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The Journal of Clinical Endocrinology & Metabolism Vol. 83, No. 9 3296-3301
Copyright © 1998 by The Endocrine Society

Original Studies

Serum Calcitonin Precursors in Sepsis and Systemic Inflammation1

Kevin T. Whang, Paul M. Steinwald, Jon C. White, Eric S. Nylen, Richard H. Snider, Gary L. Simon, Robin L. Goldberg and Kenneth L. Becker

Georgetown University (K.T.W.), Veterans Affairs Medical Center Surgery Service and Surgical Intensive Care Unit (K.T.W., J.C.W.), Veterans Affairs Medical Center Medical Service and Endocrinology Section (E.S.N., R.H.S., K.L.B.), and George Washington University (P.M.S., J.C.W., E.S.N., G.L.S., R.L.G., K.L.B.), Washington, D.C. 20422

Address all correspondence and requests for reprints to: Kevin T. Whang, M.D., University of California-Davis, 4860 Y Street, Suite 3100, Sacramento, California 95817. E-mail: ktwhang{at}yahoo.com

High serum levels of the calcitonin (CT) prohormone, procalcitonin (pro-CT), and its component peptides occur in systemic inflammation and sepsis. Using two different assays, we undertook a prospective study to determine the utility of serum precalcitonin peptides (pre-CT) as markers in this condition.

Twenty-nine patients meeting criteria for the systemic inflammatory response syndrome were studied daily in two intensive care units. Sera were collected, and APACHE II scores were determined until recovery or death. All patients had markedly elevated serum pre-CT. Prognostically, peak values were the most important. The highest values portended mortality, and a lower level could be ascertained below which all patients survived. Peak pre-CT levels were significantly higher in patients with infection documented by blood cultures than in those patients with no documented infection from any source (P < 0.05). Mature CT remained normal or only moderately elevated. Compared with the serum pre-CT levels, receiver operating characteristic curve analysis revealed that the APACHE II scores, although more cumbersome, were better overall predictors of mortality.

Thus, pre-CT is an important serum marker for systemic inflammatory response syndrome and is predictive of outcome. It also provides data concerning the presence of severe infection and may prove to be clinically useful for proactive patient care.




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