Short Attention Span Summary
Biomarker for pneumonia severity
Procalcitonin (PCT) is an early acute phase reactant. In this prospective study, they found that the PCT level had a linear correlation with need for invasive respiratory or vasopressor support (IRVS) in adults with community-acquired pneumonia. For each 1 ng/mL rise, there was a 1-2% rise in need for IRVS. It also improved risk calculation for IRVS (need for ICU-level care) when used in conjunction with pneumonia severity scores.
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When deciding whether a patient with pneumonia needs ICU admission, PCT can help predict the risk for subsequent intubation or pressors.
Abstract
Chest. 2016 Oct;150(4):819-828. doi: 10.1016/j.chest.2016.04.010. Epub 2016 Apr 21.
Self WH1, Grijalva CG2, Williams DJ3, Woodworth A4, Balk RA5, Fakhran S6, Zhu Y7, Courtney DM8, Chappell J4, Anderson EJ9, Qi C10, Waterer GW11, Trabue C12, Bramley AM13, Jain S13, Edwards KM3, Wunderink RG14.
Author information:
1Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: [email protected].
2Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN.
3Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
4Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
5Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL.
6Department of Medicine, Division of Pulmonary, John H. Stroger, Jr Hospital of Cook County, Chicago, IL.
7Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
8Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
9Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA.
10Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL.
11Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
12Department of Medicine, University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN.
13Influenza Division of the National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
14Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.
Abstract
BACKGROUND:
Predicting the need for intensive care among adults with community-acquired pneumonia (CAP) remains challenging.
METHODS:
Using a multicenter prospective cohort study of adults hospitalized with CAP, we evaluated the association of serum procalcitonin (PCT) concentration at hospital presentation with the need for invasive respiratory or vasopressor support (IRVS), or both, within 72 h. Logistic regression was used to model this association, with results reported as the estimated risk of IRVS for a given PCT concentration. We also assessed whether the addition of PCT changed the performance of established pneumonia severity scores, including the pneumonia severity index and the American Thoracic Society minor criteria, for prediction of IRVS.
RESULTS:
Of 1,770 enrolled patients, 115 required IRVS (6.5%). Using the logistic regression model, PCT concentration had a strong association with IRVS risk. Undetectable PCT (< 0.05 ng/mL) was associated with a 4% (95% CI, 3.1%-5.1%) risk of IRVS. For concentrations < 10 ng/mL, PCT had an approximate linear association with IRVS risk: for each 1 ng/mL increase in PCT, there was a 1% to 2% absolute increase in the risk of IRVS. With a PCT concentration of 10 ng/mL, the risk of IRVS was 22.4% (95% CI, 16.3%-30.1%) and remained relatively constant for all concentrations > 10 ng/mL. When added to each pneumonia severity score, PCT contributed significant additional risk information for the prediction of IRVS.
CONCLUSIONS:
Serum PCT concentration was strongly associated with the risk of requiring IRVS among adults hospitalized with CAP and is potentially useful for guiding decisions about ICU admission.
Copyright © 2016 American College of Chest Physicians. All rights reserved.
PMID: 27107491 [PubMed – in process]
