Procalcitonin: Inflammatory Biomarker for Assessing the Severity of Community-Acquired Pneumonia – A Clinical Observation in Geriatric Patients

Abstract

Community-acquired pneumonia is a common disease of the elderly and involves a high mortality risk. Demographic developments are creating new challenges for acute medical treatment strategies in geriatric patients with their underlying multimorbidity. In addition to the diagnostic parameters recorded on hospital admission, such as white cell count and C-reactive protein, procalcitonin, more than the risk scores CRB- and CURB-65 evaluated to date, appears to be a promising parameter for assessing the severity of pneumonia in elderly patients to allow early detection of severe courses and initiation of suitable treatment. The decisive factor is the dynamic course of the procalcitonin values over 3 consecutive days, as demonstrated in this case series.

C-Reactive Protein, Procalcitonin, Clinical Pulmonary Infection Score, and Pneumonia Severity Scores in Nursing Home Acquired Pneumonia

“…In our study, serum procalcitonin levels Ͻ 1.1 ng/mL upon admission were associated with an improved survival. These results are in agreement with previous studies regarding the value of procalcitonin in the prognosis of severe CAP, 24,25,29,30 where a similar cutoff value of procalcitonin (Ͻ 0.95 ng/ mL) was associated with a favorable outcome.…”

“…1,2,[8][9][10]12,17,[20][21][22][23][24] The results from our study showed that CURB-65 and the pneumonia severity index were more accurate in predicting in-hospital mortality from NHAP compared with the other pneumonia severity scores. The findings are in agreement with previous studies 10,20,24 but in contrast to other studies. [8][9][10]12 These differences are likely to reflect the fact that most nursing home residents have a worse general condition due to comorbidities, making the estimation of the risk of death based on clinical parameters difficult and less accurate.…”

“…2 C-reactive protein and procalcitonin have been described as reliable markers for the diagnosis and prognosis of CAP and VAP with contradictory results, especially for VAP. [3][4][5][6][24][25][26][27][28][29][30] According to American Thoracic Society/Infectious Diseases Society of America guidelines, NHAP is considered to be a distinct group of respiratory infections with more similarities with hospital acquired pneumonia and VAP than with CAP. 15 However, there are only limited data in the literature on the role of biomarkers in NHAP.…”

Clinical characteristics and prognostic factors in elderly patients with COVID-19

“…Procalcitonin had emerged as an indicator of bacterial infection and helped initiate or discontinue antibiotic therapy [22,23]. In elderly patients with community acquired pneumonia, procalcitonin allowed early detection of severe courses and initiation of suitable treatment [24]. The qSOFA score was rst used to identify risk of patients with sepsis for a poor outcome, it only required a few parameters and vital signs, which made it easy to operate in isolation wards.…”

Besonderheiten des älteren Notfallpatienten

“…So können initial fehlerhaft getroffene Entscheidungen in der Notaufnahme, welche zu einer falschen Therapie und nachfolgend schlechteren Prognose für die Patienten führen, vermieden werden. Prokalzitonin bietet sich als Biomarker zur verlässlichen Detektion einer bakteriellen Infektion beim älteren Patienten an, um durch diese Intensivierung der Diagnostik Risikopatienten zu identifizieren und rasch und richtig die individuelle Initialtherapie beginnen zu können [25].…”