Inflammatory biomarkers are associated with aetiology and predict outcomes in community-acquired pneumonia: results of a 5-year follow-up cohort study

Abstract

BackgroundBiomarkers may facilitate clinical decisions in order to guide antimicrobial treatment and prediction of prognosis in community-acquired pneumonia (CAP). We measured serum C-reactive protein, procalcitonin (PCT) and calprotectin levels, and plasma pentraxin 3 (PTX3) and presepsin levels, along with whole-blood white cell counts, at three time-points, and examined their association with microbial aetiology and adverse clinical outcomes in CAP.MethodsBlood samples were obtained at hospital admission, clinical stabilisation and 6-week follow-up from 267 hospitalised adults with CAP. Adverse short-term outcome was defined as intensive care unit admission and 30-day mortality. Long-term outcome was evaluated as 5-year all-cause mortality.ResultsPeak levels of all biomarkers were seen at hospital admission. Increased admission levels of C-reactive protein, PCT and calprotectin were associated with bacterial aetiology of CAP, while increased admission levels of PCT, PTX3 and presepsin were associated with adverse short-term outcome. In univariate and multivariate regression models, white blood cells and calprotectin at 6-week follow-up were predictors of 5-year all-cause mortality.ConclusionsCalprotectin emerges as both a potential early marker of bacterial aetiology and a predictor for 5-year all-cause mortality in CAP, whereas PCT, PTX3 and presepsin may predict short-term outcome.

Vitamin D Status in Neonatal Pulmonary Infections: Relationship to Inflammatory Indicators

“…Besides, multiple studies have identified an association of respiratory infectious disease and inadequate serum vitamin D in nonrachitic children [13], [14]. Biomarkers, applied in synergy with clinical signs and symptoms of pneumonia may provide extra data on disease severity and the differentiation between bacterial and viral aetiology [15], [16]. Pentraxin 3 is known as an acute-phase mediator that rapidly increases in inflammatory and infectious disorders [17], [18].…”

Biomarkers in Community-Acquired Pneumonia (Cardiac and Non-Cardiac)

“…PCT is also useful as a prognostic biomarker. High levels of PCT at hospital admission for CAP are associated with ICU admission [62] and short-term mortality [10,63]. Furthermore, the persistence of elevated levels at 72 h before the start treatment is associated with treatment failure and mortality, while PCT being decreased improves the prognostic with a lower risk of shock, ICU admission, invasive mechanical ventilation, and death [54].…”

“…FGF21 is a metabolic regulator with anti-inflammatory and immunoregulatory properties [103]. Siljan et al recently evaluated the role of another biomarkers in CAP [10]. Presepsin, calprotectin, and pentraxin 3 (PTX3) are a soluble CD14-subtype molecule (sCD14-ST), a neutrophil biomarker, and a receptor involved in innate immunity, respectively.…”

“…Stratification of the risk of mortality due to pneumonia, as well as identifying those patients most susceptible to complications in the short and long-term, are key in establishing preventive strategies and optimizing treatment [8]. Biomarkers in CAP could be useful for the diagnosis of infection [9,10], severity assessment [11], to monitor clinical response and antibiotic duration, and recently, to predict cardiovascular complications [12]. Many biomarkers have been studied for these purposes.…”

Das neue Verständnis pulmonaler Infektionen

“…Es fehlen prospektive Studien, die einen direkten Nutzen der zumeist in einem Multiplex-PCR-Ansatz durchgeführten Verfahren auf wichtige klinische Endpunkte wie Mortalität, stationäre Verweildauer oder auch den effizienteren Einsatz von Antibiotika zeigen. Eine Kombination von zeitnaher und sensitiver Erregerdiagnostik erscheint derzeit nur in Kombination mit neuen, prädiktiven Biomarkern eine Verbesserung aktueller Therapiealgorithmen zu erbringen [29].…”