Vol.:(0123456789) 1 3 Int Urol Nephrol DOI 10.1007/s11255-017-1710-z NEPHROLOGY - ORIGINAL PAPER Predictive value of procalcitonin for diagnosis of infections in patients with chronic kidney disease: a comparison with traditional infammatory markers C‑reactive protein, white blood cell count, and neutrophil percentage Yanbei Sun 1  · Lijuan Jiang 2  · Xiaonan Shao 3   Received: 19 July 2017 / Accepted: 22 September 2017 © Springer Science+Business Media B.V. 2017 and 0.780, respectively, and only PCT and N% could predict sepsis with AUC of 0.823 and 0.683, respectively. Conclusions The baseline PCT level of CKD patients is negatively correlated with renal function. In both CKD1–4 and CKD5 patients, the predictive value of PCT for local infection is not as good as that of CRP, while it has a signif- cant advantage in predicting sepsis. Keywords Chronic kidney disease · Procalcitonin · Diferential diagnosis · Infection · Sepsis Introduction CKD is the major risk factor for end-stage renal disease (ESRD), cardiovascular diseases, and premature death. The global prevalence of CKD in adults exceeded 10% in 2015. CKD has become a serious challenge for global health, espe- cially in low- and middle-income countries [1]. Due to func- tional decline of immune system [2], CKD patients are at a higher risk of serious infection [3]. On the other hand, severe infection and sepsis, along with multiple organ dysfunction or failure, are also the important causes of elevated morbid- ity and mortality in patients with CKD at all stages [4, 5]. Because of the chronic elevation of common infamma- tory markers and non-specifcity of clinical manifestations of CKD patients, it is difcult to clinically distinguish infec- tious and non-infectious causes of systemic infammatory responses [6]. Since 1993, PCT has been widely used in the diagnosis and treatment of infectious diseases [7]. Recent studies have found that elevated level of serum PCT can be observed in both infected and uninfected CKD patients, including patients on dialysis, patients not yet on dialysis, and patients on maintenance renal replacement therapy (RRT) [8–12]. Abstract Purpose To investigate the predictive value of procalci- tonin (PCT) in patients with stage 1–4 and stage 5 chronic kidney disease (CKD). Methods Five hundred and forty-one CKD inpatients were retrospectively analyzed and divided into CKD stage 1–4 (CKD1–4) and CKD stage 5 (CKD5) groups. Each group was further divided into non-infection, local infection, and sepsis subgroups. The clinical characteristics and infam- matory indexes of each subgroup including PCT, C-reactive protein (CRP), white blood cell count (WBC), and neu- trophil percentage (N%) were compared, and the receiver operating characteristic curves to predict local infection and sepsis were plotted. Results Our research showed that the incidence and sever- ity of infection in CKD5 group were signifcantly higher than those of CKD1–4 group; the baseline PCT level in CKD patients increased as renal function decreased and strongly correlated with CKD staging (r = 0.749); for CKD1–4 group, PCT, WBC, and N% could predict sepsis with the area under the curve (AUC) of 0.956, 0.854, and 0.917, respectively, but only CRP could predict local infec- tion with AUC of 0.729, and for CKD5 group, only PCT and CRP could predict local infection with AUC of 0.715 Yanbei Sun and Lijuan Jiang are co-frst authors. * Xiaonan Shao scorey@sina.com 1 Department of Nephrology, Third Afliated Hospital of Soochow University, Changzhou 213003, China 2 Department of Clinical Laboratory, Third Afliated Hospital of Soochow University, Changzhou 213003, China 3 Department of Nuclear Medicine, Third Afliated Hospital of Soochow University, Changzhou 213003, China