Evolution and significance of circulating procalcitonin levels compared with IL-6, TNFα and endotoxin levels early after thermal injury

doi:10.1016/S0305-4179(96)00124-6

Burns

Volume 23, Issue 3, May 1997, Pages 218-224

https://doi.org/10.1016/S0305-4179(96)00124-6 Get rights and content

Abstract

To determine the evolution and significance of circulating procalcitonin (ProCT), IL-6, TNFα and endotoxin levels early after thermal injury, we performed a prospective, single unit, longitudinal study. Forty burn patients with total body surface area (TBSA) >30 per cent were studied, of whom 33 suffered an inhalation injury. Blood samples were taken on the day of admission, every 4 h during the first day and daily during the first week. All patients had increased ProCT and IL-6 levels without any proven infection. Endotoxin and TNFα levels remained very low or undetectable. ProCT and IL-6 levels correlated well with the severity of skin burn injury (respectively, p<0.006 and p<0.028, using the non-parametric Kruskal-Wallis test). ProCT levels are not associated with smoke inhalation. ProCT and IL6 are prognostic factors of mortality at the time of admission but less reliable than the clinical UBS (unit burn standard) score. Endotoxin and TNFα were undetectable, suggesting that the problem of the early gut bacterial translocation remains to be proven.

References (18)

M Assicot et al.
High serum procalcitonin concentrations in patients with sepsis and infection
Lancet
(1993)
THE Davis et al.
Serum procalcitonin concentrations in acute malaria
Trans R Soc Trop Med
(1994)
A Sachs et al.
Four years' experience at a specialized burn center
Lancet
(1969)
Y Guo et al.
Increased level of circulating interleukin 6 in burn patients
Clin Immunol Immunopathol
(1990)
S Endo et al.
Are plasma endotoxin levels related to burn size and prognosis
Burns
(1992)
JNWN Barker et al.
Keratinocytes as initiators of inflammation
Lancet
(1991)
P Dandona et al.
Procalcitonin increase following endotoxin injection in normal subjects
J Clin Endocrinol Metab
(1994)
WJ O'Neill et al.
Serum calcitonin may be a marker for inhalation injury in burns
J Burn Care Rehabil
(1992)
A Skolnick
Calcitonin assay may help identify burn patients at risk for respiratory distress
JAMA
(1990)

There are more references available in the full text version of this article.

