Journal List > Tuberc Respir Dis > v.67(3) > 1001413

TOOLS
Kim, Kim, Park, Lee, Hwang, Choi, Shin, Park, Jang, Lee, Park, Kim, Lee, Hyun, and Jung: Semi-quantitative Procalcitonin Assay in Critically ill Patients with Respiratory infections
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(3): 205-211.

Published online: 30 September 2009

DOI: https://doi.org/10.4046/trd.2009.67.3.205

Semi-quantitative Procalcitonin Assay in Critically ill Patients with Respiratory infections

Ji-Youn Kim, M.D., Cheol-Hong Kim, M.D., Sunghoon Park, M.D., Chang-Youl Lee, M.D., Yong Il Hwang, M.D., Jeong-Hee Choi, M.D., Taerim Shin, M.D., Yong-Bum Park, M.D., Seung-Hun Jang, M.D., Jae Young Lee, M.D., Sang Myeon Park, M.D., Dong-Gyu Kim, M.D., Myung-Goo Lee, M.D., In-Gyu Hyun, M.D., Ki-Suck Jung, M.D.

Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.

Address for correspondence: Cheol-Hong Kim, M.D. Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, 94-200, Yeongdeungpodong, Yeongdeungpo-gu, Seoul 150-719, Korea. Phone: 82-2-2639-5787, Fax: 82-2-2677-9756, kimch2002@hallym.or.kr

Received 2 July 2009       Accepted 1 September 2009

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

Abstract

Background

Serum procalcitonin level has been considered prognostic during sepsis and septic shock. We investigated the significance of procalcitonin in critically ill patients with respiratory infections.

Methods

The patients who had radiographically diagnosed diffuse lung infiltrations were enrolled on a prospective basis. Bronchoalveolar lavage (BAL) fluid for the purpose of quantitative cultures (≥104 cfu/mL) was obtained from all patients. Serum procalcitonin levels determined by PCT-Q kit were measured on BAL day and classified as follows; <0.5 ng/mL, 0.5~2.0 ng/mL, 2.0~10.0 ng/mL and >10.0 ng/mL. We analyzed the patient's characteristics according to outcome; favorable or unfavorable, defined as death.

Results

Patients from the following categories were included: medical 17 (47.2%), surgical 9 (25%), and burned 10 (27.8%). APACHE II scores on admission to intensive care unit were 11.5±6.89 and 11 (30.6%) had unfavorable outcomes. A procalcitonin level ≥0.5 ng/mL was in 17 (47.2%) of all. On univariate analysis, the frequencies of burn injury, mechanical ventilation, multiple organ failure, and a procalcitonin level ≥0.5 ng/mL were more often increased in patients with unfavorable outcomes than in those with favorable outcomes (p<.05). Also, a higher procalcitonin range and ventilator-associated pneumonia (VAP) were more closely associated with an unfavorable outcome (p<.05). However in multivariate analysis, a strong predictor of unfavorable outcome was burn injury (p<.05). A procalcitonin level ≥0.5 ng/mL was more sensitive in predicting VAP than unfavorable outcome.

Conclusion

A higher procalcitonin level seems to be associated with VAP, but further study is required to know that procalcitonin would be a prognostic marker in critically ill patients with respiratory infections.

Keywords: Bronchoaveolar lavage, Procalcitonin, Respiratory infections, Ventilator-associated pneumonia

Figures and Tables

Figure 1
Receiver operating characteristics (ROC) curves of markers to predict ventilator-associated pneumonia. Areas under the ROC curves for WBC count, CRP, ESR, modified clinical pulmonary infection score (mCPIS) and serum procalcitonin (≥0.5 ng/mL) were 0.681 (95% confidence interval [CI]; 0.474, 0.888), 0.699 (95% CI; 0.491, 0.907), 0.541 (95% CI; 0.312, 0.770), 0.745 (95% CI; 0.552, 0.937) and 0.750 (95% CI; 0.562, 0.938), respectively.
trd-67-205-g001
Figure 2
Receiver operating characteristics (ROC) curves of factors to predict unfavorable outcome. Areas under the ROC curves for burn injury, mechanical ventilation (MV), number (No.) of organ failure and serum procalcitonin (≥0.5 ng/mL) were 0.758 (95% confidence interval [CI]; 0.569, 0.947), 0.735 (95% CI; 0.566, 0.903), 0.735 (95% CI; 0.543, 0.926) and 0.684 (95% CI; 0.493, 0.874), respectively.
trd-67-205-g002
Table 1
Clinical characteristics of the 36 patients
trd-67-205-i001

No. (%) unless otherwise stated.

