Stellenwert des Procalcitonins als Sepsismarker

Zusammenfassung

Bei einer Sepsis sind eine adäquate Diagnostik und Therapie von wesentlicher prognostischer Bedeutung. Neben der Blutkulturanalyse werden u. a. Biomarker wie das Procalcitonin (PCT) in der Diagnostik und zur Steuerung der antibiotischen Therapie eingesetzt. Aktuelle Daten legen nahe, dass eine PCT-gesteuerte Therapie auch das Outcome verbessern kann. Das PCT als diagnostisches Instrument ist jedoch mit einigen Einschränkungen verbunden.

Abstract

Adequate diagnosis and therapy of sepsis is of major prognostic relevance. Besides the gold standard (blood culture diagnostics) biomarkers, e.g. serum procalcitonin (PCT), are clinically increasingly used in the diagnosis and for guiding anti-infective treatment. Recent guidelines recommend early determination of PCT. However, trauma, burns, surgical procedure, and intoxications may significantly impact PCT levels. As a rare cause, PCT producing tumors have been described and may be potentially misleading in the clinical setting. While several other constellations for increased PCT in the absence of sepsis (e.g., trauma, intoxications) have been described, it needs to be summarized that according to currently available data, sensitivity and specificity for PCT for the diagnosis of sepsis in critically ill patients is on average between 70 and 80%. Thus, PCT must be interpreted carefully in the context of medical history, physical examination, and microbiological assessment. However, the existing body of literature emphasizes the value of PCT to shorten the duration of an antibiotic treatment. So far, different cut-off values for PCT for certain infections have been identified. While different treatment algorithms have been studied, PCT-guided treatment not only enables to reduce use of antibiotics but as shown most recently may improve outcome of critically ill patients.

Kernaussagen

• Das Serum-Procalcitonin ist ein vielversprechender und klinisch weit verbreiteter Biomarker in der Diagnose und Therapie der Sepsis, dessen Einsatz in den Leitlinien mit Einschränkungen empfohlen wird.

• Es gibt keinen idealen Biomarker zur Diagnose der Sepsis. Das PCT ist mit Limitationen verbunden, es steigt auch bei nichtinfektiösen Triggern (Trauma, Verbrennung, Operationen und Intoxikationen).

• Ein isoliert pathologisch erhöhtes Serum-PCT ohne entsprechende klinische oder laborchemische Korrelation muss kritisch hinterfragt werden.

• Eine Erhöhung des PCT kann auf seltenen Ursachen wie einer ektopen Produktion im Rahmen eines paraneoplastischen Syndroms beruhen.

• Die Sensitivität und Spezifität des PCT zur Diagnose der Sepsis bei kritisch Kranken beträgt 70 – 80%.

• Der Einsatz des PCT zur Therapiesteuerung ist mit einer Verkürzung der Dauer einer antibiotischen Therapie und möglicherweise einer Verbesserung der Prognose kritisch Kranker verbunden.

Schlüsselwörter

Sepsis - Biomarker - Procalcitonin

Key words

sepsis - biomarker - procalcitonin

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