Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia

Self, Wesley H.; Grijalva, Carlos G.; Williams, Derek J.; Woodworth, Alison; Balk, R.A.; Fakhran, Sherene; Zhu, Yuwei; Courtney, D. Mark; Chappell, James D.; Anderson, Evan J.; Qi, Chao; Waterer, Grant; Trabue, Christopher; Bramley, Anna M.; Jain, Seema; Edwards, Kathryn M.; Wunderink, Richard G.

doi:10.1016/j.chest.2016.04.010

Cited by 45 publications

(29 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17 Biomarkers in isolation perform marginally and are insufficient to predict ICU needs. For example, procalcitonin level had an AUC of 0.69 for predicting the need for vasopressor or mechanical ventilation within 72 hours of presentation 18 and is modestly outperformed by American Thoracic Society and Infectious Diseases Society of America guidelines. 19 Although a serum lactate level of greater than 4 mmol/L in patients with sepsis is a known risk factor for progression to shock and is associated with ICU admission, lactate level alone is not associated with ICU length of stay.…”

Section: Discussionmentioning

confidence: 99%

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Murphy

Johnson

Hall

et al. 2019

American Journal of Critical Care

View full text Add to dashboard Cite

Background Sepsis risk stratification tools typically predict mortality, although stays in the intensive care unit (ICU) of 24 hours or longer may be more clinically relevant for emergency department disposition. Objective To explore predictors of ICU stay of 24 hours or longer among infected, hypotensive emergency department patients. Methods A secondary analysis of 2 prospective, observational studies of adult patients with severe sepsis or an infection with a systolic blood pressure less than 90 mm Hg in 3 urban, academic emergency departments was performed. Patients with hypotension and infection were included. Patients with emergency department intubation, vasopressor administration, and/or death were excluded. The primary outcome was ICU stay of 24 hours or longer or death in less than 24 hours. Multivariable logistic regression was used to predict ICU stay of 24 hours or longer. Results Of 233 patients, 108 (46.4%) had ICU stays of 24 hours or longer. History of heart failure (odds ratio, 3.6; 95% CI, 1.5-8.3), bicarbonate level less than 20 mEq/L (odds ratio, 2.0; 95% CI, 1.1-3.8), respiratory rate greater than 20/min (odds ratio, 2.0; 95% CI, 1.1-3.7), and creatinine level greater than 2.0 mg/dL (odds ratio, 3.6; 95% CI, 1.9-6.7) were independent predictors of ICU stay of 24 hours or longer (area under curve, 0.74). The presence of 1 of these factors predicted ICU stay of 24 hours or longer (area under curve, 0.74) with 82.4% sensitivity and 49.6% specificity. Conclusions These exploratory results show that heart failure, bicarbonate level of less than 20 mEq/L, tachypnea, or creatinine level greater than 2.0 mg/dL increases the likelihood of an ICU stay of 24 hours or longer among infected, hypotensive emergency department patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Murphy

Johnson

Hall

et al. 2019

American Journal of Critical Care

View full text Add to dashboard Cite

show abstract

“…[116][117][118][119] The benefit of procalcitonin, or any other biomarker, over existing validated clinical scoring systems such as the pneumonia severity index, ATS major and minor criteria, or CURB-65 remains unclear. 120 121 CAP and acute cardiac disease Several studies in patients admitted with CAP show an increased risk of acute myocardial infarction, 77-126 cardiac arrhythmia, and new onset heart failure.…”

Section: Guidelinesmentioning

confidence: 99%

Advances in the causes and management of community acquired pneumonia in adults

Wunderink

Waterer

2017

BMJ

158

112

View full text Add to dashboard Cite

Community acquired pneumonia remains a common cause of morbidity and mortality. Usually, the causal organism is not identified and treatment remains empiric. Recent computed tomography and magnetic resonance imaging studies have challenged the accuracy of the clinical diagnosis of pneumonia, and epidemiologic studies are changing our perspective of what causes community acquired pneumonia, especially the role of viral pathogens and the frequent finding of multiple pathogens. The past decade has seen increasing overuse of empiric coverage of meticillin resistant and antibiotic resistant Gram negative pathogens owing to inappropriate application of guidelines for healthcare associated pneumonia. Optimal treatment remains a matter for debate, especially in very sick patients, including the role of combination antibiotic therapy and corticosteroids. Pneumonia care bundles are being defined to improve outcomes. Increased recognition of both acute and long term cardiac complications is shifting our concept of pneumonia from an acute lung disease to a multisystem problem with adverse chronic health consequences.

show abstract

“…Similarly, in the adult EPIC cohort, the addition of PCT contributed significant prognostic information beyond existing severity scores for predicting the need for invasive respiratory or vasopressor support; each 1 µg/L increase in PCT was associated with a 1% to 2% absolute increase in the need for this outcome. 10 A European study of 100 children with pneumonia also demonstrated higher PCT values among hospitalized children (n = 26, median PCT 17.8 µg/L) compared with outpatient children (n = 73, median PCT 0.72 µg/L, P < .01). 11 Among the 532 children from the EPIC study, a PCT < 0.25 µg/L was associated with the reduced odds of ICU admission (adjusted OR: 0.48; 95% CI: 0.30, 0.78) and a 2.3-day (95% CI: 1.4, 3.2) decrease in the average length of stay compared with those with higher PCT concentrations.…”

Section: Procalcitonin For Severity Prediction In Lrtimentioning

confidence: 92%

Clinical Progress Note: Procalcitonin in the Management of Pediatric Lower Respiratory Tract Infection

Katz

Sartori

Williams

2019

Journal of Hospital Medicine

View full text Add to dashboard Cite

Procalcitonin (PCT) is a biomarker that has shown promise to identify bacterial etiology in acute infections, including bacterial lower respiratory tract infection (LRTI). In 2017, the United States Food and Drug Administration (FDA) approved the use of PCT as a diagnostic aid to guide the decisions around antibiotic therapy in acute LRTI.1 Although most of the data supporting the use of PCT for LRTI stems from adult studies, the high disease burden, predominance of viral etiologies, and frequent diagnostic uncertainty resulting in antibiotic overuse make pediatric LRTI an ideal target for the use of PCT as a diagnostic aid. This review evaluates and summarizes the current evidence regarding the role of PCT in the clinical care of pediatric LRTI, including its use in guiding antibiotic use and prognosticating disease severity.

show abstract

Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia

Abstract: Serum PCT concentration was strongly associated with the risk of requiring IRVS among adults hospitalized with CAP and is potentially useful for guiding decisions about ICU admission.

Cited by 45 publications

References 33 publications

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Predicting Prolonged Intensive Care Unit Stay Among Patients With Sepsis-Induced Hypotension

Advances in the causes and management of community acquired pneumonia in adults

Clinical Progress Note: Procalcitonin in the Management of Pediatric Lower Respiratory Tract Infection

Contact Info

Product

Resources

About