BACKGROUND
The clinical utility of procalcitonin in the diagnosis and management of pneumonia remains controversial.
METHODS
We assessed the clinical utility of procalcitonin in 2 prospective studies: first, a multicenter diagnostic study in patients presenting to the emergency department with acute dyspnea to directly compare the diagnostic accuracy of procalcitonin with that of interleukin 6 and C-reactive protein (CRP) in the diagnosis of pneumonia; second, a randomized management study of procalcitonin guidance in patients with acute heart failure and suspected pneumonia. Diagnostic accuracy for pneumonia as centrally adjudicated by 2 independent experts was quantified with the area under the ROC curve (AUC).
RESULTS
Among 690 patients in the diagnostic study, 178 (25.8%) had an adjudicated final diagnosis of pneumonia. Procalcitonin, interleukin 6, and CRP were significantly higher in patients with pneumonia than in those without. When compared to procalcitonin (AUC = 0.75; 95% CI, 0.71–0.78), interleukin 6 (AUC = 0.80; 95% CI, 0.77–0.83) and CRP (AUC = 0.82; 95% CI, 0.79–0.85) had significantly higher diagnostic accuracy (P = 0.010 and P < 0.001, respectively). The management study was stopped early owing to the unexpectedly low AUC of procalcitonin in the diagnostic study. Among 45 randomized patients, the number of days on antibiotic therapy and the length of hospital stay were similar (both P = 0.39) in patients randomized to the procalcitonin-guided group (n = 25) and usual-care group (n = 20).
CONCLUSIONS
In patients presenting with dyspnea, diagnostic accuracy of procalcitonin for pneumonia is only moderate and lower than that of interleukin 6 and CRP. The clinical utility of procalcitonin was lower than expected.
SUMMARY
Pneumonia has diverse and often unspecific symptoms. As the role of biomarkers in the diagnosis of pneumonia remains controversial, it is often difficult to distinguish pneumonia from other illnesses causing shortness of breath. The current study prospectively enrolled unselected patients presenting with acute dyspnea and directly compared the diagnostic accuracy of procalcitonin, interleukin 6, and CRP for the diagnosis of pneumonia. In this setting, diagnostic accuracy of procalcitonin for pneumonia was lower as compared to interleukin 6 and CRP. The clinical utility of procalcitonin was lower than expected.
ClinicalTrials.gov Identifier
NCT01831115.
This quality improvement initiative in sepsis in an emerging country was associated with a reduction in mortality and with improved compliance with quality indicators. However, this reduction was sustained only in private institutions.
IntroductionDespite having higher sensitivity as compared to conventional troponins,
sensitive troponins have lower specificity, mainly in patients with renal
failure.ObjectiveStudy aimed at assessing the sensitive troponin I levels in patients with
chest pain, and relating them to the existence of significant coronary
lesions.MethodsRetrospective, single-center, observational. This study included 991 patients
divided into two groups: with (N = 681) and without (N = 310) significant
coronary lesion. For posterior analysis, the patients were divided into two
other groups: with (N = 184) and without (N = 807) chronic renal failure.
The commercial ADVIA Centaur® TnI-Ultra assay (Siemens
Healthcare Diagnostics) was used. The ROC curve analysis was performed to
identify the sensitivity and specificity of the best cutoff point of
troponin as a discriminator of the probability of significant coronary
lesion. The associations were considered significant when p < 0.05.ResultsThe median age was 63 years, and 52% of the patients were of the male sex.
The area under the ROC curve between the troponin levels and significant
coronary lesions was 0.685 (95% CI: 0.65 - 0.72). In patients with or
without renal failure, the areas under the ROC curve were 0.703 (95% CI:
0.66 - 0.74) and 0.608 (95% CI: 0.52 - 0.70), respectively. The best cutoff
points to discriminate the presence of significant coronary lesion were: in
the general population, 0.605 ng/dL (sensitivity, 63.4%; specificity, 67%);
in patients without renal failure, 0.605 ng/dL (sensitivity, 62.7%;
specificity, 71%); and in patients with chronic renal failure, 0.515 ng/dL
(sensitivity, 80.6%; specificity, 42%).ConclusionIn patients with chest pain, sensitive troponin I showed a good correlation
with significant coronary lesions when its level was greater than 0.605
ng/dL. In patients with chronic renal failure, a significant decrease in
specificity was observed in the correlation of troponin levels and severe
coronary lesions.
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