Sammons Chelsea, Doligalski Christina T
Tampa General Hospital, Tampa, FL, USA.
Ann Pharmacother. 2014 Jan;48(1):116-22. doi: 10.1177/1060028013508085. Epub 2013 Oct 17.
To evaluate the utility of procalcitonin (PCT) as a biomarker for rejection and differentiation of infectious complications in lung transplant recipients.
An English-language literature search was conducted using MEDLINE (1966-September 2013) using the terms procalcitonin, transplantation, and lung transplantation. Additional articles were identified through a manual search of reference lists of the articles obtained.
All articles evaluating PCT use in lung transplant recipients, including those where lung transplant patients were a subgroup of immunocompromised patients, were included.
Infection and rejection are leading causes of mortality in lung transplant recipients, with similar clinical presentations; PCT could be a valuable biomarker to differentiate between these complications. Five prospective and 2 retrospective single-center observational evaluations were reviewed. Study populations were diverse, with only 3 focused solely on lung transplant recipients. PCT levels were not elevated during episodes of rejection and viral infections, whereas elevations were seen with bacterial infections. The effect of colonization or fungal infection on PCT varied.
Current data suggest that PCT can be used to differentiate bacterial infections from rejection in lung transplant recipients, with unclear utility in colonization or fungal infection. It is reasonable to conclude that PCT values more than 8.18 ng/mL and PCT area under receiver operating curve greater than 0.97 indicate bacterial infection in this population, and PCT trends may increase predictive value. Because of the lack of randomized controlled trials, PCT should only be utilized in conjunction with standard tests for infection and rejection diagnosis.
评估降钙素原（PCT）作为肺移植受者排斥反应及感染并发症鉴别生物标志物的效用。
使用MEDLINE（1966年至2013年9月）以降钙素原、移植和肺移植为检索词进行英文文献检索。通过手工检索所获文章的参考文献列表确定其他文章。
纳入所有评估PCT在肺移植受者中应用的文章，包括肺移植患者作为免疫受损患者亚组的那些文章。
感染和排斥是肺移植受者死亡的主要原因，临床表现相似；PCT可能是区分这些并发症的有价值生物标志物。回顾了五项前瞻性和两项回顾性单中心观察性评估。研究人群多样，仅有三项研究仅聚焦于肺移植受者。排斥反应和病毒感染发作期间PCT水平未升高，而细菌感染时可见升高。定植或真菌感染对PCT的影响各异。
当前数据表明，PCT可用于区分肺移植受者的细菌感染与排斥反应，在定植或真菌感染方面效用不明确。可以合理得出结论，PCT值超过8.18 ng/mL且受试者工作特征曲线下面积大于0.97表明该人群存在细菌感染，PCT趋势可能会增加预测价值。由于缺乏随机对照试验，PCT仅应与感染和排斥反应诊断的标准检测结合使用。
