Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both?

Meili, Marc; Müller, Beat; Kulkarni, Prasad S.; Schütz, Philipp

doi:10.1586/17476348.2015.1081063

Cited by 26 publications

(20 citation statements)

References 57 publications

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“…The diagnostic patterns between CRP and HNL were essentially identical whether all patients with respiratory infections were included or only patients with upper respiratory infections were examined. We also confirmed that PCT did not add much to the diagnostic distinction between bacterial and viral causes of acute respiratory infections (10–12), although numerous publications have advocated PCT as a tool to manage the antibiotic treatment of such patients (13–15). It is possible that the severity of our patients' infections is less than in many of those studies, although our previous results on sepsis also showed the diagnostic superiority of HNL over PCT (16).…”

Section: Discussionsupporting

confidence: 68%

Human Neutrophil Lipocalin in Activated Whole Blood Is a Specific and Rapid Diagnostic Biomarker of Bacterial Infections in the Respiratory Tract

Eriksson

Douhan-Håkansson

Pauksen

2017

Clin Vaccine Immunol

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The distinction between bacterial and viral causes of infections of the respiratory tract is a major but important clinical challenge. We investigated the diagnostic performance of human neutrophil lipocalin (HNL) in respiratory tract infections compared to those of C-reactive protein (CRP) and procalcitonin (PCT). Patients were recruited from the emergency department and from a primary care unit (n = 162). The clinical diagnosis with regard to bacterial or viral cause of infection was complemented with objective microbiological/serological testing. HNL was measured in whole blood after preactivation with the neutrophil activator formyl-methionine-leucine-phenylalanine (fMLP) (B-HNL), and CRP and PCT were measured in plasma. Head-to-head comparisons of the three biomarkers showed that B-HNL was a superior diagnostic means to distinguish between causes of infections, with areas under the concentration-time curve (AUCs) of receiver operating characteristic (ROC) analysis for HNL of 0.91 (95% confidence interval [CI], 0.83 to 0.96) and 0.92 (95% CI, 0.82 to 0.97) for all respiratory infections and for upper respiratory infections, respectively, compared to 0.72 (95% CI, 0.63 to 0.80) and 0.68 (95% CI, 0.56 to 0.79) for CRP, respectively (P = 0.001). In relation to major clinical symptoms of respiratory tract infections (cough, sore throat, stuffy nose, and signs of sinusitis), AUCs varied between 0.88 and 0.93 in those patients with likely etiology (i.e., etiology is likely determined) of infection, compared to 0.63 and 0.71 for CRP, respectively, and nonsignificant AUCs for PCT. The diagnostic performance of B-HNL is superior to that of plasma CRP (P-CRP) and plasma PCT (P-PCT) in respiratory tract infections, and the activity specifically reflects bacterial challenge in the body. The rapid and accurate analysis of HNL by point-of-care technologies should be a major advancement in the diagnosis and management of respiratory infections with respect to antibiotic treatment.

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Section: Discussionsupporting

confidence: 68%

Human Neutrophil Lipocalin in Activated Whole Blood Is a Specific and Rapid Diagnostic Biomarker of Bacterial Infections in the Respiratory Tract

Eriksson

Douhan-Håkansson

Pauksen

2017

Clin Vaccine Immunol

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“…We have also not discussed in detail other markers of infection such as CRP. However, there is a lack of well-done and large studies comparing the effect of both markers when used in the context of antibiotic stewardship [82, 83]. …”

