Significance of high levels of procalcitonin in patients with influenza A (H1N1) pneumonia

Guervilly, Christophe; Coisel, Y.; Botelho-Nevers, E; Dizier, Stéphanie; Castanier, Matthias; Lepaul-Ercole, Renaud; Brissy, Olivier; Roch, Antoine; Forel, Jean-Marie; Papazian, Laurent

doi:10.1016/j.jinf.2010.07.013

Cited by 19 publications

(23 citation statements)

References 11 publications

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“…Guervilly et al observed that patients infected with this virus might present high PCT levels despite the absence of bacterial coinfection (13). Similar results were reported by Cunha et al in subjects with a definite or probable 2009 H1N1 diagnosis (14).…”

Section: Discussionmentioning

confidence: 99%

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The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

Paiva¹,

Botoni²,

Teixeira³

et al. 2012

Clinics

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OBJECTIVES:During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection.METHODS:The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs.RESULTS:Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1β were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients.CONCLUSION:Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes.

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Section: Discussionmentioning

confidence: 99%

“…It has been suggested that the immune response against the 2009 H1N1 virus might diverge from that observed against the seasonal influenza virus (16). Interestingly, elevated levels of PCT have been observed in patients with viral 2009 H1N1 infection even when the patients did not have a concomitant bacterial infection (13,14). …”

Section: Introductionmentioning

confidence: 99%

The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

Paiva¹,

Botoni²,

Teixeira³

et al. 2012

Clinics

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“…This immune response is complex however and biomarker dynamics may not be specific to the underlying disease and clinical status of the patient (26). When monitoring biomarker levels confounding factors should be taken in to consideration for example the effect of age, antibiotic pretreatment, corticosteroids, chronic hepatic disease, renal impairment and viral confection (10,(42)(43)(44)(45). For example, there is concern that the PCT response in patients with influenza, particularly influenza A (H1N1) PDM 09 may relate to the severity of viral pneumonitis as oppose to the bacterial co-infection (43,46).…”

Section: Signalling or Functioning Are Biomarkers Good Surrogates Fomentioning

confidence: 99%

“…When monitoring biomarker levels confounding factors should be taken in to consideration for example the effect of age, antibiotic pretreatment, corticosteroids, chronic hepatic disease, renal impairment and viral confection (10,(42)(43)(44)(45). For example, there is concern that the PCT response in patients with influenza, particularly influenza A (H1N1) PDM 09 may relate to the severity of viral pneumonitis as oppose to the bacterial co-infection (43,46). However, recently this was disputed when a study of 972 patients with H1N1 found that a cut off PCT of <0.29 ng/mL in a population with a 20% prevalence of community acquired respiratory coinfection has a high negative predictive value of 92%.…”

Section: Signalling or Functioning Are Biomarkers Good Surrogates Fomentioning

confidence: 99%

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

Morley¹,

Torres²,

Cillóniz³

et al. 2017

Ann. Transl. Med.

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Community acquired pneumonia (CAP) is the leading infectious cause of mortality worldwide with approximately 10% of patients hospitalized requiring intensive care unit (ICU) admission. The ability to predict clinical stability (CS) and treatment failure (TF) enables the clinician to alter antibiotics appropriately, facilitate a timely ICU admission, or arrange a suitable discharge. The detection of CS and TF can be difficult and changes in clinical signs may be subtle or delayed. Thus clinical scores and biomarkers are routinely used to identify severity and monitor clinical progression. The evidence, however, is vast and the definitive role of these systems is at times difficult to elucidate. The aim of this review is to analyse the current literature and to provide a rational and clinically focused view of the predictive utility of various systems used to identify CS and TF in CAP.

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“…Recently, several studies have examined its ability to differentiate influenza pneumonia from mixed bacterial and viral infections. However, the relatively small sample sizes in these studies have limited its generalizability 12–17 …”

Section: Introductionmentioning

confidence: 99%

Can procalcitonin tests aid in identifying bacterial infections associated with influenza pneumonia? A systematic review and meta-analysis

Huang

et al. 2012

Influenza and Other Respiratory Viruses

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Objective To summarize evidence for the diagnostic accuracy of procalcitonin (PCT) tests for identifying secondary bacterial infections in patients with influenza. Methods Major databases, including MEDLINE, EMBASE, and the Cochrane Library, were searched for studies published between January 1966 and May 2009 that evaluated PCT as a marker for diagnosing bacterial infections in patients with influenza infections and that provided sufficient data to construct two‐by‐two tables. Results Six studies were selected that included 137 cases with bacterial coinfection and 381 cases without coinfection. The area under a summary ROC curve was 0·68 (95% CI: 0·64–0·72). The overall sensitivity and specificity estimates for PCT tests were 0·84 (95% CI: 0·75–0·90) and 0·64 (95% CI: 0·58–0·69), respectively. These studies reported heterogeneous sensitivity estimates ranging from 0·74 to 1·0. The positive likelihood ratio for PCT (LR+ = 2·31; 95% CI: 1·93–2·78) was not sufficiently high for its use as a rule‐in diagnostic tool, while its negative likelihood ratio was reasonably low for its use as a rule‐out diagnostic tool (LR− = 0·26; 95% CI: 0·17–0·40). Conclusions Procalcitonin tests have a high sensitivity, particularly for ICU patients, but a low specificity for identifying secondary bacterial infections among patients with influenza. Because of its suboptimal positive likelihood ratio and good negative likelihood ratio, it can be used as a suitable rule‐out test but cannot be used as a standalone rule‐in test.

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Significance of high levels of procalcitonin in patients with influenza A (H1N1) pneumonia

Cited by 19 publications

References 11 publications

The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

Predictors of treatment failure and clinical stability in patients with community acquired pneumonia

Can procalcitonin tests aid in identifying bacterial infections associated with influenza pneumonia? A systematic review and meta-analysis

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