Published in:
01-05-2008 | Correspondence
Sophisticated biomarkers for community-acquired pneumonia severity asessment: gadgets or useful tools?
Published in: Intensive Care Medicine | Issue 5/2008
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Sir: To assess the severity of community-acquired pneumonia (CAP) emergency department (ED) physicians can use specific, validated prediction rules [1] or various biochemical biomarkers such as cortisol [2], procalcitonin [2, 3], proatrial-natriuretic peptide, and provasopressin [3]. However, because these biomarkers may be expensive [3], and most of them are not immediately available for the practitioner, their usefulness for ED triage remains questionable. Furthermore, there are conflicting data concerning the prognostic value of cortisol [4] and procalcitonin levels [2, 3]. Whereas Christ-Crain and colleagues [2] demonstrated that total cortisol level is the sole biochemical predictor of severity and outcome, Salluh et al. [4] and our group were unable to demonstrate the impact of cortisol levels in severe CAP requiring intensive care unit admission. These results may be explained by our population, which was more severely ill, and by the fact that majority of our patients (Table 1), as were those of Salluh et al. were treated with hydrocortisone.
Table 1
Severe CAP patients admitted to an intensive care unit (SAPS II, Simplified Acute Physiology Score II; ATS, American Thoracic Society)
|
Survivors (n = 26)
|
Nonsurvivors (n = 12)
|
p
|
|
|---|---|---|---|
|
Age (years)
|
69.8 ± 18
|
78.6 ± 7.5
|
NS
|
|
SAPS II score
|
53.1 ± 22.5
|
67.3 ± 13.9
|
< 0.05
|
|
PaO2/FIO2 ratio, median (mmHg; IQR)
|
224 (156–285)
|
172 (104–216)
|
< 0.05
|
|
Cortisol, median (nmol/l, IQR)
|
514 (418–604)
|
586 (408–923)
|
NS
|
|
Mechanical ventilation
|
17 (65.5%)
|
12 (100%)
|
< 0.02
|
|
ATS 2001 ICU criteria
|
17 (65.5%)
|
10 (83.3%)
|
NS
|
|
Hydrocortisone treatment
|
16 (64%)
|
9 (75%)
|
NS
|