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Han, Kim, Kim, Lee, Ryu, and Cheon: Diagnostic Role of C-reactive Protein, Procalcitonin and Lipopolysaccharide-Binding Protein in Discriminating Bacterial-Community Acquired Pneumonia from 2009 H1N1 Influenza A Infection
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2011; 70(6): 490-497.

Published online: 30 June 2011

DOI: https://doi.org/10.4046/trd.2011.70.6.490

Diagnostic Role of C-reactive Protein, Procalcitonin and Lipopolysaccharide-Binding Protein in Discriminating Bacterial-Community Acquired Pneumonia from 2009 H1N1 Influenza A Infection

Seon-Sook Han, M.D.1, Se-Hyun Kim, M.D.1, Woo Jin Kim, M.D.1, Seung-Joon Lee, M.D.1, Sook-Won Ryu, M.D.2, Myeong Ju Cheon3

1Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

2Department of Laboratory Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.

3Clinical Research Institute of Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Korea.

Address for correspondence: Seon-Sook Han, M.D. Department of Internal Medicine, Kangwon National University Hospital, Hyoja 3-dong, Chuncheon 200-722, Korea. Phone: 82-33-258-2377, Fax: 82-33-258-2455, ssunimd@kangwon.ac.kr

Received 7 March 2011       Accepted 29 April 2011

Copyright © 2011. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

It is difficult but important to differentiate between bacterial and viral infections, especially for respiratory infections. Hence, there is an ongoing need for sensitive and specific markers of bacterial infections. We investigated novel biomarkers for discriminating community acquired bacterial pneumonia from 2009 H1N1 influenza A infections.

Methods

This was a prospective, observational study of patients with community acquired bacterial pneumonia, 2009 H1N1 Influenza A infection, and healthy controls. Serum samples were obtained on the initial visit to the hospital and stored at -80℃. We evaluated CRP (C-reactive protein), PCT (procalcitonin), LBP (lipopolysaccharide-binding protein) and copeptin. These analytes were all evaluated retrospectively except CRP. Receiver operating characteristic curve (ROC) analyses were performed on the resulting data.

Results

Enrolled patients included 27 with community acquired bacterial pneumonia, 20 with 2009 H1N1 Influenza A infection, and 26 who were healthy controls. In an ROC analysis for discriminating community acquired bacterial pneumonia from 2009 H1N1 influenza A infection, areas under the curve (AUCs) were 0.799 for CRP (95% Confidence interval [CI], 0.664~0.934), 0.753 for PCT (95% CI, 0.613~0.892) and 0.684 for LBP (95% CI, 0.531~0.837). Copeptin was not different among the three groups.

Conclusion

These findings suggest that serum CRP, PCT and LBP can assist physicians in discriminating community acquired bacterial pneumonia from 2009 H1N1 influenza A infection.

Keywords: C-Reactive Protein, procalcitonin, lipopolysaccharide-binding protein, Bacteria, Influenza A Virus

Figures and Tables

Figure 1
Receiver operating characteristic curves comparing CRP, PCT, LBP and WBC for differentiating between bacterial pneumonia and 2009 Influenza A H1N1 infection. CRP: C-reactive protein; PCT: procalcitonin; LBP: lipopolysaccharide-binding protein; WBC: white blood cell count.
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Table 1
Baseline characteristics
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Values are presented as number (%) unless otherwise indicated. Kruskall-Wallis test (in age) and chi-square test (in other variables) were used for p-values.

*p=0.001 by Mann-Whiynet U test between bacterial pneumonia and 2009 Influenza A H1N1, †p=0.018 by Fisher's exact test between bacterial pneumonia and 2009 Influenza A H1N1, ‡p=0.013 by Fisher's exact test between bacterial pneumonia and control.

NS: non-specific.

Table 2
PCT, CRP, LBP, copeptin and WBC in bacterial pneumonia, 2009 Influenza A H1N1 infection and control
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Data are presented as median (range). Mann-Whitney U test was used for p-values.

*Compared with bacterial pneumonia vs. 2009 influenza A H1N1, †Compared with bacterial pneumonia vs. control, ‡Compared with 2009 influenza A H1N1 vs. control.

NS: non-specific.

Table 3
Sensitivity and specificity as cut-off value of CRP, PCT and LBP for differentiating between bacterial pneumonia and 2009 Influenza A H1N1 infection
trd-70-490-i003

CRP: C-reactive protein; PCT: procalcitonin; LBP: lipopolysaccharide-binding protein; WBC: white blood cell count; PPV: positive predictive value; NPV: negative predictive value.

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