Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of vitreous Procalcitonin as a diagnostic biomarker in infectious endophthalmitis

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Endophthalmitis is a potentially blinding intraocular infection following intraocular surgery or trauma. Prompt diagnosis and treatment are important in preventing devastating visual complications. Procalcitonin (PCT) is a promising biomarker for diagnosing bacterial infections. The aim of the study was to measure vitreous PCT in infectious endophthalmitis and assess its utility as a biomarker.

Methods

In this prospective study, vitreous was collected from patients with non-infectious retinal disorders and infectious endophthalmitis. PCT was measured using the Human Procalcitonin ELISA Kit. The diagnostic performance of PCT was calculated via receiver operating characteristic curves.

Results

The study included three groups: patients with non-infectious retinal conditions, culture-positive endophthalmitis, and culture-negative endophthalmitis. The average PCT was 75.74 ± 26.8 pg mL−1, 100.24 ± 12.9 pg mL−1, and 126.41 ± 26.47 pg mL−1 in control, culture-negative, and culture-positive endophthalmitis, respectively. There was a significant difference in the vitreous PCT in the study and control groups (p = 0.04), but not between culture-positive and culture-negative endophthalmitis (p = 0.65). The sensitivity (66.7%) and specificity (65%) for PCT with a cut-off of ≤ 54.88 pg mL−1(p = 0.31) implied that its diagnostic accuracy was not significant. But there was a significant difference in gram-negative (68.2 ± 16.5 pg mL−1) and gram-positive (175.09 ± 45 pg mL−1) (p = 0.02) bacterial infections; the sensitivity and specificity were 70%, with a cut-off of ≤ 82.3 pg mL−1.

Conclusions

This study showed that vitreous procalcitonin concentration might not be a suitable biomarker for diagnosing culture-negative endophthalmitis though it could help distinguish between gram-positive and gram-negative infections.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Weber DJ, Hoffman KL, Thoft RA, Baker AS (1986) Endophthalmitis following intraocular lens implantation: report of 30 cases and review of the literature. Rev Infect Dis 8(1):12–20. https://doi.org/10.1093/clinids/8.1.12

    Article  CAS  PubMed  Google Scholar 

  2. Speaker MG, Milch FA, Shah MK, Eisner W, Kreiswirth BN (1991) Role of external bacterial flora in the pathogenesis of acute postoperative endophthalmitis. Ophthalmology 98(5):639–649. https://doi.org/10.1016/s0161-6420(91)32239-5

    Article  CAS  PubMed  Google Scholar 

  3. Das T, Kunimoto DY, Sharma S, Jalali S, Majji AB, Nagaraja Rao T et al (2005) Endophthalmitis research group. Relationship between clinical presentation and visual outcome in postoperative and posttraumatic endophthalmitis in south central India. Indian J Ophthalmol. 53(1):5–16. https://doi.org/10.4103/0301-4738.15298

    Article  PubMed  Google Scholar 

  4. Naik P, Singh S, Dave VP, Ali MH, Kumar A, Joseph J (2020) Vitreous D-lactate levels as a biomarker in the diagnosis of presumed infectious culture negative endophthalmitis. Curr Eye Res 45(2):184–189. https://doi.org/10.1080/02713683.2019.1662057

    Article  CAS  PubMed  Google Scholar 

  5. SR, Gardner TW (2016) Diabetic retinopathy and diabetic macular edema. In: Nguyen QD, Rodrigues EB, Farah ME, Mieler WF, Do DV, editors. Retinal pharmacotherapeutics. Dev Ophthalmol. Basel: Karger 55: 137–46

  6. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P (2013) Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis 13(5):426–435. https://doi.org/10.1016/S1473-3099(12)70323-7

    Article  CAS  PubMed  Google Scholar 

  7. BalcI C, Sungurtekin H, Gürses E, Sungurtekin U, Kaptanoglu B (2003) Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care 7(1):85–90. https://doi.org/10.1186/cc1843

    Article  PubMed  Google Scholar 

  8. Tang BM, Eslick GD, Craig JC, McLean AS (2007) Accuracy of procalcitonin for sepsis diagnosis in critically ill patients: systematic review and meta-analysis. Lancet Infect Dis 7(3):210–217. https://doi.org/10.1016/S1473-3099(07)70052-X

    Article  CAS  PubMed  Google Scholar 

  9. Bernard L, Ferrière F, Casassus P, Malas F, Lévêque S, Guillevin L et al (1998) Procalcitonin as an early marker of bacterial infection in severely neutropenic febrile adults. Clin Infect Dis 27(4):914–915. https://doi.org/10.1086/517175

    Article  CAS  PubMed  Google Scholar 

  10. Blijlevens NM, Donnelly JP, Meis JF, De Keizer MH, De Pauw BE (2000) Procalcitonin does not discriminate infection from inflammation after allogeneic bone marrow transplantation. Clin Diagn Lab Immunol 7(6):889–892. https://doi.org/10.1128/cdli.7.6.889-892.2000

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K (1997) Procalcitonin—a new indicator of the systemic response to severe infections. Infection 25(6):329–34. https://doi.org/10.1007/BF01740811

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Reinhart K, Bauer M, Riedemann NC, Hartog CS (2012) New approaches to sepsis: molecular diagnostics and biomarkers. Clin Microbiol Rev 25(4):609–634. https://doi.org/10.1128/CMR.00016-12

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bateman Brian T, Schmidt Ulrich, Berman Mitchell F, Bittner Edward A (2010) Temporal trends in the epidemiology of severe postoperative sepsis after elective surgery a large nationwide sample. Anesthesiology 112:917–925. https://doi.org/10.1097/ALN.0b013e3181cea3d0

