Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients with Community-Acquired Pneumonia

  • Kim, Ji Hye (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Seo, Joo Wan (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Mok, Jeong Ha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Mi Hyun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Cho, Woo Hyun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Kwangha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ki Uk (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Jeon, Doosoo (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Hye-Kyung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Yun Seong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Hyung Hoi (Department of Laboratory Medicine, Pusan National University School of Medicine) ;
  • Lee, Min Ki (Department of Internal Medicine, Pusan National University School of Medicine)
  • Received : 2012.09.16
  • Accepted : 2013.03.21
  • Published : 2013.05.30
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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 (${\geq}65$ 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, ${\rho}$=0.408 with p<0.001; procalcitonin and PSI, ${\rho}$=0.293 with p=0.003; procalcitonin and mortality, ${\rho}$=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.

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References

  1. Korea National Statistical Office. 2011 Annual report on the cause of death statistics. Daejeon: Korea National Statistical Office; 2011.
  2. Loeb M. Pneumonia in older persons. Clin Infect Dis 2003;37:1335-9. https://doi.org/10.1086/379076
  3. 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;48:1316-20.
  4. 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:S27-72. https://doi.org/10.1086/511159
  5. 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;336:243-50. https://doi.org/10.1056/NEJM199701233360402
  6. 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;51:1010-6. https://doi.org/10.1136/thx.51.10.1010
  7. 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;58:377-82. https://doi.org/10.1136/thorax.58.5.377
  8. 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;38:107-13. https://doi.org/10.1067/mem.2001.115880
  9. 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;143:881-94. https://doi.org/10.7326/0003-4819-143-12-200512200-00006
  10. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000;28: 68-73. https://doi.org/10.1007/s150100050049
  11. 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. https://doi.org/10.1086/339198
  12. 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: 515-8. https://doi.org/10.1016/0140-6736(93)90277-N
  13. 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;68:205-11. https://doi.org/10.4046/trd.2010.68.4.205
  14. 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. https://doi.org/10.1164/rccm.200512-1922OC
  15. 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;128:2223-9. https://doi.org/10.1378/chest.128.4.2223
  16. 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;40:373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  17. Le Moullec JM, Jullienne A, Chenais J, Lasmoles F, Guliana JM, Milhaud G, et al. The complete sequence of human preprocalcitonin. FEBS Lett 1984;167:93-7. https://doi.org/10.1016/0014-5793(84)80839-X
  18. Christ-Crain M, Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007; 30:556-73. https://doi.org/10.1183/09031936.00166106
  19. Karzai W, Oberhoffer M, Meier-Hellmann A, Reinhart K. Procalcitonin: a new indicator of the systemic response to severe infections. Infection 1997;25:329-34. https://doi.org/10.1007/BF01740811
  20. 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. https://doi.org/10.1186/1471-2334-7-10
  21. Christ-Crain M, Muller B. Procalcitonin in bacterial infections: hype, hope, more or less? Swiss Med Wkly 2005;135:451-60.
  22. 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;39:206-17. https://doi.org/10.1086/421997
  23. 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;139:1410-8. https://doi.org/10.1378/chest.10-1747
  24. Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem 2004;279:48487-90. https://doi.org/10.1074/jbc.R400025200
  25. 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;72:643-9.
  26. 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: 864-74. https://doi.org/10.1097/00003246-199206000-00025
  27. 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;34:2596-602. https://doi.org/10.1097/01.CCM.0000239116.01855.61
  28. 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;31:349-55. https://doi.org/10.1183/09031936.00054507
  29. 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;42:1025-31. https://doi.org/10.1016/j.clinbiochem.2009.03.012
  30. Stucker F, Herrmann F, Graf JD, Michel JP, Krause KH, Gavazzi G. Procalcitonin and infection in elderly patients. J Am Geriatr Soc 2005;53:1392-5. https://doi.org/10.1111/j.1532-5415.2005.53421.x

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