Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes

Krüger, Stefan; Ewig, Santiago; Marre, R.; Papassotiriou, Jana; Richter, K; Baum, Heike von; Suttorp, Norbert; Welte, Tobias

doi:10.1183/09031936.00054507

Cited by 258 publications

(212 citation statements)

References 23 publications

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“…6,8,21 However, in the present study, we did not find the semi-quantitative serum procalcitonin test to be useful for predicting mortality from CAP. We propose 2 explanations for this discrepancy.…”

Section: Discussioncontrasting

confidence: 49%

Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia

Ugajin¹,

Yamaki²,

Hirasawa³

et al. 2013

Respir Care

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BACKGROUND:The semi-quantitative serum procalcitonin test (Brahms PCT-Q) is available conveniently in clinical practice. However, there are few data on the relationship between results for this semi-quantitative procalcitonin test and clinical outcomes of community-acquired pneumonia (CAP). We investigated the usefulness of this procalcitonin test for predicting the clinical outcomes of CAP in comparison with severity scoring systems and the blood urea nitrogen/serum albumin (B/A) ratio, which has been reported to be a simple but reliable prognostic indicator in our prior CAP study. METHODS: This retrospective study included data from subjects who were hospitalized for CAP from August 2010 through October 2012 and who were administered the semiquantitative serum procalcitonin test on admission. The demographic characteristics; laboratory biomarkers; microbiological test results; Pneumonia Severity Index scores; confusion, urea nitrogen, breathing frequency, blood pressure, > 65 years of age (CURB-65) scale scores; and age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scale scores on hospital admission were retrieved from their medical charts. The outcomes were mortality within 28 days of hospital admission and the need for intensive care. RESULTS: Of the 213 subjects with CAP who were enrolled in the study, 20 died within 28 days of hospital admission, and 32 required intensive care. Mortality did not differ significantly among subjects with different semi-quantitative serum procalcitonin levels; however, subjects with serum procalcitonin levels > 10.0 ng/mL were more likely to require intensive care than those with lower levels (P < .001). The elevation of semi-quantitative serum procalcitonin levels was more frequently observed in subjects with proven etiology, especially pneumococcal pneumonia. Using the receiver operating characteristic curves for mortality, the area under the curve was 0.86 for Pneumonia Severity Index class, 0.81 for B/A ratio, 0.81 for A-DROP, 0.80 for CURB-65, and 0.57 for semi-quantitative procalcitonin test. CONCLU-SIONS: The semi-quantitative serum procalcitonin level on hospital admission was less predictive of mortality from CAP compared with the B/A ratio. However, the subjects with serum procalcitonin levels > 10.0 ng/mL were more likely to require intensive care than those with lower levels.

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Section: Discussioncontrasting

confidence: 49%

Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia

Ugajin¹,

Yamaki²,

Hirasawa³

et al. 2013

Respir Care

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“…Platelet-neutrophil interactions play a pivotal role in NETosis [26,27]. PCT is commonly used as an inflammatory marker and is useful for predicting the prognosis and deciding whether to use antibiotics in pneumonia [28,29]. Nosocomial tracheobronchitis is common in mechanically ventilated ICU patients [30].…”

Section: Discussionmentioning

confidence: 99%

Neutrophil extracellular traps in bronchial aspirates: a quantitative analysis

Hamaguchi

Hirose

Matsumoto

et al. 2014

European Respiratory Journal

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Neutrophil extracellular traps (NETs) are structures composed of DNA and granular proteins, which rapidly trap and kill pathogens. The formation of NETs has been detected during infection in animal experiments, but their role in humans is unclear. The purposes of this study were to quantitatively evaluate the production of NETs during acute respiratory infection and to study the relationship between the NET length and various inflammatory mediators.We examined bronchial aspirates collected from nine intubated patients in an intensive care unit. Samples were collected at the onset of acute respiratory infection (day 0) and on days 1, 3-5, and 6-8. The NET length was visualised by immunohistochemistry and quantified using computer tracing software.The NET length was measured and compared at each time point. The length differed significantly between time points (p,0.001). NETs were significantly longer on day 1 than on day 0 (p,0.001). Neutrophils released NETs abundantly in response to respiratory infection and regression analysis showed that NET length correlated with six clinical parameters (white blood cells, platelets, lactate, CXC ligand-2, interleukin-8, and procalcitonin) as the explanatory variables.NETs in bronchial aspirates may reflect disease progression of respiratory infections. Quantification of NETs in bronchial aspirates may provide a new indicator of inflammation. @ERSpublications NET length increases with respiratory inflammation which correlates with progression of infections

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“…In the study done by Müller et al, the mean age was 67 ± 18 years. In the study by Krüger et al, 16 the mean ± SD (range) age was 61 ± 18 (18-98) years. In our study of 35 patients PCT < 0.5 ng/mL, out of which 19 (54.3%) had CRP <6 mg/mL, 16 (45.7%) had CRP >6 mg/mL.…”

Section: Discussionmentioning

confidence: 99%

Study of Clinical Profile of Community-acquired Pneumonia with Special Reference to C-reactive Protein and Procalcitonin Levels

Prajwal¹,

Krishna²,

Patil³

2016

The Journal of Medical Sciences

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Introduction: Pneumonia is defined as an infection of the pulmonary parenchyma. Despite being the cause of significant complications and deaths, pneumonia is often wrongly diagnosed, mistreated, and underestimated. The incidence rates are highest in old-aged patients. In the current prospective observational study, we intend to study the utility of procalcitonin (PCT) level and serum C-reactive protein (CRP) level for diagnosing pneumonia.Design: Prospective observational studies. Materials and methods:The study was conducted in RajaRajeswari Medical College and Hospital, Bengaluru, during the period extending from June to May 2014. Eighty patients, aged more than 18 years, with diagnosis of pneumonia were included in the study. Serum PCT levels were calculated using BRAHMS PCT Kryptor immunofluorescent assay (Biomerieux, France). Other routine investigations, including CRP, sputum culture, and endotracheal secretions cultures, were done. Chisquare analysis was done to assess its prognostic and diagnostic significance. Data were analysed with Statistical Package for the Social Sciences (version 17.0 for Windows).Results and conclusion: C-reactive protein was positive in 60 (75%) of the patients, and PCT was positive in 45 (56.25%) patients; 28 patients had PCT levels 0.5 to 1.5 ng/mL, 1 (3.6%) had CRP <6 mg/mL, 27 (96.4%) had CRP >6 mg/mL; 17 patients had PCT values >1.5 ng/mL and CRP was positive in all patients (p < 0.001). Streptococcus pneumonia was the most common and isolated in 8 (10%) patients. C-reactive protein is a useful and better adjuvant in the diagnosis of community-acquired pneumonia (CAP). Positive PCT levels indicate a bacterial etiology for pneumonia. A high PCT level is a poor prognostic indicator and is associated with a higher mortality.

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Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes

Cited by 258 publications

References 23 publications

Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia

Predictive Values of Semi-Quantitative Procalcitonin Test and Common Biomarkers for the Clinical Outcomes of Community-Acquired Pneumonia

Neutrophil extracellular traps in bronchial aspirates: a quantitative analysis

Study of Clinical Profile of Community-acquired Pneumonia with Special Reference to C-reactive Protein and Procalcitonin Levels

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