Procalcitonin as an early predictor of acute infection in hemodialysis patients.

Borja Quiroga, Maite Villaverde, Almudena Vega, Soraya Abad, Javier Reque, Juan M López-Gómez

Background and aims: Hemodialysis patients have a greater risk of infection than individuals not on dialysis. Procalcitonin has been shown to rise in bacterial from but widely studied in hemodialysis patients. The present study evaluates procalcitonin as an early predictor of infection in this population. Methods: A historical cohorts study was made of 211 prevalent hemodialysis patients (median age 73 years [range 60-80], 58% males) covering the period 2005-2012. Serum samples were thawed and patients were followed-up on for 40±25 months (0-84). Demographic and laboratory test (including inflammatory values) data were recorded at baseline. During follow-up, all infections were documented and analyzed. Results: During follow-up, 112 patients (53.3%) suffered acute infection. A positive correlation was established for procalcitonin and C-reactive protein (σ=0.482, p<0.0001). Procalcitonin was the only inflammatory marker capable of predicting infection at one month (p=0.023) in a model with all the studied inflammatory markers. C-reactive protein was the best predictor of infection over global follow-up (p=0.003), after adjusting for all the studied factors. Conclusions: Procalcitonin is an early predictor of infection in the first 30 days in hemodialysis patients. However, in relation to the long-term prognosis, C-reactive protein is the most important independent predictor of infection.