Can procalcitonin help identify associated bacterial infection in patients with severe influenza pneumonia? A multicentre study

E Cuquemelle, F Soulis, D Villers, F Roche-Campo, C Ara Somohano, M Fartoukh, A Kouatchet, B Mourvillier, J Dellamonica, W Picard, M Schmidt, T Boulain, C Brun-Buisson, A/H1N1 REVA-SRLF Study Group, L Brochard, C Brun-Buisson, A Mercat, J C Richard, A Kouatchet, L Arroudj, D Royer, F Roche Campo, J Mancebo, C Charron, A Vieillard-Baron, A Ait Hssain, E Cuquemelle, C A Somohano, J F Timsit, G Chanques, B Jung, E Vivier, R Chelha, D Villiers, B Mourvillier, W Yaba, C Faisy, J L Dhiel, B Megarbane, M Schmidt, C E Luyt, A Combes, M Fartoukh, M Djibre, F Soulis, J C Richard, J Theodore, A Combes, T Boulain, M Capron, W Picard, P Badia, P Beuret, J Dellamonica, J L Ricome, N Robin, E Cuquemelle, F Soulis, D Villers, F Roche-Campo, C Ara Somohano, M Fartoukh, A Kouatchet, B Mourvillier, J Dellamonica, W Picard, M Schmidt, T Boulain, C Brun-Buisson, A/H1N1 REVA-SRLF Study Group, L Brochard, C Brun-Buisson, A Mercat, J C Richard, A Kouatchet, L Arroudj, D Royer, F Roche Campo, J Mancebo, C Charron, A Vieillard-Baron, A Ait Hssain, E Cuquemelle, C A Somohano, J F Timsit, G Chanques, B Jung, E Vivier, R Chelha, D Villiers, B Mourvillier, W Yaba, C Faisy, J L Dhiel, B Megarbane, M Schmidt, C E Luyt, A Combes, M Fartoukh, M Djibre, F Soulis, J C Richard, J Theodore, A Combes, T Boulain, M Capron, W Picard, P Badia, P Beuret, J Dellamonica, J L Ricome, N Robin

Abstract

Purpose: To determine whether procalcitonin (PCT) levels could help discriminate isolated viral from mixed (bacterial and viral) pneumonia in patients admitted to the intensive care unit (ICU) during the A/H1N1v2009 influenza pandemic.

Methods: A retrospective observational study was performed in 23 French ICUs during the 2009 H1N1 pandemic. Levels of PCT at admission were compared between patients with confirmed influenzae A pneumonia associated or not associated with a bacterial co-infection.

Results: Of 103 patients with confirmed A/H1N1 infection and not having received prior antibiotics, 48 (46.6%; 95% CI 37-56%) had a documented bacterial co-infection, mostly caused by Streptococcus pneumoniae (54%) or Staphylococcus aureus (31%). Fifty-two patients had PCT measured on admission, including 19 (37%) having bacterial co-infection. Median (range 25-75%) values of PCT were significantly higher in patients with bacterial co-infection: 29.5 (3.9-45.3) versus 0.5 (0.12-2) μg/l (P < 0.01). For a cut-off of 0.8 μg/l or more, the sensitivity and specificity of PCT for distinguishing isolated viral from mixed pneumonia were 91 and 68%, respectively. Alveolar condensation combined with a PCT level of 0.8 μg/l or more was strongly associated with bacterial co-infection (OR 12.9, 95% CI 3.2-51.5; P < 0.001).

Conclusions: PCT may help discriminate viral from mixed pneumonia during the influenza season. Levels of PCT less than 0.8 μg/l combined with clinical judgment suggest that bacterial infection is unlikely.

Figures

Fig. 1
Fig. 1
PCT levels on ICU admission in 52 patients having isolated viral or mixed bacterial and viral pneumonia
Fig. 2
Fig. 2
ROC analysis of PCT (solid line) and CRP (dashed line) for predicting bacterial co-infection at ICU admission, in patients in whom measurements of the two biomarkers were obtained simultaneously (n = 32)

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