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Procalcitonin-Early-Warning System

Irwin Reiss, MD PhD

Professor of Neonatology

Head, Division of Neonatology

Erasmus MC, Rotterdam

i.reiss@erasmusmc.nl

Weiss et al. AJRCM 2015

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Stoll BJ et al. JAMA 2004 Weiss SL et al Crit Care Med 2014

JAMA Pediatrics 2016

Vincent JL , PLoS Med 2016

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The inflammatory response Various possible courses of the immune response to severe sepsis and septic shock

Reinhart K. et al. 2012

The developing human preterm neonatal

immune system Sharma et al. Clin Immunol 2015

In this article we use the term ‘biomarker’in a very general sense to describe anymeasurable diagnostic indicator that is usedto assess the risk or presence of disease

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Biological marker (biomarker): A characteristicthat is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention.

Lancet Infect Dis 2015

Infect Dis (London) 2015

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Potential Biomarkers and their sensitivity in Neonatal Sepsis Infections

Chauhan N et al. Microbial Path 2017

Ubiquitus Expression of the Calcitonin-I Gene in Multiple Tissues in response to Sepsis

Muller B et al. JCEM 2001

Procalcitonin as marker and therapeutic target ins sepsis

Becker KL et al. Br J Pharmacol 2010

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Dandona P et J Clin Endocrinol Metab 1994

Van Rossum et al. Lancet Infectious Dis 2004

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Lapillone A et al. Lancet 1998

Postnatal age-specifc percentile curve of serum PCT concentrations from birth to 12

weeks old in preterm infants

Fukuzumi N et al Sci Rep 2016

Healty Preterm infants

Confirmed SepsisSuspected sepsis

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J Perinatol 2005

Bouadma L et al. Lancet 2010

• Procalcitonin-guided decision making wassuperior to standard care in reducingantibiotic therapy in neonates withsuspected early-onset sepsis.

• Non-inferiority for re-infection or deathcould not be shown due to the lowoccurrence of re-infections and absence ofstudy-related death.

Stocker et al. Lancet 2017

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IL-6 42251 pg/mlCRP 139 mg/lPCT 18.06 ng/ml

CRP 6 mg/LPCT 11.47 ng/mlIL-6 13488 pg/ml

CRP 54 mg/lPCT 1.5 ng/mlIL-6 149pg/ml

Sepsis: a roadmap for future research

Lancet 2015

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Nature 2015

SepsisRiskFactors

SepsisImmune response

Neugebauer S et al. Crit Care Med. 2016

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Summary and Conclusion

• The use of PCT should be considered within the contextof the clinical workup and should take into account allpatient-and therapy related factors that may interferewith the initial magnitude and the course of thisparameter.

• Presently there is no single biomarker that fulfills all thecriteria’s for becoming an ideal biomarker in neonatalsepsis

• Combination of several biomarkers may be moreeffective than single biomarkers, but this requirefurther evaluation