Brodska Helena, Drabek Tomas, Malickova Karin, Kazda Antonin, Vitek Antonin, Zima Tomas, Markova Marketa
Institute of Clinical Biochemistry and Laboratory Diagnostics, General Teaching Hospital, U nemocnice 2, CZ-128 08 Prague 2, Czech Republic.
Crit Care. 2009;13(2):R37. doi: 10.1186/cc7749. Epub 2009 Mar 16.
Procalcitonin (PCT) and C-reactive protein (CRP) are established markers of infection in the general population. In contrast, several studies reported falsely increased PCT levels in patients receiving T-cell antibodies. We evaluated the validity of these markers in patients scheduled for hemopoietic stem cell transplantation receiving anti-thymocyte globulin (ATG) during conditioning. We also assessed renal and liver functions and their relationship to PCT and CRP changes.
Twenty-six patients without clinical signs of infection were prospectively studied. ATG was administered in up to three doses over the course of 5 days. PCT, CRP, white blood cell (WBC) count, urea, creatinine, glomerular filtration rate, bilirubin, alanin amino-transferase (ALT), and gamma-glutamyl transferase (GGT) were assessed daily during ATG administration. Pharyngeal, nose, and rectal swabs and urine samples were cultured twice weekly. Blood cultures were obtained if clinical symptoms of infection were present.
Baseline (BL) levels of both PCT and CRP before ATG administration were normal. WBC count decreased after ATG administration (P = 0.005). One day after ATG administration, both PCT and CRP levels increased significantly, returning to BL levels on day 4. Microbiological results were clinically unremarkable. There was no interrelationship between PCT levels and BL markers of renal or liver functions (P > 0.05 for all comparisons). Bilirubin and GGT were increased on days 2 to 5 and ALT was increased on day 3 (P < 0.05 versus BL). No difference in renal functions was observed. Three patients developed bacterial infection on days 7 to 11 with different dynamics of PCT and CRP. There was no association between the number of ATG doses and PCT levels or between the risk of developing infection and previous PCT levels.
ATG triggered a marked early surge in PCT and CRP followed by a steady decrease over the course of 3 days. The dynamics of both PCT and CRP were similar and were not associated with infection. PCT levels were independent of renal and liver functions and were not predictive of further infectious complications. A direct effect of ATG on T lymphocytes could be the underlying mechanism. Hepatotoxic effect could be a contributing factor. Neither PCT nor CRP is a useful marker that can identify infection in patients receiving ATG.
降钙素原（PCT）和C反应蛋白（CRP）是普通人群中已确立的感染标志物。相比之下，多项研究报告接受T细胞抗体治疗的患者PCT水平会出现假性升高。我们评估了这些标志物在接受造血干细胞移植并在预处理期间接受抗胸腺细胞球蛋白（ATG）治疗的患者中的有效性。我们还评估了肾功能和肝功能及其与PCT和CRP变化的关系。
对26例无感染临床症状的患者进行前瞻性研究。在5天的疗程中，ATG最多分三次给药。在给予ATG期间，每天评估PCT、CRP、白细胞（WBC）计数、尿素、肌酐、肾小球滤过率、胆红素、丙氨酸转氨酶（ALT）和γ-谷氨酰转移酶（GGT）。每周两次对咽、鼻和直肠拭子以及尿液样本进行培养。如果出现感染的临床症状，则进行血培养。
给予ATG前PCT和CRP的基线（BL）水平均正常。给予ATG后白细胞计数下降（P = 0.005）。给予ATG后1天，PCT和CRP水平均显著升高，在第4天恢复到BL水平。微生物学结果在临床上无明显异常。PCT水平与肾功能或肝功能的BL标志物之间无相互关系（所有比较P>0.05）。胆红素和GGT在第2至5天升高，ALT在第3天升高（与BL相比P<0.05）。未观察到肾功能有差异。3例患者在第7至11天发生细菌感染，PCT和CRP的动态变化不同。ATG剂量数与PCT水平之间或发生感染的风险与先前的PCT水平之间均无关联。
ATG引发PCT和CRP早期明显升高，随后在3天内稳步下降。PCT和CRP的动态变化相似且与感染无关。PCT水平与肾功能和肝功能无关，也不能预测进一步的感染并发症。ATG对T淋巴细胞的直接作用可能是潜在机制。肝毒性作用可能是一个促成因素。PCT和CRP均不是可用于识别接受ATG治疗患者感染情况的有用标志物。
