Can steroid use elevate procalcitonin levels?

Can Steroid Use Elevate Procalcitonin Levels?

Yes, steroid use can cause false elevations in procalcitonin levels, particularly when pan-T-cell antibodies like ATG or OKT3 are administered concurrently with steroids in transplant patients. 1

Mechanisms of Procalcitonin Elevation with Steroids

• Procalcitonin (PCT) is typically a marker for bacterial infection, but can be falsely elevated in specific clinical scenarios involving steroid therapy 1
• In kidney transplant patients receiving pan-T-cell antibodies (ATG or OKT3) along with steroids, PCT levels can reach up to 600 ng/ml, comparable to levels seen in severe sepsis, even in the absence of infection 1
• The elevation in PCT appears to be preceded by increases in TNF-alpha plasma levels, suggesting an immunological mechanism rather than infectious cause 1
• These elevations typically peak on day 1 of therapy and return to normal values regardless of continued antibody administration 1

Clinical Scenarios Where Steroids May Affect PCT Levels

• Kidney transplant patients receiving rejection treatment with both steroids and pan-T-cell antibodies show significant PCT elevations 1
• Patients with systemic autoimmune diseases on steroid therapy may have altered PCT responses, though a 2008 study found that PCT maintained good specificity (97.1%) for bacterial infection regardless of steroid dosage 2
• In inflammatory bowel disease, particularly acute severe ulcerative colitis, PCT may be elevated in active disease states when patients are receiving steroid therapy 3
• In multisystem inflammatory syndrome in children (MIS-C), elevated PCT levels were noted in patients treated with steroids and anakinra 4

Interpreting PCT in Patients on Steroids

• When interpreting PCT levels in patients on steroid therapy, clinicians should consider the clinical context and type of immunosuppression 2
• Standard steroid bolus therapy alone does not typically cause significant PCT elevation 1
• The combination of steroids with certain immunomodulators appears to have the greatest impact on PCT levels 1
• PCT monitoring for infectious complications in transplant patients must be done cautiously during pan-T-cell antibody therapy 1

Clinical Implications

• False elevations in PCT may lead to unnecessary antibiotic use, which guidelines specifically recommend against in the absence of confirmed bacterial infection 5
• In patients with sepsis, PCT levels may be used to guide steroid therapy decisions, but the interpretation must account for potential false elevations 5
• For patients with systemic autoimmune diseases, PCT remains a useful marker for bacterial infection with high specificity despite steroid use 2
• When evaluating for possible infection in patients on steroids, multiple biomarkers and clinical parameters should be considered rather than PCT alone 6

Recommendations for Clinical Practice

• In transplant patients receiving pan-T-cell antibodies and steroids, interpret elevated PCT with caution and do not rely solely on PCT to diagnose infection 1
• For patients with systemic autoimmune diseases on steroids, PCT values ≥0.5 ng/ml still maintain good specificity for bacterial infection 2
• In inflammatory conditions where steroids are commonly used (IBD, autoimmune disorders), consider that PCT may have limited prognostic value 3
• When monitoring patients on steroid therapy for potential infections, combine PCT with other clinical and laboratory parameters for more accurate assessment 6