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Ahn, Kim, Yoon, Sohn, Seo, Kim, Hong, Lim, Koh, and Kim: Procalcitonin in 2009 H1N1 Influenza Pneumonia: Role in Differentiating from Bacterial Pneumonia
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 68(4): 205-211.

Published online: 30 April 2010

DOI: https://doi.org/10.4046/trd.2010.68.4.205

Procalcitonin in 2009 H1N1 Influenza Pneumonia: Role in Differentiating from Bacterial Pneumonia

Shin Ahn, M.D.1, Won Young Kim, M.D., Ph.D.1, Ji Young Yoon, M.D.1, Chang Hwan Sohn, M.D.1, Dong Woo Seo, M.D.1, Sung Han Kim, M.D., Ph.D.3, Sang Bum Hong, M.D., Ph.D.2, Chae Man Lim, M.D., Ph.D.2, Youn Suck Koh, M.D., Ph.D.2, Won Kim, M.D., Ph.D.1

1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

2Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

3Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address for correspondence: Won Young Kim, M.D. Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea. Phone: 82-2-3010-3350, Fax: 82-2-3010-3360, wonpia@yahoo.co.kr

Received 24 February 2010       Accepted 22 March 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Background

Procalcitonin is a well known marker in infection that plays a role in distinguishing between bacterial and viral infections in screening. The aim of the present study was to evaluate the role of procalcitonin in differentiating between 2009 H1N1 influenza pneumonia and community acquired pneumonia of bacterial origin, or mixed bacterial origin and 2009 H1N1 influenza infection.

Methods

A retrospective observational study was performed over the 6-month winter period during the 2009 H1N1 influenza pandemic. Ninety-six patient-subjects were enrolled, all of whom had been diagnosed with community acquired pneumonia in emergency department during the study period. On admission, laboratory studies were performed, which included 2009 H1N1 influenza real-time polymerase chain reaction of nasal secretions and procalcitonin on serum; the laboratory values were compared between the study groups. Receiver operating characteristic curve analyses were performed on the resulting data.

Results

Compared to those with bacterial or mixed infections (n=62) and bacterial pneumonia with confirmed organisms (n=30), patients with 2009 H1N1 pneumonia (n=34) were significantly more likely to have low procalcitonin levels (p=0.008, 0.001). Using cutoff of value >0.3 ng/mL, the sensitivity and specificity of procalcitonin for detection of patients with confirmed bacterial pneumonia were 76.2% and 60.6%, respectively. A significant difference in procalcitonin was found between 2009 H1N1 pneumonia and pneumonia caused by mixed influenza viral and bacterial infections (0.15 [0.05~0.84] vs. 10.3 [0.05~22.87] ng/mL, p=0.045).

Conclusion

Serum procalcitonin measurement may assist in the discrimination between pneumonia of bacterial and of 2009 H1N1 influenza origin. High values of procalcitonin suggest that bacterial infection or mixed infection of bacteria and 2009 H1N1 influenza is more likely.

Keywords: Influenza A Virus, H1N1 Subtype, Procalcitonin, Pneumonia

Figures and Tables

Figure 1
Receiver-operating characteristics curve for discriminating between 2009 H1N1 pneumonia and bacterial/mixed community acquired pneumonia for procalcitonin. Cutoff of >0.3 ng/mL for procalciton best identified patients with bacterial/mixed pneumonia (sensitivity 61.9%, specificity 60.6%, positive predictive value 75.0%, negative predictive value 45.5%).
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Figure 2
Receiver-operating characteristics curve for discriminating between 2009 H1N1 pneumonia and microorganism confirmed bacterial community acquired pneumonia for procalcitonin. Cutoff of >0.3 ng/mL for procalciton best identified patients with microorganism confirmed bacterial pneumonia (sensitivity 76.2%, specificity 60.6%, positive predictive value 55.2%, negative predictive value 80.0%).
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Figure 3
Box plot of procalcitonin levels between 2009 H1N1 pneumonia and bacterial pneumonia with confirmed organisms.
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Table 1
Baseline patient characteristics
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SD: standard deviation; WBC: white blood cell; IQR: interquartile range; PCT: procalcitonin; PSI: pneumonia severity index.

Table 2
Demographic, clinical and laboratory data of the 2009 H1N1 and bacterial/mixed groups
trd-68-205-i002

SD: standard deviation; SBP: systolic blood pressure; DBP: diastolic blood pressure; RR: respiratory rate; HR: heart rate; BT: body temperature; IQR: interquartile range; WBC: white blood cell; ANC: absolute neutrophil count; PCT: procalcitonin; PSI: pneumonia severity index.

*p<0.05.

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