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

Abstract

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.

Prognostic value of severity indicators of nursing-home-acquired pneumonia versus community-acquired pneumonia in elderly patients

“…Therefore, more simple severity indicators such as the CURB-65 scale and the A-DROP scale have been advocated and widely used 7,8. As a simple and objective severity indicator for CAP patients, we introduced the B/A ratio through our previous studies 9,10. The present study also showed that the B/A ratio was a good prognostic indicator for CAP patients through the ROC curve analysis.…”

“…The ATS/IDSA recommends the pneumonia severity index (PSI);6 the British Thoracic Society recommends the confusion, urea, respiratory rate, blood pressure, and age ≥65 (CURB-65) scale;7 and the Japanese Respiratory Society recommends the age, dehydration, respiratory failure, orientation disturbance, and pressure (A-DROP) scale 8. Moreover, we previously reported that the ratio of blood urea nitrogen to serum albumin (B/A) is a simple severity indicator for CAP 9,10. However, the credibility of these severity indicators in NHAP has not been confirmed.…”

Community-acquired pneumonia

“…In addition, procalcitonin levels are higher in bacterial versus viral or atypical CAP [12,60]. Procalcitonin may be specifically elevated in pneumococcal CAP [60,61] and in patients with bacteremic CAP [60]. Procalcitonin may be specifically elevated in pneumococcal CAP [60,61] and in patients with bacteremic CAP [60].…”

Procalcitonin Levels in Acute Respiratory Infection

“…PCT has a high negative predictive value (15). If PCT is negative, it is highly unlikely there is a systemic inflammatory reaction due to bacteria.…”