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European Journal of Clinical Microbiology & Infectious Diseases

Published in:

01-05-2012 | Article

Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia

Authors: A. Lacoma, N. Rodríguez, C. Prat, J. Ruiz-Manzano, F. Andreo, A. Ramírez, A. Bas, M. Pérez, V. Ausina, J. Domínguez

Published in: European Journal of Clinical Microbiology & Infectious Diseases | Issue 5/2012

Abstract

The aim of this study was to investigate whether procalcitonin (PCT), neopterin, C-reactive protein (CRP), and mid regional pro-atrial natriuretic peptide (MR-proANP) levels at admission and during the clinical course can be useful for the management of patients with pneumonia. The study population consisted of 75 patients with clinical and radiological diagnosis of pneumonia. Serum samples were collected at admission and during hospitalization. Complications were defined as intensive care unit (ICU) admission or death. The levels of PCT were significantly higher in pneumonia of definite bacterial origin in comparison to probable bacterial or unknown origin. The PCT levels were higher in pneumococcal pneumonia. The PCT and MR-proANP levels increased significantly according to the Pneumonia Severity Index (PSI). All biomarkers levels are higher in patients developing complications and who were dying. The serial levels of MR-proANP remain significantly elevated in patients developing complications and in patients classified in PSI and CURB-65 risk groups. In patients not developing complications, there is a significant decrease in the PCT levels. PCT can be useful for identifying pneumonia etiology. PCT and MR-proANP levels correlate with pneumonia severity rules. PCT and MR-proANP serial measurements can be useful for predicting short-term prognosis. Systemic biomarkers can provide additional information regarding clinical evolution, because these are dynamic and can be measured daily.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM Jr, Musher DM, Niederman MS, Torres A, Whitney CG; Infectious Diseases Society of America; American Thoracic Society (2007) Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 44(Suppl 2):S27–S72PubMedCrossRef

Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336(4):243–250PubMedCrossRef

Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58(5):377–382PubMedCrossRef

Christ-Crain M, Müller B (2007) Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 30(3):556–573PubMedCrossRef

Krüger S, Ewig S, Giersdorf S, Hartmann O, Suttorp N, Welte T; German Competence Network for the Study of Community Acquired Pneumonia (CAPNETZ) Study Group (2010) Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med 182(11):1426–1434PubMedCrossRef

Prat C, Domínguez J, Andreo F, Blanco S, Pallarés A, Cuchillo F, Ramil C, Ruiz-Manzano J, Ausina V (2006) Procalcitonin and neopterin correlation with aetiology and severity of pneumonia. J Infect 52(3):169–177PubMedCrossRef

Schuetz P, Batschwaroff M, Dusemund F, Albrich W, Bürgi U, Maurer M, Brutsche M, Huber AR, Müller B (2010) Effectiveness of a procalcitonin algorithm to guide antibiotic therapy in respiratory tract infections outside of study conditions: a post-study survey. Eur J Clin Microbiol Infect Dis 29(3):269–277PubMedCrossRef

Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V, Domínguez J (2011) Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 6:157–169PubMed

Müller B, Prat C (2006) Markers of acute inflammation in assessing and managing lower respiratory tract infections: focus on procalcitonin. Clin Microbiol Infect 12(Suppl 9):8–16CrossRef

10.

Prat C, Domínguez J, Rodrigo C, Giménez M, Azuara M, Jiménez O, Galí N, Ausina V (2003) Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection. Pediatr Infect Dis J 22(11):963–968PubMedCrossRef

11.

Almirall J, Bolíbar I, Toran P, Pera G, Boquet X, Balanzó X, Sauca G; Community-Acquired Pneumonia Maresme Study Group (2004) Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 125(4):1335–1342PubMedCrossRef

12.

Smith RP, Lipworth BJ, Cree IA, Spiers EM, Winter JH (1995) C-reactive protein. A clinical marker in community-acquired pneumonia. Chest 108(5):1288–1291PubMedCrossRef

13.

Tang H, Huang T, Jing J, Shen H, Cui W (2009) Effect of procalcitonin-guided treatment in patients with infections: a systematic review and meta-analysis. Infection 37(6):497–507PubMedCrossRef

14.

Ip M, Rainer TH, Lee N, Chan C, Chau SS, Leung W, Leung MF, Tam TK, Antonio GE, Lui G, Lau TK, Hui DS, Fuchs D, Renneberg R, Chan PK (2007) Value of serum procalcitonin, neopterin, and C-reactive protein in differentiating bacterial from viral etiologies in patients presenting with lower respiratory tract infections. Diagn Microbiol Infect Dis 59(2):131–136PubMedCrossRef

15.

Rainer TH, Chan CP, Leung MF, Leung W, Ip M, Lee N, Cautherley GW, Graham CA, Fuchs D, Renneberg R (2009) Diagnostic utility of CRP to neopterin ratio in patients with acute respiratory tract infections. J Infect 58(2):123–130PubMedCrossRef

16.

