neopterin concentrations are common in patients in the clinical course
after, e.g., multiple trauma and provide early predictive information for
development of sepsis, multiple organ failure and death.
laboratory differentiation of infectious versus non-infectious systemic
inflammatory response syndrome
Mitaka C. Department of Critical Care Medicine, Tokyo Medical and Dental
University Graduate School, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519,
Chim Acta 2005;351:17-29)
To evaluate the accuracy of C-reactive protein (CRP), procalcitonin (PCT),
neopterin, and endotoxin in the differential diagnosis of sepsis and
non-infectious systemic inflammatory response syndrome (SIRS), a Medline
database and references from identified articles were used to perform a
literature search relating to the differential diagnosis of sepsis versus
PCT, and neopterin are released both in sepsis and in non-infectious
inflammatory disease. CRP and PCT are equally effective, although not
perfect, in differentiating between sepsis and non-infectious SIRS.
However, CRP and PCT have different kinetics and profiles. The kinetics of
CRP is slower than that of PCT, and CRP levels may not further increase
during more severe stages of sepsis. On the contrary, PCT rises in
proportion to the severity of sepsis and reaches its highest levels in
septic shock. PCT tends to be higher in non-survivor than in survivor.
Therefore, PCT demonstrated a closer correlation with the severity of
sepsis and outcome than CRP. Unlike CRP and PCT, neopterin is increased in
viral infection as well as bacterial infection, and neopterin is also a
useful indicator of sepsis. Endotoxemia was detected in no more than half
of patients with Gram-negative bacteremia, and Gram-negative bacteremia was
detected in half of patients with endotoxemia.
diagnostic capacity of PCT is superior to that of CRP due to the close
correlation between PCT levels and the severity of sepsis and outcome.
Neopterin is very useful in the diagnosis of viral infection. The endotoxin
assay in combination with CRP, PCT, or neopterin may help as a diagnostic
marker for Gram-negative bacterial infection.
plasma levels in intensive care patients with and without septic
Strohmaier W, et al. Ludwig-Boltzmann-Institute for Experimental
Traumatology, Vienna, Austria
(Crit Care Med 1987; 15: 757-60)
The activation of macrophages is accompanied by release of
(D-erythro-neopterin). The neopterin levels of 21 patients were measured
with radioimmunoassay. The patients were classified according to the
clinical course and outcome. We found highly significant differences
between survivors and nonsurvivors for each of the evaluated days of the
observation period. In addition to a sustained increase, patients with
fatal outcome always showed a higher percentage of neopterin levels (88.2
+/- 28 [SD]%) exceeding the upper confidence limit (27.4 nmol/L) than
survivors (31.8 +/- 29.9%). We conclude that the assessment of
D-erythro-neopterin might be an easily available aid for an early
evaluation of the immunologic status of a patient at risk for septic