Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Shi, Yan; Xu, Yingchun; Rui, Xiaoting; Zhang, Hongmin; Wang, Yao; Du, Wei

doi:10.4187/respcare.02364

Cited by 13 publications

(15 citation statements)

References 37 publications

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“…While some investigators reported usefulness of PCT for diagnosing bacterial infection in the elderly [8, 11, 47], others revealed that PCT was inferior to CRP for predicting bacterial infection in these population [9, 48, 49]. As for predicting capacity for clinical course, Shi et al reported that there were no differences in PCT between the improved and not-improved subjects in nosocomial pneumonia in the elderly [50]. To our knowledge, this is the first study to examine the relationship between PCT levels by pneumonia severity in younger and elderly patients with pneumonia, particularly patients with S. pneumoniae pneumonia, occurring outside the hospital setting.…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, this is the first study to examine the relationship between PCT levels by pneumonia severity in younger and elderly patients with pneumonia, particularly patients with S. pneumoniae pneumonia, occurring outside the hospital setting. In addition, the present study included more elderly patients than those that previously assessed the clinical usefulness of PCT in the elderly population [8–11, 47–50]. We assessed the relationship between PCT and PSI, because mortality in this frail elderly population is frequently not directly due to pneumonia [51], and PSI could be more specific of pneumonia severity than all cause mortality.…”

Section: Discussionmentioning

confidence: 99%

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Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital

et al. 2019

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BackgroundProcalcitonin (PCT) is a useful marker for pneumonia. However, its clinical usefulness in elderly patients has not been studied extensively. This study aimed to assess the relationship between PCT and prognosis and pneumonia severity in elderly patients with pneumonia acquired outside the hospital.MethodsData considered relevant to pneumonia severity and prognosis were retrospectively obtained from clinical charts of all patients with pneumonia who were admitted to our hospital from 2010 to 2017. The primary outcome was 30-day mortality in elderly patients (aged ≥75 years), and the relationship between PCT levels and pneumonia severity, as determined by the pneumonia severity index (PSI) was also examined.ResultsData were collected from 667 patients, of which 436 were elderly patients. Multivariate and receiver operating characteristic curve analysis revealed that albumin, body mass index, and PSI class rather than PCT are important factors related to 30-day mortality in elderly patients. PCT was also not an independent prognostic factor in younger patients. PCT levels significantly differed by pneumonia severity (mild, moderate, and severe) in both younger (p < 0.001) and elderly (p < 0.0001) patients, with levels increasing as severity increased. In contrast, C-reactive protein (CRP) levels and white blood cell counts did not significantly differ by pneumonia severity in younger and elderly patients. A subgroup analysis focused on Streptococcus pneumoniae pneumonia revealed that PCT levels differed by severity in elderly patients (p = 0.03), with levels increasing as severity increased.ConclusionPCT was not an independent predictor of 30-day mortality in both of elderly and younger patients. PCT levels, but not CRP levels, significantly increased with increasing pneumonia severity in younger and elderly patients, although the degree of increase tended to be lower in elderly patients compared to younger patients for the same severity. PCT levels also significantly increased with increasing pneumonia severity in elderly patients with Streptococcus pneumoniae pneumonia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital

et al. 2019

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“…In addition to CAP, we investigated the role of PCT in patients with HCAP, a group with limited investigation in this field [30, 31]. It is interesting to note that there was no significant difference between PCT values for patients with CAP and HCAP.…”

Section: Discussionmentioning

confidence: 99%

Serial Procalcitonin as a Predictor of Bacteremia and Need for Intensive Care Unit Care in Adults With Pneumonia, Including Those With Highest Severity: A Prospective Cohort Study

McCluskey

Schuetz

Bearnot³

et al. 2017

Open Forum Infectious Diseases

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Background.Procalcitonin (PCT) is a prohormone that rises in bacterial pneumonia and has promise in reducing antibiotic use. Despite these attributes, there are inconclusive data on its use for clinical prognostication. We hypothesize that serial PCT measurements can predict mortality, intensive care unit (ICU) admission, and bacteremia.Methods.A prospective cohort study of inpatients diagnosed with pneumonia was performed at a large tertiary care center in Boston, Massachusetts. Procalcitonin was measured on days 1 through 4. The primary endpoint was a composite adverse outcome defined as all-cause mortality, ICU admission, and bacteremia. Regression models were calculated with area under the receiver operating characteristic curve (AUC) as a measure of discrimination.Results.Of 505 patients, 317 patients had a final diagnosis of community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP). Procalcitonin was significantly higher for CAP and HCAP patients meeting the composite primary endpoint, bacteremia, and ICU admission, but not mortality. Incorporation of serial PCT levels into a statistical model including the Pneumonia Severity Index (PSI) improved the prognostic performance of the PSI with respect to the primary composite endpoint (AUC from 0.61 to 0.66), bacteremia (AUC from 0.67 to 0.85), and need for ICU-level care (AUC from 0.58 to 0.64). For patients in the highest risk class PSI >130, PCT was capable of further risk stratification for prediction of adverse outcomes.Conclusion.Serial PCT measurement in patients with pneumonia shows promise for predicting adverse clinical outcomes, including in those at highest mortality risk.

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“…In a recent study involving 60 older patients with nosocomial pneumonia who were admitted to the ICU, the evaluation of PCT kinetics between the time of admission and the third day of follow-up was the best single predictor of therapeutic efficacy, with an AUC of 0.79 (p < 0.001). ( 38 ) Similarly, a study from 2006 evaluated the prognostic value of PCT kinetics in patients with CAP who were admitted to the ICU; the study indicated favorable results. ( 39 ) One hundred patients were included, and serum PCT levels were measured on days 1 and 3.…”

Section: Prognostic Value Of Procalcitonin In Lower Respiratory Tractmentioning

confidence: 99%

Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections

Nobre¹,

Borges²

2016

Revista Brasileira De Terapia Intensiva

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Lower respiratory tract infections are common and potentially lethal conditions and are a major cause of inadequate antibiotic prescriptions. Characterization of disease severity and prognostic prediction in affected patients can aid disease management and can increase accuracy in determining the need for and place of hospitalization. The inclusion of biomarkers, particularly procalcitonin, in the decision taken process is a promising strategy. This study aims to present a narrative review of the potential applications and limitations of procalcitonin as a prognostic marker in hospitalized patients with lower respiratory tract infections. The studies on this topic are heterogeneous with respect to procalcitonin measurement techniques, cutoff values, clinical settings, and disease severity. The results show that procalcitonin delivers moderate performance for prognostic prediction in patients with lower respiratory tract infections; its predictive performance was not higher than that of classical methods, and knowledge of procalcitonin levels is most useful when interpreted together with other clinical and laboratory results. Overall, repeated measurement of the procalcitonin levels during the first days of treatment provides more prognostic information than a single measurement; however, information on the cost-effectiveness of this procedure in intensive care patients is lacking. The results of studies that evaluated the prognostic value of initial procalcitonin levels in patients with community-acquired pneumonia are more consistent and have greater potential for practical application; in this case, low procalcitonin levels identify those patients with a low risk of adverse outcomes.

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Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients

Cited by 13 publications

References 37 publications

Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital

Procalcitonin is not an independent predictor of 30-day mortality, albeit predicts pneumonia severity in patients with pneumonia acquired outside the hospital

Serial Procalcitonin as a Predictor of Bacteremia and Need for Intensive Care Unit Care in Adults With Pneumonia, Including Those With Highest Severity: A Prospective Cohort Study

Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections

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