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Vol. 34. Núm. 3.Mayo 2014
Páginas 273-424
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Vol. 34. Núm. 3.Mayo 2014
Páginas 273-424
DOI: 10.3265/Nefrologia.pre2014.Mar.12313
Acceso a texto completo
La procalcitonina como indicador temprano de infección aguda en pacientes en hemodiálisis
Procalcitonin as an early predictor of acute infection in hemodialysis patients
Visitas
...
Borja Quirogaa, Maite Villaverdeb, Almudena Vegaa, Soraya Abada, Javier Requea, Juan M. López-Gómeza
a Servicio de Nefrología, Hospital Gregorio Marañón, Madrid, Madrid, España,
b Clínica Dialcentro, Madrid, Madrid, España,
Información del artículo

Antecedentes y objetivos: Los pacientes en hemodiálisis tienen un riesgo aumentado de padecer infecciones en comparación con sujetos no en diálisis. La procalcitonina se eleva en pacientes con infecciones bacterianas. Sin embargo, no ha sido estudiada en los pacientes en diálisis. El objetivo del presente estudio es evaluar la procalcitonina como predictor precoz de infecciones en los pacientes en hemodiálisis. Métodos: Se trata de un estudio de cohortes retrospectivo con 211 pacientes prevalentes en hemodiálisis (mediana de edad: 73 años [rango 60-80], 58 % varones) entre 2005-2012. Se extrajeron muestras prediálisis y se siguió a los pacientes durante 40 ± 25 meses (0-84). Se recogieron datos basales demográficos y de laboratorio, incluyendo marcadores inflamatorios. Durante el seguimiento se documentaron y analizaron las nuevas infecciones. Resultados: Durante el seguimiento, 112 pacientes (53 %) tuvieron una infección. Se estableció una correlación entre procalcitonina y proteína C reactiva (PCR) (σ = 0,482, p < 0,0001). El único marcador estudiado capaz de predecir infecciones al primer mes fue la procalcitonina (p = 0,023) en un modelo ajustado. La PCR fue el mejor predictor de infección durante el seguimiento global (p = 0,003), en un modelo ajustado. Conclusiones: La procalcitonina es un marcador de infección precoz (a 30 días) en los pacientes en hemodiálisis. Sin embargo, la PCR resultó ser el único marcador asociado con infecciones a largo plazo.

Palabras clave:
Procalcitonina
Palabras clave:
Pronóstico
Palabras clave:
Hemodiálisis
Palabras clave:
Infección
Palabras clave:
Proteína C reactiva

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.

Keywords:
Procalcitonin
Keywords:
Prognosis
Keywords:
Hemodialysis
Keywords:
Infection
Keywords:
C-reactive protein
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Bibliografía
[1]
Kato S, Lindholm B, Stenvinkel P, Ekström TJ, Luttropp K, Yuzawa Y, et al. DNA hypermethylation and inflammatory markers in incident Japanese dialysis patients. Nephron Extra 2012;2(1):159-68. [Pubmed]
[2]
Quiroga B, Marin C, Goicoechea M, Reque J, Luño J. Inflammatory Biomarkers in Chronic Kidney Disease: A Review. Recent patents on biomarkers 2012;2(2):131-8.
[3]
Stenvinkel P, Pecoits-Filho R, Lindholm B. Coronary artery disease in end-stage renal disease: no longer a simple plumbing problem. J Am Soc Nephrol 2003;14(7):1927-39. [Pubmed]
[4]
Henderson IS, Koch KM, Dinarello CA, Shaldon S. Hemodialysis hypotension: The interleukin hypothesis. Blood Purif 1983;1:3-8.
[5]
Iliou MC, Fumeron C, Benoit MO, Tuppin P, Calonge VM, Moatti N, et al. Prognostic value of cardiac markers in ESRD: Chronic Hemodialysis and New Cardiac Markers Evaluation (CHANCE) study. Am J Kidney Dis 2003;42(3):513-23. [Pubmed]
[6]
Goicoechea M, Quiroga B, García de Vinuesa S, Verdalles U, Reque J, Panizo N, et al. Intraindividual interleukin-6 variations on the cardiovascular prognosis of patients with chronic renal disease. Ren Fail 2012;34(8):1002-9. [Pubmed]
[7]
Williams VR, Quinn R, Callery S, Kiss A, Oliver MJ. The impact of treatment modality on infection-related hospitalization rates in peritoneal dialysis and hemodialysis patients. Perit Dial Int 2011;31(4):440-9. [Pubmed]
[8]
Carrero JJ, Stenvinkel P. Inflammation in end-stage renal disease --what have we learned in 10 years? Semin Dial 2010;23(5):498-509. [Pubmed]
[9]
Rosenberger EL, Goff DC Jr, Davis CC, Blackwell CS, Bertoni AG. Control of blood pressure in North Carolina primary care: baseline data from the GLAD Heart Trial. N C Med J 2008;69(6):441-6. [Pubmed]
[10]
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National High Blood Pressure Education Program. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2004.
[11]
Klein Klouwenberg PM, Ong DS, Bonten MJ, Cremer OL. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Intensive Care Med 2012;38(5):811-9. [Pubmed]
[12]
Memoli B, Minutolo R, Bisesti V, Postiglione L, Conti A, Marzano L, et al. Changes of serum albumin and C-reactive protein are related to changes of interleukin-6 release by peripheral blood mononuclear cells in hemodialysis patients treated with different membranes. Am J Kidney Dis 2002;39(2):266-73. [Pubmed]
[13]
Stenvinkel P, Diczfalusy U, Lindholm B, Heimbuürger O. Phospholipid plasmalogen, a surrogate marker of oxidative stress, is associated with increased cardiovascular mortality in patients on renal replacement therapy. Nephrol Dial Transplant 2004;19(4):972-6. [Pubmed]
[14]
Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 2004;39(2):206-17. [Pubmed]
[15]
Herget-Rosenthal S, Marggraf G, Pietruck F, Hüsing J, Strupat M, Philipp T, et al. Procalcitonin for accurate detection of infection in haemodialysis. Nephrol Dial Transplant 2001;16(5):975-9. [Pubmed]
[16]
Lu XL, Xiao ZH, Yang MY, Zhu YM. Diagnostic value of serum procalcitonin in patients with chronic renal insufficiency: a systematic review and meta-analysis. Nephrol Dial Transplant 2013;28(1):122-9. [Pubmed]
[17]
Goldstein SL, Ikizler TA, Zappitelli M, Silverstein DM, Ayus JC. Non-infected hemodialysis catheters are associated with increased inflammation compared to arteriovenous fistulas. Kidney Int 2009;76(10):1063-9. [Pubmed]
[18]
Colì L, Donati G, Cappuccilli ML, Cianciolo G, Comai G, Cuna V, et al. Role of the hemodialysis vascular access type in inflammation status and monocyte activation. Int J Artif Organs 2011;34(6):481-8. [Pubmed]
[19]
Beddhu S, Kaysen GA, Yan G, Sarnak M, Agodoa L, Ornt D, et al. Association of serum albumin and atherosclerosis in chronic hemodialysis patients. Am J Kidney Dis 2002;40(4):721-7. [Pubmed]
[20]
Malatino LS, Benedetto FA, Mallamaci F, Tripepi G, Zoccali C, Parlongo S, et al. Smoking, blood pressure and serum albumin are major determinants of carotid atherosclerosis in dialysis patients. CREED Investigators. Cardiovascular Risk Extended Evaluation in Dialysis patients. J Nephrol 1999;12(4):256-60.
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