SaO048PROCALCITONIN IN END-STAGE KIDNEY DISEASE: DEFINING EXPECTED RANGES
Bibliographic record
Abstract
INTRODUCTION AND AIMS: Procalcitonin (PCT) has been shown, particularly in the context of sepsis and respiratory diseases and the settings of intensive care and emergency department units, to be a powerful biomarker for diagnosis and management of infectious diseases in the general population. At normally undetectable levels (i.e. < 0.1 ng/ml), a PCT elevation greater than 0.5 ng/ml is then very suggestive of bacterial infection and its lowering is associated with treatment response. Renal failure (RF) is however known to affect PCT levels. Various higher PCT threshold levels have been proposed to make adjustments to published PCT guided care algorithms in RF patients, although these are supported by weak evidence. METHODS: To enhance understanding of RF’s effect on PCT levels and to explore PCT’s effectiveness as a biomarker in RF population, we have been conducting a single centre prospective blinded cohort study in prevalent end-stage kidney disease (ESRD) patients on hemodialysis (HD), in stable and unstable condition, with repeated PCT sampling over three months and followed up to one year since March 2016. Data used in this initial cross-sectional analysis are from the baseline assessment of all stable patients recruited thus far. RESULTS: 132 (83 men (67%), 49 women (37%)) patients with a mean age of 68 years (range 19-93) and a 45-month ESRD vintage (range 1-223) were included. Of these, 72 (55%) had diabetes mellitus (Db) and 85 (64%) had some form of cardiovascular disease (CVD). Their mean body mass index (BMI) was 29 kg/m2 (range 16.6 - 52.7). They received, on average, 12 hours of HD weekly (range 8 - 16) with a mean Kt/V of 1.54 (range 0.1 - 2.67). Their mean baseline PCT level was 0.47 ng/ml (< 0.1 - 3.44) with an asymmetric distribution skewed to the right (median 0.3 ng/ml, mode < 0.1 ng/ml). Univariate analyses revealed PCT to be statistically positively correlated with ESRD vintage, BMI, HD weekly duration, albuminemia, alkaline phosphatase, calcitonin, c-reactive protein (CRP), creatinine, leukocytes count, urea (pre-HD) and negatively correlated with age. No correlation was found with gender, Db, CVD, Kt/V, calcemia, phosphatemia, PTH, hemoglobin or ferritin levels. In a multivariate model, only ESRD vintage, HD weekly duration, albuminemia, alkaline phosphatase, CRP and creatinine correlations remained statistically significant. CONCLUSIONS: These results corroborate that RF affects PCT levels widely, most likely due to a priming effect related to ESRD-HD inflammatory and mineral and bone metabolism disorders rather than a decrease in PCT clearance. They support the need to use a higher PCT level threshold in ESRD(HD) patients, though PCT’s effectiveness as a biomarker in this population and critical threshold levels cannot yet be specified from these findings. Future results of this on-going cohort study will seek to determine, in even greater confidence, expected PCT level ranges of stable and unstable ESRD(HD) patients and their determining factors.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".