APACHE: acute physiology and chronic health evaluation; BAL: bronchoalveolar lavage; ICU: intensive care unit.

Table 2
Bacterial isolates from bronchoalveolar lavage in respiratory infections
trd-67-205-i002

No. (%) unless otherwise stated.

VAP: ventilator-associated pneumonia; HAP: hospital acquired pneumonia; PCP: Pneumocystis pneumonia; MRSA: methicillin-resistant Staphylococcus aureus; MRCNS: methicillin-resistant coagulase-negative Staphylococci.

Table 3
Serum procalcitonin range according to the respiratory infection status
trd-67-205-i003

No. (%) unless otherwise stated.

VAP: ventilator-associated pneumonia; HAP: hospital acquired pneumonia; PCP: Pneumocystis pneumonia.

Table 4
Comparisons of clinical characteristics according to the outcome
trd-67-205-i004

Values are presented as mean±standard deviation or No. (%) unless otherwise stated.

mCPIS: modified clinical pulmonary infection score; APACHE: acute physiology and chronic health evaluation; BAL: bronchoalveolar lavage.

*p<0.05.

Table 5
Serum procalcitonin range and the type of respiratory infections according to the outcome
trd-67-205-i005

No. (%) unless otherwise stated.

VAP: ventilator-associated pneumonia; HAP: hospital acquired pneumonia; PCP: Pneumocystis pneumonia.

*p<0.05 by score test for trend, †p<0.05.

Table 6
Multivariate logistic-regression analysis of factors used to differentiate between patients with favorable or unfavorable outcome
trd-67-205-i006

OR: odds ratio; CI: confidence interval.

References

1. Vincent JL. Nosocomial infections in adult intensive-care units. Lancet. 2003. 361:2068–2077.
2. 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.
3. Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med. 2000. 28:3171–3176.
4. Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab. 1994. 79:1605–1608.
5. Wanner GA, Keel M, Steckholzer U, Beier W, Stocker R, Ertel W. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med. 2000. 28:950–957.
6. Nylén ES, Snider RH Jr, Thompson KA, Rohatgi P, Becker KL. Pneumonitis-associated hyperprocalcitoninemia. Am J Med Sci. 1996. 312:12–18.
7. Oberhoffer M, Stonans I, Russwurm S, Stonane E, Vogelsang H, Junker U, et al. Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis-related cytokines in vitro. J Lab Clin Med. 1999. 134:49–55.
8. Duflo F, Debon R, Monneret G, Bienvenu J, Chassard D, Allaouchiche B. Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology. 2002. 96:74–79.
9. Chastre J, Fagon JY, Bornet-Lecso M, Calvat S, Dombret MC, al Khani R, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med. 1995. 152:231–240.
10. Clinical Laboratory Standards Institute. CLSI document M100-S18. Performance standards for antimicrobial susceptibility testing; eighteenth informational supplement. 2008. Wayne: Clinical and Laboratory Standards Institute.
11. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001. 163:1730–1754.
12. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005. 171:388–416.
13. Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med. 2003. 31:676–682.
14. Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med. 2002. 165:867–903.
15. Dennesen PJ, van der Ven AJ, Kessels AG, Ramsay G, Bonten MJ. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med. 2001. 163:1371–1375.
16. Ioanas M, Ferrer M, Cavalcanti M, Ferrer R, Ewig S, Filella X, et al. Causes and predictors of nonresponse to treatment of intensive care unit-acquired pneumonia. Crit Care Med. 2004. 32:938–945.
17. Luyt CE, Guérin V, Combes A, Trouillet JL, Ayed SB, Bernard M, et al. Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med. 2005. 171:48–53.
18. Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care. 1999. 3:45–50.
19. Shirani KZ, Pruitt BA Jr, Mason AD Jr. The influence of inhalation injury and pneumonia on burn mortality. Ann Surg. 1987. 205:82–87.
20. von Heimburg D, Stieghorst W, Khorram-Sefat R, Pallua N. Procalcitonin: a sepsis parameter in severe burn injuries. Burns. 1998. 24:745–750.
21. Mandi Y, Farkas G, Takacs T, Boda K, Lonovics J. Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis. Int J Pancreatol. 2000. 28:41–49.
22. Nylen ES, O'Neill W, Jordan MH, Snider RH, Moore CF, Lewis M, et al. Serum procalcitonin as an index of inhalation injury in burns. Horm Metab Res. 1992. 24:439–443.
23. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006. 34:2596–2602.
24. Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med. 2004. 350:451–458.
TOOLS
Similar articles