Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia

Ji Hye Kim, Joo Wan Seo, Jeong Ha Mok, Mi Hyun Kim, Woo Hyun Cho, Kwangha Lee, Ki Uk Kim, Doosoo Jeon, Hye-Kyung Park, Yun Seong Kim, Hyung Hoi Kim, Min Ki Lee, Ji Hye Kim, Joo Wan Seo, Jeong Ha Mok, Mi Hyun Kim, Woo Hyun Cho, Kwangha Lee, Ki Uk Kim, Doosoo Jeon, Hye-Kyung Park, Yun Seong Kim, Hyung Hoi Kim, Min Ki Lee

Abstract

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP.

Methods: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (≥65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI).

Results: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ρ=0.408 with p<0.001; procalcitonin and PSI, ρ=0.293 with p=0.003; procalcitonin and mortality, ρ=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly.

Conclusion: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

Keywords: Aged; Community-Acquired Infections; Pneumonia; Procalcitonin.

Figures

Figure 1
Figure 1
Receiver operating characteristic curves of procalcitonin (AUC 0.663), CRP (AUC 0.556), WBC (AUC 0.597) for prediction of severe community-acquired pneumonia defined as PSI≥IV in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; PSI: pneumonia severity index; CAP: community-acquired pneumonia; PCT: procalcitonin.
Figure 2
Figure 2
Receiver operating characteristic curves comparing procalcitonin (AUC 0.741), CRP (AUC 0.567), WBC (AUC 0.644) for prediction of severe community-acquired pneumonia defined as CURB-65≥II in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; CAP: community-acquired pneumonia; PCT: procalcitonin.

References

    1. Korea National Statistical Office. 2011 Annual report on the cause of death statistics. Daejeon: Korea National Statistical Office; 2011.
    1. Loeb M. Pneumonia in older persons. Clin Infect Dis. 2003;37:1335–1339.
    1. Johnson JC, Jayadevappa R, Baccash PD, Taylor L. Nonspecific presentation of pneumonia in hospitalized older people: age effect or dementia? J Am Geriatr Soc. 2000;48:1316–1320.
    1. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27–S72.
    1. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–250.
    1. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax. 1996;51:1010–1016.
    1. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382.
    1. American College of Emergency Physicians. Clinical policy for the management and risk stratification of community-acquired pneumonia in adults in the emergency department. Ann Emerg Med. 2001;38:107–113.
    1. Yealy DM, Auble TE, Stone RA, Lave JR, Meehan TP, Graff LG, et al. Effect of increasing the intensity of implementing pneumonia guidelines: a randomized, controlled trial. Ann Intern Med. 2005;143:881–894.
    1. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection. 2000;28:68–73.
    1. Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis. 2002;34:895–901.
    1. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet. 1993;341:515–518.
    1. Ahn S, Kim WY, Yoon JY, Sohn CH, Seo DW, Kim SH, et al. Procalcitonin in 2009 H1N1 influenza pneumonia: role in differentiating from bacterial pneumonia. Tuberc Respir Dis. 2010;68:205–211.
    1. Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med. 2006;174:84–93.
    1. Masia M, Gutierrez F, Shum C, Padilla S, Navarro JC, Flores E, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest. 2005;128:2223–2229.
    1. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–383.
    1. Le Moullec JM, Jullienne A, Chenais J, Lasmoles F, Guliana JM, Milhaud G, et al. The complete sequence of human preprocalcitonin. FEBS Lett. 1984;167:93–97.
    1. Christ-Crain M, Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J. 2007;30:556–573.
    1. Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Procalcitonin: a new indicator of the systemic response to severe infections. Infection. 1997;25:329–334.
    1. Muller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis. 2007;7:10.
    1. Christ-Crain M, Muller B. Procalcitonin in bacterial infections: hype, hope, more or less? Swiss Med Wkly. 2005;135:451–460.
    1. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39:206–217.
    1. Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, et al. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest. 2011;139:1410–1418.
    1. Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem. 2004;279:48487–48490.
    1. Muller B, Peri G, Doni A, Perruchoud AP, Landmann R, Pasqualini F, et al. High circulating levels of the IL-1 type II decoy receptor in critically ill patients with sepsis: association of high decoy receptor levels with glucocorticoid administration. J Leukoc Biol. 2002;72:643–649.
    1. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med. 1992;20:864–874.
    1. Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006;34:2596–2602.
    1. Kruger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J. 2008;31:349–355.
    1. Meng FS, Su L, Tang YQ, Wen Q, Liu YS, Liu ZF. Serum procalcitonin at the time of admission to the ICU as a predictor of short-term mortality. Clin Biochem. 2009;42:1025–1031.
    1. Stucker F, Herrmann F, Graf JD, Michel JP, Krause KH, Gavazzi G. Procalcitonin and infection in elderly patients. J Am Geriatr Soc. 2005;53:1392–1395.

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