Prognostic value of procalcitonin in community-acquired pneumonia

Schuetz, Philipp; Suter‐Widmer, Isabelle; Chaudri, A.; Christ‐Crain, Mirjam; Zimmerli, Werner; Müeller, Beat

doi:10.1183/09031936.00035610

Cited by 149 publications

(133 citation statements)

References 28 publications

Supporting

Mentioning

115

Contrasting

Unclassified

Order By: Relevance

“…Elevation of the serum procalcitonin level in patients with CAP, unless sepsis is present, is generally minimal. 24 Schuetz et al 20 showed that although the serum procalcitonin level was significantly higher in non-survivors of CAP than in survivors, the difference between the median values was very small (0.39 ng/mL). In contrast, PCT-Q categorizes serum procalcitonin levels into only 4 grades (Ͻ 0.5, 0.5 to Ͻ 2.0, 2.0 to Ͻ 10.0, and Ն 10.0 ng/mL).…”

Section: Discussionmentioning

confidence: 99%

“…ICϭ intensive care CURB-65ϭ confusion, urea nitrogen, breathing frequency, blood pressure, Ն 65 years of age A-DROPϭ age, dehydration, respiratory failure, orientation disturbance, pressure B/A ratioϭ blood urea nitrogen to serum albumin ratio half of the patients who were admitted to ICUs had serum procalcitonin levels of Ͻ 0.5 ng/mL. 20 In short, semiquantitative serum procalcitonin levels Ն 10.0 ng/mL might indicate a high probability of need for intensive care, but the lower levels of semi-quantitative serum procalcitonin cannot exclude the possibility of the need for intensive care.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Ugajin¹,

Yamaki²,

Hirasawa³

et al. 2013

Respir Care

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Ugajin¹,

Yamaki²,

Hirasawa³

et al. 2013

Respir Care

View full text Add to dashboard Cite

show abstract

“…We used blood levels of C-reactive protein (CRP), PCT, white blood cell count (WBC) and pro-adrenomedullin (ProADM) from the day of admission and days 3, 5 and 7 to reflect the inflammatory response. These markers are upregulated during systemic infections and correlate with inflammation (CRP, WBC), bacterial aetiology (PCT) and disease severity/mortality and other adverse outcome risk (ProADM) [18][19][20][21][22]. For the purpose of this study, we defined 'adverse clinical course' as all-cause mortality, intensive-care unit (ICU) admission, or both, during a 30 day follow-up.…”

Section: Methodsmentioning

confidence: 99%

Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study

et al. 2013

View full text Add to dashboard Cite

Aims/hypothesis Despite the condition's high prevalence, the influence of hyperglycaemia on clinical outcomes in noncritical-care inpatients with infections remains ill defined. In this study, we analysed associations of glucose levels at admission and during initial inpatient treatment with the inflammatory response and clinical outcome in communityacquired pneumonia (CAP) patients. Methods This secondary observational analysis included 880 confirmed CAP patients. We used severity-adjusted multivariate regression models to investigate associations of initial and 96 h mean glucose levels with serially measured biomarker levels over 7 days (C-reactive protein [CRP], procalcitonin, white blood cell count [WBC], pro-adrenomedullin [ProADM]) and adverse clinical course (death and intensivecare unit admission). Results In the 724 non-diabetic patients (82.3% of the study population), moderate or severe hyperglycaemia (glucose 6-11 mmol/l and >11 mmol/l, respectively) was associated with increased risk for adverse clinical course (adjusted OR [95% CI] 1.4 [0.8, 2.4] and 3.0 [1.1, 8.0], respectively) and with higher CRP, WBC and ProADM levels over 7 days (p <0.05, ANOVA, all days). In diabetic patients (n =156), no similar associations were found for initial hyperglycaemia, although mean 96 h glucose levels ≥9 mmol/l were associated with adverse clinical course (adjusted OR 5.4 [1.1, 25.8]; p =0.03). No effect modification by insulin treatment was detected (interaction terms p >0.2 for all analyses). Conclusions/interpretation Initial hyperglycaemia in nondiabetic CAP patients, and prolonged hyperglycaemia in diabetic or non-diabetic CAP patients, are associated with a more pronounced inflammatory response and CAP-related adverse clinical outcome. Optimal glucose targets for insulin treatment of hyperglycaemia in non-critical-care settings should be defined.

show abstract

“…The data from recent studies suggest that some blood markers, e.g. pro-adrenomedullin (proADM) [6][7][8][9][10][11] or procalcitonin (PCT) [12][13][14][15], mirror the severity of infection and enhance clinical risk scores for short-term prognostication. However, less extensive research has been conducted for a better understanding of factors influencing longterm mortality after initial hospitalisation of CAP patients.…”

mentioning

confidence: 99%

Inflammatory responses predict long-term mortality risk in community-acquired pneumonia

Guertler

Wirz²,

Christ‐Crain³

et al. 2010

Eur Respir J

Self Cite

View full text Add to dashboard Cite

Long-term outcomes in patients surviving community-acquired pneumonia (CAP) are still incompletely understood. This study investigates the association of clinical parameters and blood markers with long-term mortality.We prospectively followed 877 CAP patients from a previous multicentre trial for 18 months follow-up and investigated all-cause mortality following hospital discharge.Overall mortality was 17.3% (95% CI 14.8-19.8%) with a 12.8% (95% CI 10.9-15.0%) mortality incidence rate per year. Initial risk assignment using the Pneumonia Severity Index was accurate during the 18 month follow-up. Multivariable regression models (hazard ratio, 95% CI) designated the following as independent risk factors for long-term mortality: male sex (1.7, 1.2-2.5); chronic obstructive pulmonary disease (1.5, 1.1-2.1); neoplastic disease (2.5, 1.7-3.7); and highest quartile of peak pro-adrenomedullin level (3.3, 1.7-6.2). Initial presentation with temperature .38.7uC (0.4, 0.2-0.6), chills (0.6, 0.4-0.99) and highest quartile of the inflammatory marker C-reactive-protein (0.3, 0.2-0.5) were independent protective factors. A weighted risk score based on these variables showed good discrimination (area under receiver operating characteristic curve 0.78, 95% CI 0.74-0.82).Pronounced clinical and laboratory signs of systemic inflammatory host response upon initial hospital stay were associated with favourable long-term prognosis. Further studies should address whether closer monitoring of high-risk CAP patients after hospital discharge favourably impacts long-term mortality.

show abstract

Prognostic value of procalcitonin in community-acquired pneumonia

Cited by 149 publications

References 28 publications

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

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

Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study

Inflammatory responses predict long-term mortality risk in community-acquired pneumonia

Contact Info

Product

Resources

About