Serial Procalcitonin Measurements for Improved Prognostic Assessment of Patients Admitted with Bacterial Pneumonia
Year: 2015
Type: article
Study design: Observational Study
Abstract: Background. Procalcitonin (PCT) is a pro-hormone that rises in response to bacterial infections including pneumonia. While PCT has applications in the initial assessment of patients with pneumonia, data is inconclusive on its use for prognostication of clinical outcomes. We propose that serial, daily PCT measurements for inpatients with bacterial pneumonia can predict mortality, intensive care unit (ICU) admission, and bacteremia. Methods. We conducted a prospective, observational cohort study of 505 inpatients diagnosed with pneumonia based on radiographic findings. PCT was measured on hospital days one through four. Demographics, medical history, objective data, and outcomes were obtained through chart review. Final diagnosis of community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) was determined by two or more physicians blinded to PCT values. The primary endpoint for the study was a composite adverse outcome defined as all-cause mortality, ICU admission, and bacteremia. We calculated regression models with area under the ROC curve as a measure of discrimination. Statistical analysis was performed using STATA 12.1. Results. Of 505 patients, 317 patients had a final diagnosis of CAP or HCAP. No significant difference was found for PCT values between CAP versus HCAP (Mann-Whitney U test, p = 0.30). Among patients meeting the primary endpoint versus those who did not, there was no significant difference in age or the proportion with underlying lung disease, diabetes, heart failure, malignancy, or smoking. There was a significant association of PCT measured at day one through day four with the composite endpoint with AUCs ranging between 0.66 and 0.69 for CAP and 0.61 to 0.62 for HCAP. Addition of initial PCT to a statistical model including the pneumonia severity index (PSI) score significantly improved prognostic performance, increasing the AUC from 0.59 to 0.66 and from 0.58 to 0.63 for CAP and HCAP, respectively. Finally, the ability of PCT to predict adverse outcomes further improves when used for patients with PSI scores greater than 130 across all days one through four with AUCs ranging from 0.71 to 0.82 for CAP and 0.60 to 0.66 for HCAP. Conclusion. Serial measurements of PCT in hospitalized patients with bacterial pneumonia are a promising tool for predicting adverse clinical outcomes, particularly in high-risk patients. Disclosures. P. Schuetz, BRAHMS/Thermofisher: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium. BioMerieux: Consultant and Speaker's Bureau, Consulting fee and Speaker honorarium ; J. Vyas, Biomerieux: Investigator, unrestricted research grant; M. Mansour, Biomerieux: Investigator.
Source: Open Forum Infectious Diseases
Authors: Suzanne Mccluskey, Michael Abers, Benjamin Bearnot, Debora Hoffman, Maria Morales, Shreya Patel, Lauren Rosario, Phillip Schuetz, Blair Parry, Ryan Callahan, Victor Chiappa, Kent Lewandrowski, William Binder, Michael Filbin, Jatin Vyas, Michael Mansour
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W2266132684