Abstract: Objective   To explore the level and influencing factors of serum procalcitonin (PCT) in maintenance hemodialysis (MHD) patients, and to evaluate the diagnostic value of PCT for infections in MHD patients.  Methods  A total of 500 MHD patients without clinical infection were selected in this cross-sectional study. They were further stratified according to serum PCT level. The influencing factors for the higher serum PCT in MHD patients were investigated by inter-group comparison, univariate and multivariate logistic regression analyses. Additionally, a total of 115 MHD patients with clinical infections were recruited. The optimal cut-off value of serum PCT for the diagnosis of infections in the MHD patients was determined by receiver operating characteristic (ROC) curve and the area under the curve (AUC).  Results   Compared with non-infected groups,serum PCT was significantly elevated in patients in the infected group (Z=-14.204, P＜0.001). Logistic regression showed that catheters as the dialysis access (OR=2.142, 95% CI:1.282~3.579, P=0.004), male (OR=1.517, 95% CI: 1.036~2.221, P=0.032), hemoglobin＜110g/L (OR=1.792, 95% CI 1.225~2.623, P=0.003), blood phosphorus≥1.78mmol/L (OR=1.608, 95% CI:1.079~2.379, P=0.020) and parathyroid hormone >300pg/ml (OR=1.693, 95% CI:1.156~2.479, P=0.007) were the independent risk factors for higher serum PCT level in MHD patients. When the cut-off value of serum PCT was set at 0.851ng/ml, the sensitivity and specificity of PCT to predict infections in MHD patients were 85.2% and 87.2% respectively, with the AUC of 0.924 (95% CI 0.896~0.953).  Conclusions  Serum PCT is significantly increased in MHD patients. We recommend a higher diagnostic threshold of serum PCT for the clinical diagnosis of infections in MHD patients.

Key words: Maintenance hemodialysis, Procalcitonin, Microinflammation, Infection