Section: Introductionmentioning

confidence: 99%

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Sager

Kutz

Müeller

et al. 2017

BMC Med

235

181

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Several controlled clinical studies have evaluated the potential of the infection biomarker procalcitonin (PCT) to improve the diagnostic work-up of patients with bacterial infections and its influence on decisions regarding antibiotic therapy. Most research has focused on lower respiratory tract infections and critically ill sepsis patients. A clinical utility for PCT has also been found for patients with urinary tract infections, postoperative infections, meningitis, and patients with acute heart failure with possible superinfection (i.e., pneumonia). In these indications, PCT levels measured on hospital admission were found to substantially reduce the initiation of antibiotic treatment in low-risk situations (i.e., bronchitis, chronic obstructive pulmonary disease exacerbation). For more severe infections (i.e., pneumonia, sepsis), antibiotic stewardship by monitoring of PCT kinetics resulted in shorter antibiotic treatment durations with early cessation of therapy. Importantly, these strategies appear to be safe without increasing the risk for mortality, recurrent infections, or treatment failures. PCT kinetics also proved to have prognostic value correlating with disease severity (i.e., pancreatitis, abdominal infection) and resolution of illness (i.e., sepsis). Although promising findings have been published in these different types of infections, there are a number of limitations regarding PCT, including suboptimal sensitivity and/or specificity, which makes a careful interpretation of PCT in the clinical context mandatory. This narrative review aims to update clinicians on the strengths and limitations of PCT for patient management, focusing on research conducted within the last 4 years.

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“…Incubation of cells with S. aureus resulted in TNF-α production by mononuclear and granulocytic cells [19,20]. Increased levels of sPCT are, however, attenuated by the release of IFN-γ in response to viral infections, and non-infectious inflammatory stimuli, such as autoimmune disease and chronic inflammatory processes, are much less pronounced, rarely exceeding 0·5 ng/ml [21,22]. These findings demonstrate that TNF-α is the main mediator in the S. aureus-induced stimulation of PCT production in monocytes and granulocytes, as the effect could be almost totally abrogated when the cytokine was neutralized by anti-TNF-α [19].…”

mentioning

confidence: 99%

“…These findings demonstrate that TNF-α is the main mediator in the S. aureus-induced stimulation of PCT production in monocytes and granulocytes, as the effect could be almost totally abrogated when the cytokine was neutralized by anti-TNF-α [19]. Increased levels of sPCT are, however, attenuated by the release of IFN-γ in response to viral infections, and non-infectious inflammatory stimuli, such as autoimmune disease and chronic inflammatory processes, are much less pronounced, rarely exceeding 0·5 ng/ml [21,22]. Interestingly, during these processes, the mature CT peptide concentration either does not increase or is only slightly augmented [16,23].…”

mentioning

confidence: 99%

Overview of procalcitonin in pregnancy and in pre-eclampsia

Mangogna

Agostinis

Ricci

et al. 2019

Clinical and Experimental Immunology

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Procalcitonin (PCT), a precursor for calcitonin, is a prohormone involved in the inflammatory processes, which has been poorly studied in the context of pregnancy. During severe inflammation, PCT derives from almost all cell types, including monocytes and parenchymal tissues, making it a good predictive and diagnostic marker of an inflammatory state with rapidly increased serum levels in inflammation or sepsis. In normal pregnancy, PCT is basally expressed at very low level by decidual cells, even if decidual macrophages, which in normal pregnancy are skewed to M2 macrophages, are resistant to lipopolysaccharide (LPS)-induced production of PCT. As PCT increase is associated with an inflammatory state, several research groups investigated whether PCT can be considered a marker of pre-eclampsia, a pregnancy disease characterized by systemic inflammation. The first aim of this review is to summarize what is already known about the tissues synthesizing PCT, about the stimuli that cause the increase of circulating PCT levels and how PCT acts as a proinflammatory stimulus by itself. Secondly, we will describe the role of this prohormone in normal pregnancy and in pregnancies complicated by pre-eclampsia, highlighting the involvement of the decidual macrophages and the proinflammatory cytokine tumor necrosis factor-α in the modulation of PCT expression in the decidual microenvironment.

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Management of patients with respiratory infections in primary care: procalcitonin, C-reactive protein or both?

Cited by 26 publications

References 57 publications

Human Neutrophil Lipocalin in Activated Whole Blood Is a Specific and Rapid Diagnostic Biomarker of Bacterial Infections in the Respiratory Tract

Human Neutrophil Lipocalin in Activated Whole Blood Is a Specific and Rapid Diagnostic Biomarker of Bacterial Infections in the Respiratory Tract

Procalcitonin-guided diagnosis and antibiotic stewardship revisited

Overview of procalcitonin in pregnancy and in pre-eclampsia

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