Pneumonitis-Associated Hyperprocalcitoninemia

Nylen, Eric; Rohatgi, Prashant K.; Becker, Kenneth L.; Snider, Richard H.; Thompson, Kenneth

doi:10.1016/s0002-9629(15)41740-9

Cited by 81 publications

(46 citation statements)

References 20 publications

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“…An elevated, >0.5 ng . mL -1 serum PCT level was found in over half of PNC pneumonia cases, in agreement with previous studies on bacterial pneumonia [14,15]. On the other hand, that limit was exceeded as often as in one third of viral pneumonia cases.…”

Section: Discussionsupporting

confidence: 92%

Serum procalcitonin in pneumococcal pneumonia in children

Korppi

Remes

2001

Eur Respir J

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Serum procalcitonin in pneumococcal pneumonia in children. M. Korppi, S. Remes. #ERS Journals Ltd 2001. ABSTRACT: Serum procalcitonin (PCT), a marker of bacterial infection, was measured in children with pneumonia to examine whether PCT can be used to screen pneumococcal (PNC) from viral pneumonia.The number of patients was 132; mean age 3.0 yrs, and 64% were males. In all cases, pneumonia was radiologically con®rmed, being alveolar in 46 and interstitial in 86 cases. The aetiology of infection was studied by a panel of serological tests for PNC, for ®ve other respiratory bacteria and for seven common respiratory viruses. PNC infection was found in 25, mixed viral-PNC infections in 13 and viral infection in 17 cases.In general, serum PCT was not associated with the type or aetiology of pneumonia. PCT values were >1.0 mg . L -1 in 40% of PNC cases, as compared to 12±15% in viral or mixed cases, respectively (p<0.05). PCT values were signi®cantly higher in >2 yrs old children than in younger ones. The cut-off limits of 0.5 ng . mL -1 , 1.0 ng . mL -1 and 2.0 ng . mL -1 were tested for screening between PNC and viral pneumonia. The highest sensitivity of 55% was found at the 0.5 ng . mL -1 cut-off level, whereas the highest speci®city of 88% was reached at the level of 1.0 ng . mL -1 . The likelihood ratios, however, were far from optimal for both the positive and negative results.Although marginally higher in pneumococcal pneumonia than in viral pneumonia, serum procalcitonin cannot be used to discriminate between these two types of pneumonia. Community-acquired pneumonia is a common clinical problem in childhood. Bacterial pneumonia cannot be differentiated from viral pneumonia on the basis of clinical or chest radiographic ®ndings [1±3]. In young children, the most important problem is how to differentiate between pneumonia caused by respiratory viruses and Streptococcus pneumoniae [1,4]. In addition, mixed infections caused by viruses and bacteria, especially respiratory syncytial virus (RSV) and pneumococci (PNC), are common [5]. Leukocyte count, serum C-reactive protein (CRP) concentration or another nonspeci®c laboratory ®nding sometimes helps to differentiate between either bacterial or viral aetiology. In recent years, several studies have focused on the use of CRP in bacterial and viral respiratory infections in children, but the results have been inconsistent [6±8]. Therefore, most children with pneumonia are treated with antibiotics without knowledge of the causative agent.Procalcitonin (PCT) is a newly recognized marker of bacterial infection [9], it contributes to the differentiation between septic and other infections in neonates [10] and older paediatric patients [11]. In a panel of children in which the aetiology of infection was assessed [12], it was examined whether PCT can be applied for the discrimination between bacterial and especially pneumococcal pneumonia and viral aetiology of pneumonia. Material and methods Study subjectsIn the course of a prospective study in 1981±1982, 195 children wer...

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Section: Discussionsupporting

confidence: 92%

Serum procalcitonin in pneumococcal pneumonia in children

Korppi

Remes

2001

Eur Respir J

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“…Previously, increases in serum calcitonin-like reactivities were found in patients with infections [14] or with lung disease [11,12]. However, the methods employed did not discriminate between calcitonin and procalcitonin although some of the "calcitonin-like activity" in these studies may well be attributable to increases in procalcitonin levels.…”

Section: Measurement Of Procalcitoninmentioning

confidence: 65%

“…Thus, patients who have previously undergone a total thyroidectomy can still produce high levels of procalcitonin during a severe infectious episode [9]. The exact site of procalcitonin production during sepsis is uncertain; one investigator, using katacalcin antibodies, has identified procalcitonin-like activity in human leukocytes [10], others suggest neuroendocrine cells and the lungs [11][12][13] as possible sites of production. Remarkably, the large amounts of procalcitonin produced during infections do not lead to an increase in plasma calcitonin levels or activity [9].…”

Section: Physiology Of Procalcitoninmentioning

confidence: 99%

Procalcitonin — A new indicator of the systemic response to severe infections

et al. 1997

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“…In the PCT group, the physician was advised to follow the antibiotic treatment algorithm based on the PCT value and the likelihood of bacterial disease [1,12,58,59]. In four now completed intervention trials enrolling .1,200 patients, the success of the intervention was measured by clinical outcomes, assuming that if the patient recovered without antibiotics then there was no serious bacterial illness [60][61][62][63].…”

Section: Pct For Antibiotic Stewardship Of Respiratory Tract Infectionsmentioning

confidence: 99%

Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators

Christ‐Crain¹,

Müller²

2007

European Respiratory Journal

221

149

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Used appropriately, biomarkers improve the assessment of respiratory tract infections and sepsis. Most prominently, circulating procalcitonin levels increase by a factor of several tens of thousands during sepsis. Using a sensitive assay, procalcitonin safely and markedly reduces antibiotic usage in respiratory tract infections and nonbacterial meningitis. Procalcitonin is the protopye of hormokine mediators. The term ''hormokine'' encompasses the cytokine-like behaviour of hormones during inflammation and infections. The concept is based on a ubiquitous expression of calcitonin peptides during sepsis. Adrenomedullin, another member of the calcitonin peptide superfamily, was shown to complement and improve the current prognostic assessment in lower respiratory tract infections. Other peptides share some features of hormokines, e.g. natriuretic peptide and copeptin. Hormokines are not only biomarkers of infection but are also pivotal inflammatory mediators. Like all mediators, their role during systemic infections is basically beneficial, possibly to combat invading microbes. However, at increased levels they can become harmful for their host. Multiple mechanisms of action were proposed. In several animal models the modulation and neutralisation of hormokines during infection was shown to improve survival, and thus might open new treatment options for severe infections, especially of the respiratory tract.

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Pneumonitis-Associated Hyperprocalcitoninemia

Cited by 81 publications

References 20 publications

Serum procalcitonin in pneumococcal pneumonia in children

Serum procalcitonin in pneumococcal pneumonia in children

Procalcitonin — A new indicator of the systemic response to severe infections

Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators

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