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Measurement of procalcitonin in bronchoalveolar lavage and serum as early predictors in acute respiratory distress syndrome


Procalcitonin (PCT) is a diagnostic for identifying severe bacterial infections and reliably indicating complications secondary to systemic inflammation. PCT levels increase in cases of sepsis, septic shock and in severe systemic inflammatory reactions. The early pathological features of acute respiratory distress syndrome (ARDS) are generally described as diffuse alveolar damage, which can be diagnosed by cytological examination of bronchoalveolar lavage fluid (BAL) [1]. The aim of this study was to evaluate the value of PCT measurement in BAL and serum in the early diagnosis, and to faciliate reliable follow-up of the clinical course of ARDS.


This study included 35 patients admitted to the Critical Care Department at Alexandria Hospital. Patients were allocated into two groups, the study group (25 cases) and the control group (10 cases). A plain X-ray scan was performed, and the hypoxic index (PaO2/FiO2) was calculated daily. PCT in BAL and blood was measured on days 0, 3 and 6 from the diagnosis of ARDS in the patient group using an automated immunofluorescent assay (KRYPTOR BRAHAMS PCT). Disease severity was assessed daily during the stay of the patient using the Acute Lung Injury Score and the Multiple Organ Failure Score (MODS).


In the ARDS group the mean serum PCT was higher than the control, 6.86 ± 3.34, and increased insignificantly after 3 days to 8.06 ± 7.21 (P = 0.195) and after 6 days to 8.60 ± 9.49 (P = 0.232). On the other hand, there was no significant change between the study and control groups for BAL PCT. There was a significant direct correlation between serum PCT and the Murray score on diagnosis of ARDS, on day 3 and day 6. All were significantly higher in nonsurvivors, compared with survivors.


Serum PCT is helpful in the diagnosis of ARDS, but there was no significant change in the value of BAL PCT. A direct correlation exists between serum PCT, the MODS and the Murray score in ARDS patients.


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  2. Estenssoro E, Dubin A, Laffaire E, et al.: Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 2002, 30: 2450-2456. 10.1097/00003246-200211000-00008

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Razek, A.A., Arida, E.A.M. & Deghady, A. Measurement of procalcitonin in bronchoalveolar lavage and serum as early predictors in acute respiratory distress syndrome. Crit Care 12 (Suppl 2), P188 (2008).

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