    Article  PubMed  Google Scholar 

  14. Sugita S, Ogawa M, Shimizu N, Morio T, Ohguro N, Nakai K et al (2013) Use of a comprehensive polymerase chain reaction system for diagnosis of ocular infectious diseases. Ophthalmology 120:1761–1768

    Article  Google Scholar 

  15. Sugita S, Shimizu N, Watanabe K, Katayama M, Horie S, Ogawa M et al (2011) Diagnosis of bacterial endophthalmitis by broad-range quantitative PCR. Br J Ophthalmol 95:345–349

    Article  Google Scholar 

  16. Brodská H, Malíčková K, Adámková V, Benáková H, Šťastná MM, Zima T (2013) Significantly higher procalcitonin levels could differentiate gram-negative sepsis from gram-positive and fungal sepsis. Clin Exp Med 13(3):165–170. https://doi.org/10.1007/s10238-012-0191-8

    Article  CAS  PubMed  Google Scholar 

  17. Mogensen TH (2009) Pathogen recognition and inflammatory signaling in innate immune defenses. Clin Microbiol Rev 22(2):240–273. https://doi.org/10.1128/CMR.00046-08

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Hatzistilianou M (2010) Diagnostic and prognostic role of procalcitonin in infections. Sci World J 10:1941–1946. https://doi.org/10.1100/tsw.2010.181

    Article  CAS  Google Scholar 

  19. Charles PE, Ladoire S, Aho S, Quenot JP, Doise JM, Prin S et al (2008) Serum procalcitonin elevation in critically ill patients at the onset of bacteraemia caused by either Gram negative or Gram-positive bacteria. BMC Infect Dis 26(8):38. https://doi.org/10.1186/1471-2334-8-38

    Article  Google Scholar 

  20. Grace E, Turner RM (2014) Use of procalcitonin in patients with various degrees of chronic kidney disease including renal replacement therapy. Clin Infect Dis 59(12):1761–1767. https://doi.org/10.1093/cid/ciu732

    Article  CAS  PubMed  Google Scholar 

  21. Leli C, Ferranti M, Moretti A, Al Dhahab ZS, Cenci E, Mencacci A (2015) Procalcitonin levels in gram-positive, gram-negative, and fungal bloodstream infections. Dis Markers. https://doi.org/10.1155/2015/701480

    Article  PubMed  PubMed Central  Google Scholar 

  22. Oussalah A, Ferrand J, Filhine-Tresarrieu P, Aissa N, Aimone-Gastin I, Namour F et al (2015) Diagnostic accuracy of procalcitonin for predicting blood culture results in patients with suspected bloodstream infection: an observational study of 35,343 consecutive patients (A STROBE-Compliant Article). Medicine (Baltimore) 94(44):e1774. https://doi.org/10.1097/MD.0000000000001774

    Article  CAS  Google Scholar 

  23. Kocazeybek B, Küçükoğlu S, Oner YA (2003) Procalcitonin and C-reactive protein in infective endocarditis: correlation with etiology and prognosis. Chemotherapy 49(1–2):76–84. https://doi.org/10.1159/000069777

    Article  CAS  PubMed  Google Scholar 

  24. Koivula I, Hämäläinen S, Jantunen E, Pulkki K, Kuittinen T, Nousiainen T et al (2011) Elevated procalcitonin predicts Gram-negative sepsis in haematological patients with febrile neutropenia. Scand J Infect Dis 43(6–7):471–478. https://doi.org/10.3109/00365548.2011.554855

    Article  CAS  PubMed  Google Scholar 

  25. Nakajima A, Yazawa J, Sugiki D, Mizuguchi M, Sagara H, Fujisiro M et al (2014) Clinical utility of procalcitonin as a marker of sepsis: a potential predictor of causative pathogens. Intern Med 53(14):1497–1503. https://doi.org/10.2169/internalmedicine.53.1785

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Hyderabad Eye Research Foundation, Hyderabad

Funding

This work was supported by Hyderabad Eye Research Foundation, Hyderabad.

Author information

Authors and Affiliations

  1. Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, 500034, India

    Poonam Naik, Gagan Satyashree & Joveeta Joseph

  2. Manipal Academy of Higher Education, Manipal, Karnataka, India

    Poonam Naik

  3. Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India

    Ashik Mohamed

  4. Srimati Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, 500034, India

    Taraprasad Das & Vivek Pravin Dave

Authors
  1. Poonam Naik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gagan Satyashree
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ashik Mohamed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taraprasad Das
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vivek Pravin Dave
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joveeta Joseph
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualisation of the project, V.P.D.; J.J.; methodology, P.N., and S.G.; software, A.M.; validation, J.J.; formal analysis, P.N.; investigation and Data curation, P.N. and S.G.; resources, TD.; and J.J.; writing—original draft preparation, P.N.; writing—review and editing, V.P.D.; J.J.; and T.D.; supervision and project administration, J.J.; and V.P.D.; funding acquisition, TD.

Corresponding authors

Correspondence to Vivek Pravin Dave or Joveeta Joseph.

Ethics declarations

Conflict of interest

The authors declared that there is no conflict of interest.

Ethical approval

This study was approved by the Institutional Review Board (Ref No. LEC 12–19-371). All procedures were performed according to the principles of the Declaration of Helsinki. A written informed consent was obtained from all study subjects.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Naik, P., Satyashree, G., Mohamed, A. et al. Evaluation of vitreous Procalcitonin as a diagnostic biomarker in infectious endophthalmitis. Int Ophthalmol 41, 3401–3409 (2021). https://doi.org/10.1007/s10792-021-01903-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-01903-0

Keywords

Search

Navigation