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Reducing the overuse of antimicrobials is imperative for the sake of minimizing antimicrobial-associated adverse effects, optimizing resource utilization, and curtailing the rise in multidrug-resistant organisms. Biomarkers reflect the host responses to infection and may assist with minimizing unnecessary antimicrobial usage.
To review the literature pertaining to the performance of biomarkers specifically used to guide the duration of antimicrobial therapy (AMT).
Randomized controlled trials, observational studies, and meta-analyses assessing biomarker-guided approaches to AMT decision-making and their impact on the duration of therapy were reviewed.
Several randomized controlled trials and real-world observational studies have shown that a procalcitonin (PCT)-guided strategy can help clinicians individualize the duration of AMT, particularly among non–critically ill patients hospitalized with suspected respiratory tract infections when using a PCT cut-off value of <0.25 μg/L and critically ill patients with respiratory tract infections or undifferentiated sepsis when using a PCT cut-off value of <0.5 μg/L or ≥80% decline in the peak level. C-reactive protein is a non-specific marker of inflammation that may also assist with an early discontinuation of AMT; however, data are limited. Haematological biomarkers are prone to variance between individuals and are often influenced by medications and non-infectious conditions, making them less reliable for the purposes of AMT decision-making. Novel biomarkers such as multi-protein signatures and host gene expression tests have shown promise as tools to better differentiate between bacterial and non-bacterial infections; clinical studies are needed to determine whether they can be used to help optimize the duration of AMT.
Studies have demonstrated that a PCT-guided strategy, when utilized appropriately, can help guide clinicians to individualize and often reduce the duration of AMT, especially in patients hospitalized with respiratory tract infections and those admitted to the intensive care unit with suspected respiratory tract infections or sepsis. The impact of utilizing other biomarkers is less clear and requires further study.
Reply to: Why would procalcitonin perform better in patients with a SOFA-score less than 8?
2019, International Journal of Infectious Diseases
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Citation Excerpt :
This high rate of overruling may indicate that providers do not have sufficient confidence in the test to allow it to drive their decision-making or that the test is itself imperfect for differentiating bacterial and viral etiologies and is missing bacterial infections that are clinically identified. High false-positive rates for PCT have been observed for patients with major trauma, cardiopulmonary bypass surgery, liver cirrhosis with ascites, chronic kidney disease, colonic ischemia, acute-onset Still's disease, and heatstroke, as well as burn patients.28–35 These limitations further restrict the clinical application of PCT for a diagnosis of ARI, as these are common comorbidities, particularly in the ED and hospital environment, where the product label for PCT indicates it should be used.
The inappropriate use of antimicrobials, especially in acute respiratory infections (ARIs), is largely driven by difficulty distinguishing bacterial, viral, and noninfectious etiologies of illness. A new frontier in infectious disease diagnostics looks to the host response for disease classification. This article examines how host response–based diagnostics for ARIs are being used in clinical practice, as well as new developments in the research pipeline.
A limited search was conducted of the relevant literature, with emphasis placed on literature published in the last 5 years (2014–2019).
Advances are being made in all areas of host response–based diagnostics for ARIs. Specifically, there has been significant progress made in single protein biomarkers, as well as in various “omics” fields (including proteomics, metabolomics, and transcriptomics) and wearable technologies. There are many potential applications of a host response–based approach; a few key examples include the ability to discriminate bacterial and viral disease, presymptomatic diagnosis of infection, and pathogen-specific host response diagnostics, including modeling disease progression.
As biomarker measurement technologies continue to improve, host response–based diagnostics will increasingly be translated to clinically available platforms that can generate a holistic characterization of an individual's health. This knowledge, in the hands of both patient and provider, can improve care for the individual patient and help fight rising rates of antibiotic resistance.
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Burn injury is a severe form of trauma associated with pain, metabolic abnormalities, susceptibility to infections, muscle loss, mental and emotional distress. Conventional therapies as well as some recent approaches for the treatment of burned patients are currently in use. Nutritional therapy is also suggested as a supplementary option in major burns. Within this context, hormones involved in the regulation of appetite will have a paramount importance. The aim is to evaluate the interactions among ghrelin, some inflammatory parameters and the burn injury. Asprosin is also involved into this discussion due to its ghrelin-like actions.
Aside from the consideration of insulin as well as stress hormones (cortisol, epinephrine, norepinephrine), an orexigenic, anti-inflammatory hormone, ghrelin affecting both metabolic and inflammatory systems is also involved in the protocols designed for burn treatment. Ghrelin’s actions exerted by way of growth-hormone secretagogue receptor, neuropeptide Y, agouti-related protein, proopiomelanocortin and gamma amino butyric acid are being investigated. Asprosin, one of the remarkably few hormones identified as appetite stimulator, acts as another orexigenic hormone by using almost the same signalling pathways as those of ghrelin. Interleukin-6 should also be evaluated both as a reliable biomarker of inflammation and also with its inhibitory effects on TNF-α within the scope of burn injury.
In conclusion, treatment protocols during burn injury may be designed to raise decreased concentrations of ghrelin and to repress increased levels of inflammatory agents such as TNF-α. IL-6 may be evaluated from an entirely different aspect. The potential therapeutic use of asprosin may be considered within an integrative approach with a focus on cachexia-anorexia developed in severe burn trauma.
Age-related immune responses after burn and inhalation injury are associated with altered clinical outcomes
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This prospective study aimed to address changes in inflammatory response between different aged populations of patients who sustained burn and inhalation injury. Plasma and bronchoalveolar lavage (BAL) samples were collected from 104 patients within 15 h of their estimated time of burn injury. Clinical variables, laboratory parameters, and immune mediator profiles were examined in association with clinical outcomes. Older patients were at higher odds for death after burn injury (odds ratio (OR) = 7.37 per 10 years, p = 0.004). In plasma collected within 15 h after burn injury, significant increases in the concentrations of interleukin 1 receptor antagonist (IL-1RA), interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6), granulocyte colony-stimulating factor (G-CSF), interferon-gamma-induced protein 10 (IP-10) and monocyte chemoattractant protein 1 (MCP-1) (p < 0.05 for all) were observed in the ≥ 65 group. In the BAL fluid, MCP-1 was increased three-fold in the ≥ 65 group. This study suggests that changes in certain immune mediators were present in the older cohort, in association with in-hospital mortality.
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Scientific and clinical paperEvolution and significance of circulating procalcitonin levels compared with IL-6, TNFα and endotoxin levels early after thermal injury

Abstract

Lancet

Trans R Soc Trop Med

Lancet

Clin Immunol Immunopathol

Burns

Lancet

Procalcitonin increase following endotoxin injection in normal subjects

J Clin Endocrinol Metab

Serum calcitonin may be a marker for inhalation injury in burns

J Burn Care Rehabil

Calcitonin assay may help identify burn patients at risk for respiratory distress

JAMA

Scientific and clinical paper
Evolution and significance of circulating procalcitonin levels compared with IL-6, TNFα and endotoxin levels early after thermal injury