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Park, Lee, Jang, and Kim: Usefulness of Procalcitonin in the Assessing the Severity of Community-Acquired Pneumonia Patient
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(5): 430-435.

Published online: 30 November 2009

DOI: https://doi.org/10.4046/trd.2009.67.5.430

Usefulness of Procalcitonin in the Assessing the Severity of Community-Acquired Pneumonia Patient

Hun-Pyo Park, M.D.1, Jung-Soo Lee, M.D.2, Ye-Su Jang, M.D.2, Min-Su Kim, M.D.1

1Department of Respiratory Medicine, Changwon Fatima Hospital, Changwon, Korea.

2Department of Respiratory Medicine, Daegu Fatima Hospital, Daegu, Korea.

Address for correspondence: Hun-Pyo Park, M.D. Department of Respiratory Medicine, Changwon Fatima Hospital, 212, Myeonseo-dong, Changwon 641-560, Korea. Phone: 82-55-270-1264, Fax: 82-55-265-7766, hunpyopark@hanmail.net

Received 9 September 2009       Accepted 29 September 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP.

Methods

This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability.

Results

Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032).

Conclusion

In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.

Keywords: Pneumonia, Community-Acquired Infections, Procalcitonin, Severity Illness Index

Figures and Tables

Figure 1
Receiver operating characteristic curves comparing WBC, PCT in PSI. WBC: white blood cell; PCT: procalcitonin; PSI: pneumonia severity index.
trd-67-430-g001
Table 1
Baseline characteristics of the 92 patients
trd-67-430-i001

Values are number of patients (percentage) or means (standard deviation, SD).

PSI: pneumonia severity index; PCT: procalcitonin; CRP: C-reactive protein; WBC: white blood cell.

Table 2
Biomarkers and prognostic scales in community-acquired pneumonia
trd-67-430-i002

Values are means (±SD).

PCT: procalcitonin; CRP: C-reactive protein; WBC: white blood cell; CRB: confusion, respiratory rate, blood pressure; CURB: confusion, uremia, respiratory rate, blood pressure; PSI: pneumonia severity index.

Table 3
Comparison of clinical characteristics of patients with procalcitonin level
trd-67-430-i003

Values are means (±SD).

PCT: procalcitonin; WBC: white blood cell; CRP: C-reactive protein; RR: respiratory rate; SBP: systolic blood pressure; DBP: diastolic blood pressure; PSI: pneumonia severity index.

References

1. Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA. 1996. 275:134–141.
2. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002. 165:766–772.
3. The British Thoracic Society Research Committee and The Public Health Laboratory Service. The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit. Respir Med. 1992. 86:7–13.
4. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996. 51:1010–1016.
5. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003. 58:377–382.
6. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997. 336:243–250.
7. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007. 44:Suppl 2. S27–S72.
8. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection. 2000. 28:68–73.
9. Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis. 2002. 34:895–901.
10. Masia M, Gutierrez F, Shum C, Padilla S, Navarro JC, Flores E, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest. 2005. 128:2223–2229.
11. Kruger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J. 2008. 31:349–355.
12. Huang DT, Weissfeld LA, Kellum JA, Yealy DM, Kong L, Martino M, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med. 2008. 52:48.e2–58.e2.
13. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T. CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006. 260:93–101.
14. Niederman MS. Recent advances in community-acquired pneumonia: inpatient and outpatient. Chest. 2007. 131:1205–1215.
15. Tateda K, Kusano E, Matsumoto T, Kimura K, Uchida K, Nakata K, et al. Semi-quantitative analysis of Streptococcus pneumoniae urinary antigen: kinetics of antigen titers and severity of diseases. Scand J Infect Dis. 2006. 38:166–171.
16. Christ-Crain M, Morgenthaler NG, Stolz D, Muller C, Bingisser R, Harbarth S, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care. 2006. 10:R96.
17. Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med. 2000. 28:977–983.
18. Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Muller B. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med. 2004. 32:1715–1721.
19. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med. 2000. 26:1193–1200.
20. Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab. 2004. 89:1512–1525.
21. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993. 341:515–518.
22. Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B. Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care. 2007. 11:R60.
23. Kim HC, Kim KM, Lee SM, Lee SJ, Ham HS, Cho YJ, et al. Measuring serum procalcitonin in patients with fever in the ICU to differentiate infectious causes from non-infectious causes. Tuberc Respir Dis. 2006. 61:20–25.
24. Holm A, Pedersen SS, Nexoe J, Obel N, Nielsen LP, Koldkjaer O, et al. Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. Br J Gen Pract. 2007. 57:555–560.
25. Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Muller C, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest. 2007. 131:9–19.
26. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med. 2008. 177:498–505.
27. Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006. 174:84–93.
28. Nyamande K, Lalloo UG. Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP. Int J Tuberc Lung Dis. 2006. 10:510–515.
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