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 Table of Contents  
LETTER TO THE EDITOR
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 22

Procalcitonin to Facilitate Early Detection of Co-Infection during Flu in Critically Ill Immunosuppressed Patients: We Are Not Sure


Department of ICU, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium

Date of Submission01-Jul-2020
Date of Acceptance20-Aug-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Dr. Patrick M Honore
Department of ICU, Centre Hospitalier Universitaire Brugmann-Brugmann University Hospital, Place Van Gehuchtenplein, 41020 Brussels
Belgium
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DOI: 10.4103/jtccm.jtccm_8_20

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How to cite this article:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. Procalcitonin to Facilitate Early Detection of Co-Infection during Flu in Critically Ill Immunosuppressed Patients: We Are Not Sure. J Transl Crit Care Med 2020;2:22

How to cite this URL:
Honore PM, Mugisha A, Kugener L, Redant S, Attou R, Gallerani A, Bels DD. Procalcitonin to Facilitate Early Detection of Co-Infection during Flu in Critically Ill Immunosuppressed Patients: We Are Not Sure. J Transl Crit Care Med [serial online] 2020 [cited 2021 Dec 2];2:22. Available from: http://www.tccmjournal.com/text.asp?2020/2/1/22/305787



Dear Editor,

We read with great interest the recent article by Martin-Loeches et al. who note in their discussion that a low level of procalcitonin (PCT) has been found to have a high negative predictive value (94%) for co-infection in patients with influenza.[1],[2] Although the authors have to be congratulated for their study, we would like to make some comments. In their prospective cohort, renal replacement therapy (RRT) was used, respectively, in 15%, 17%, 17%, and 29% in the four cohorts.[1] Hence, the use of RRT was not negligible. PCT has an approximate molecular weight of 14.5 kDa.[3] The contemporary continuous RRT (CRRT) membranes can remove molecules as large as 35 kDa.[4] Hence, most of the PCT mass will be eliminated by convective flow,[4] but adsorption also contributes to the elimination if new highly adsorptive membranes are used.[5] Accordingly, an imbalance between the use of RRT in the four cohorts may have an important impact upon the values of PCT in each cohort.[1] PCT levels may therefore be affected not only by the onset of a new infection but also by the incidence of RRT. In conclusion, we believe that there is a critical need for a future study with a focus on the performance of the currently known biomarkers among patients receiving CRRT.[5] However, we agree with the authors that clinicians may not be willing to tolerate even a low probability of untreated pulmonary co-infection in light of their observation that this category was associated with higher intensive care unit mortality.[1]

Author's contributions

PMH, SR, and DDB designed the article. All authors participated in drafting and reviewing. All authors read and approved the final version of the manuscript.

Acknowledgments

We would like to thank Dr. Melissa Jackson for critical review of the manuscript.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martin-Loeches I, Lemiale V, Geoghegan P, McMahon MA, Pickkers P, Soares M, et al. Influenza and associated co-infections in critically ill immunosuppressed patients. Crit Care 2019;23:152.  Back to cited text no. 1
    
2.
Rodríguez AH, Avilés-Jurado FX, Díaz E, Schuetz P, Trefler SI, Solé-Violán J, et al. Procalcitonin (PCT) levels for ruling-out bacterial coinfection in ICU patients with influenza: A CHAID decision-tree analysis. J Infect 2016;72:143-51.  Back to cited text no. 2
    
3.
Level C, Chauveau P, Guisset O, Cazin MC, Lasseur C, Gabinsky C, et al. Mass transfer, clearance and plasma concentration of procalcitonin during continuous venovenous hemofiltration in patients with septic shock and acute oliguric renal failure. Crit Care 2003;7:R160-6.  Back to cited text no. 3
    
4.
Honoré PM, De Bels D, Spapen HD. An update on membranes and cartridges for extracorporeal blood purification in sepsis and septic shock. Curr Opin Crit Care 2018;24:463-8.  Back to cited text no. 4
    
5.
Honoré PM, Jacobs R, De Waele E, Van Gorp V, Spapen HD. Evaluating sepsis during continuous dialysis: Are biomarkers still valid? Blood Purif 2014;38:104-5.  Back to cited text no. 5
    




 

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