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Letters to the Editor: Alessandra Barassi, Francesco Pallotti, and GianVico Melzi d’Eril Biological Variation of Procalcitonin in Healthy Individuals Clin Chem 2004; 50: 1878 [Full text] [PDF]

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Procalcitonin in healthy individuals

Nils G Morgenthaler, Joachim Struck, Andreas Bergmann   (5 October 2004)

Procalcitonin in healthy individuals 5 October 2004
Nils G Morgenthaler, Head of Clinical Research BRAHMS AG, Hennigsdorf/Germany, Joachim Struck, Andreas Bergmann Send letter to journal: Re: Procalcitonin in healthy individuals n.morgenthaler{at}brahms.de Nils G Morgenthaler, et al.	Barassi and colleagues (1) published a letter on the biological variation of procalcitonin (PCT) in healthy individuals. The authors used an automated platform assay (B.R.A.H.M.S PCT KRYPTOR), and concluded that this assay is technically unsuitable to measure PCT and should be improved. We do not agree with this interpretation. The reported result on the technical imprecision at very low PCT concentrations is not surprising, since this assay is unsuitable to detect the low PCT present in healthy individuals. The Kryptor PCT assay was developed for the measurement of PCT in patients with systemic infection or sepsis, where PCT concentrations are > 0.1 µg/L. The assay has a functional assay sensitivity (< 20 % inter assay CV) of 0.06 µg/L (2) which is above the PCT values present in healthy individuals (3). If used accordingly, this assay is of considerable clinical benefit, not only in patients with sepsis, but also in patients presenting with local infections like pneumonia (2). Barassi and colleagues (1) used this assay in an unsuitable setting and should not draw broad conclusions from their data. For the intentions of their study, it is mandatory to use high sensitive PCT assays, like the one we described in this journal with a functional assay sensitivity of 0.01 µg/L (3). This assay would allow the evaluation of PCT fluctuations in healthy individuals. 1. Barassi A, Pallotti F, D'Eril GM. Biological variation of procalcitonin in healthy individuals. Clin Chem 2004;50:1878. 2. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 2004;363:600-7. 3. Morgenthaler NG, Struck J, Fischer-Schulz C, Bergmann A. Sensitive immunoluminometric assay for the detection of procalcitonin. Clin Chem 2002;48:788-90.