Lavrentieva A, Papadopoulou S, Kioumis J, Kaimakamis E, Bitzani M (2012) PCT as a diagnostic and prognostic tool in burn patients. Whether time course has a role in monitoring sepsis treatment. Burns 38(3):356–363

    Article  CAS  PubMed  Google Scholar 

  25. Riedel S, Melendez JH, An AT, Rosenbaum JE, Zenilman JM (2011) Procalcitonin as a marker for the detection of bacteremia and sepsis in the emergency department. Am J Clin Pathol 135(2):182–189

    Article  CAS  PubMed  Google Scholar 

  26. Vazzalwar R, Pina-Rodrigues E, Puppala BL, Angst DB, Schweig L (2005) Procalcitonin as a screening test for late-onset sepsis in preterm very low birth weight infants. J Perinatol 25(6):397–402

    Article  CAS  PubMed  Google Scholar 

  27. Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R (2006) Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol 72(1–2):69–80

    CAS  PubMed  Google Scholar 

  28. Balc IC, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B (2003) Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 7(1):85–90

    Article  Google Scholar 

  29. Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S, Olsson NO, Blettery B (2008) Serum procalcitonin elevation in critically ill patients at the onset of bacteremia caused by either Gram negative or Gram positive bacteria. BMC Infect Dis 8:38

    Article  PubMed Central  PubMed  Google Scholar 

  30. Chiesa C, Panero A, Rossi N, Stegagno M, De Giusti M, Osborn JF, Pacifico L (1998) Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates. Clin Infect Dis 26(3):664–672

    Article  CAS  PubMed  Google Scholar 

  31. Lapillonne A, Basson E, Monneret G, Bienvenu J, Salle BL (1998) Lack of specificity of procalcitonin for sepsis diagnosis in premature infants. Lancet 351(9110):1211–1212

    Article  CAS  PubMed  Google Scholar 

  32. Karlsson S, Heikkinen M, Pettila V, Alila S, Vaisanen S, Pulkki K, Kolho E, Ruokonen E (2010) Predictive value of procalcitonin decrease in patients with severe sepsis: a prospective observational study. Crit Care 14(6):R205

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgments

None.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard

Our retrospective study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Author information

Authors and Affiliations

  1. Urological Surgery Research Institute, Southwest Hospital, Third Military Medical University, Gao Tanyan Rd. 30, Chongqing, 400038, China

    Ji Zheng, Qianwei Li, Weihua Fu, Siji Song, Guoxian Deng, Jiwei Yao, Yongquan Wang, Weibing Li & Junan Yan

  2. Service Center for Nursing, Southwest Hospital, Third Military Medical University, Gao Tanyan Rd. 30, Chongqing, 400038, China

    Jing Ren

Authors
  1. Ji Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qianwei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Weihua Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jing Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Siji Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Guoxian Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jiwei Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yongquan Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Weibing Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Junan Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Weibing Li or Junan Yan.

Additional information

J. Zheng and Q. Li have been contributed equally to this manuscript

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zheng, J., Li, Q., Fu, W. et al. Procalcitonin as an early diagnostic and monitoring tool in urosepsis following percutaneous nephrolithotomy. Urolithiasis 43, 41–47 (2015). https://doi.org/10.1007/s00240-014-0716-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00240-014-0716-6

Keywords

Search

Navigation