Top

Intensive Care Medicine

Published in:

01-03-2006 | Brief Report

Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia

Authors: Nicolas Boussekey, Olivier Leroy, Serge Alfandari, Patrick Devos, Hugues Georges, Benoit Guery

Published in: Intensive Care Medicine | Issue 3/2006

Abstract

Objectives

Procalcitonin (PCT) kinetics is a good prognosis marker in infectious diseases, but few studies of community-acquired pneumonia (CAP) have been performed in intensive care units (ICU). We analyzed the relationship between PCT kinetics and outcome in ICU patients with severe CAP.

Design and setting

Prospective observational study in a 16-bed university hospital ICU.

Patients

100 critically ill patients with community-acquired pneumonia.

Measurements and results

Median PCT was 5.2 ng/ml on day 1 and 2.9 ng/ml on day 3. It increased from day 1 to day 3 in nonsurvivors but decreased in survivors. In multivariate analysis four variables were associated with death: invasive ventilation (odds ratio 10−), multilobar involvement (5.6−), LOD score (6.9−), and PCT increase from day 1 to day 3 (4.5−). In intubated patients with a PCT level below 0.95 ng/ml on day 3 the survival rate was 95%.

Conclusion

Increased PCT from day 1 to day 3 in severe CAP is a poor prognosis factor. A PCT level less than 0.95 ng/ml on day 3 in intubated patients is associated with a favorable outcome.

Available only for authorised users

Dandonna P, Nix D, Wilson WF, Aljada A, Love J, Assicot M, Bohuon C (1994) Procalcitonin increases after endotoxin injection in normal subjects. J Clin Endocrinol Metab 79:1605–1608CrossRef

Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Müller B (2004) Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med 32:1715–1721PubMedCrossRef

Hoffmann G, Czechowski M, Schloesser M, Schobersberger W (2002) Procalcitonin amplifies inducible nitric oxide synthase gene expression and nitric oxide production in vascular smooth muscle cells. Crit Care Med 30:2091–2095PubMedCrossRef

Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J (2004) Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis 39:206–217PubMedCrossRef

Venet C, Tardy B, Zény F (2002) Biologic markers of infection in intensive care unit in adults: place of the procalcitonin. Réanimation 11:156–171CrossRef

Cheval C, Timsit JF, Garrouste-Orgeas M, Assicot M, De Jonghe B, Misset B, Bohuon C, Carlet J (2000) Procalcitonin is useful in predicting the bacterial origin of an acute circulatory failure in critically ill patients. Intensive Care Med 26 [Suppl] S153–S158

Pettila V, Hynninen M, Takkunen O, Kuusela P, Valtonen M (2002) Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med 28:1220–1225PubMedCrossRef

Clec'h C, Ferriere F, Karoubi P, Fosse JP, Cupa M, Hoang P, Cohen Y (2004) Diagnostic and prognostic value of procalcitonin in patients with septic shock. Crit Care Med 32:1166–1169PubMedCrossRef

Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, Arndt G, Lode H (2003) Procalcitonin as a diagnostic tool in lower tract infectious and tuberculosis. Eur Respir J 21:939–943PubMedCrossRef

10.

Brunkhorst FM, Ai-Nawas B, Krummenauer F, Forycki ZF, Shah PM (2002) Procalcitonin, C-reactive protein and Apache II score for risk evaluation in patients with severe pneumonia. Clin Microbiol Infect 8:93–100PubMedCrossRef

11.

Boussekey N, Leroy O, Georges H, Devos P, d'Escrivan T, Guery B (2005) Diagnostic and prognostic values of admission procalcitonin level in community-acquired pneumonia in intensive care unit. Infection 33:93–99CrossRef

12.

Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, Vadas L, Pugin J (2001) Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 164:396–402PubMed

13.

Claeys R, Vinken S, Spapen H, ver Elst K, Decochez K, Huyghens L, Gorus FK (2002) Plasma procalcitonin and C-reactive protein in acute septic shock: clinical and biological correlates. Crit Care Med 30:757–762PubMedCrossRef

14.

de Werra I, Jaccard C, Corradin SB, Chiolero R, Yersin B, Gallati H, Assicot M, Bohuon C, Baumgartner JD, Glauser MP, Heumann D (1997) Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia. Crit Care Med 25:607–613PubMedCrossRef

15.

Luzzani A, Polati E, Dorizzi R, Rungatscher A, Pavan R, Merlini A (2003) Comparison of procalcitonin and C-reactive protein as markers of sepsis. Crit Care Med 31:1737–1741PubMedCrossRef

16.

Balci C, Sungurtekin H, Gurses E, Sungurtekin U, Kaptanoglu B (2003) Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit. Crit Care Med 7:85–90

17.

Hedlund J, Hansson LO (2000) Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 28:68–73PubMedCrossRef

18.

Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, Dean N, File T, Fine MJ, Gross PA, Martinez F, Marrie TJ, Plouffe JF, Ramirez J, Sarosi GA, Torres A, Wilson R, Yu VL (2001) American Thoracic Society: Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163:1730–1754PubMed

Title: Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia
Authors: Nicolas Boussekey
Olivier Leroy
Serge Alfandari
Patrick Devos
Hugues Georges
Benoit Guery
Publication date: 01-03-2006
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 3/2006
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-005-0047-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia

Abstract

Objectives

Design and setting

Patients

Measurements and results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Design and setting

Patients

Measurements and results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2006

Atrial fibrillation in the intensive care unit

Authors' reply to the comment by Dr. Cakar et al.

Authors' reply to the comments by Dr. Lang

Dramatic beneficial effects of sildenafil in recurrent massive pulmonary embolism

Organophosphate poisonings with parathion and dimethoate

Comparison of respiratory rate and peripheral oxygen saturation to assess severity in trauma patients