Prat C, Lacoma A, Domínguez J, Papassotiriou J, Morgenthaler NG, Andreo F, Tudela P, Ruiz-Manzano J, Ausina V (2007) Midregional pro-atrial natriuretic peptide as a prognostic marker in pneumonia. J Infect 55(5):400–407PubMedCrossRef

17.

Vazquez M, Jockers K, Christ-Crain M, Zimmerli W, Müller B, Schuetz P (2010) MR-pro-atrial natriuretic peptide (MR-proANP) predicts short- and long-term outcomes in respiratory tract infections: a prospective validation study. Int J Cardiol. doi:10.1016/j.ijcard.2010.10.037

18.

Lacoma A, Prat C, Andreo F, Lores L, Latorre I, Pérez M, Ruiz-Manzano J, Ausina V, Domínguez J (2011) Usefulness of mid regional pro-atrial natriuretic peptide in the exacerbations of chronic obstructive pulmonary disease. Clin Chim Acta 412:470–475PubMedCrossRef

19.

Lacoma A, Prat C, Andreo F, Domínguez J (2009) Biomarkers in the management of COPD. Eur Respir Rev 18(112):96–104PubMedCrossRef

20.

Albrich WC, Dusemund F, Rüegger K, Christ-Crain M, Zimmerli W, Bregenzer T, Irani S, Buergi U, Reutlinger B, Mueller B, Schuetz P (2011) Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis 11:112PubMedCrossRef

21.

Menéndez R, Martínez R, Reyes S, Mensa J, Filella X, Marcos MA, Martínez A, Esquinas C, Ramirez P, Torres A (2009) Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 64(7):587–591PubMedCrossRef

22.

Boussekey N, Leroy O, Alfandari S, Devos P, Georges H, Guery B (2006) Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med 32(3):469–472PubMedCrossRef

23.

Menéndez R, Martínez R, Reyes S, Mensa J, Polverino E, Filella X, Esquinas C, Martínez A, Ramirez P, Torres A (2009) Stability in community-acquired pneumonia: one step forward with markers? Thorax 64(11):987–992PubMedCrossRef

24.

Domínguez J, Galí N, Blanco S, Pedroso P, Prat C, Matas L, Ausina V (2001) Detection of Streptococcus pneumoniae antigen by a rapid immunochromatographic assay in urine samples. Chest 119(1):243–249PubMedCrossRef

25.

Domínguez J, Galí N, Blanco S, Pedroso P, Prat C, Matas L, Ausina V (2001) Assessment of a new test to detect Legionella urinary antigen for the diagnosis of Legionnaires’ Disease. Diagn Microbiol Infect Dis 41(4):199–203PubMedCrossRef

26.

Andreo F, Domínguez J, Ruiz J, Blanco S, Arellano E, Prat C, Morera J, Ausina V (2006) Impact of rapid urine antigen tests to determine the etiology of community-acquired pneumonia in adults. Respir Med 100(5):884–891PubMedCrossRef

27.

Schuetz P, Christ-Crain M, Huber AR, Müller B (2010) Long-term stability of procalcitonin in frozen samples and comparison of Kryptor and VIDAS automated immunoassays. Clin Biochem 43(3):341–344PubMedCrossRef

28.

Waterer GW, Wunderink RG (2001) The influence of the severity of community-acquired pneumonia on the usefulness of blood cultures. Respir Med 95(1):78–82PubMedCrossRef

29.

Andreo F, Ruiz-Manzano J, Prat C, Lores L, Blanco S, Malet A, Gallardo X, Domínguez J (2010) Utility of pneumococcal urinary antigen detection in diagnosing exacerbations in COPD patients. Respir Med 104(3):397–403PubMedCrossRef

30.

Domínguez J, Blanco S, Rodrigo C, Azuara M, Galí N, Mainou A, Esteve A, Castellví A, Prat C, Matas L, Ausina V (2003) Usefulness of urinary antigen detection by an immunochromatographic test for diagnosis of pneumococcal pneumonia in children. J Clin Microbiol 41(5):2161–2163PubMedCrossRef

31.

Andreo F, Prat C, Ruiz-Manzano J, Lores L, Blanco S, Cuesta MA, Giménez M, Domínguez J (2008) Persistence of Streptococcus pneumoniae urinary antigen excretion after pneumococcal pneumonia. Eur J Clin Microbiol 28:197–201

32.

Hedlund J, Hansson LO (2000) Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 28(2):68–73PubMedCrossRef

33.

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(2):206–217PubMedCrossRef

34.

Ortqvist A, Hedlund J, Wretlind B, Carlström A, Kalin M (1995) Diagnostic and prognostic value of interleukin-6 and C-reactive protein in community-acquired pneumonia. Scand J Infect Dis 27(5):457–462PubMedCrossRef

35.

García Vázquez E, Martínez JA, Mensa J, Sánchez F, Marcos MA, de Roux A, Torres A (2003) C-reactive protein levels in community-acquired pneumonia. Eur Respir J 21(4):702–705PubMedCrossRef

36.

Hohenthal U, Hurme S, Helenius H, Heiro M, Meurman O, Nikoskelainen J, Kotilainen P (2009) Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect 15(11):1026–1032PubMedCrossRef

37.

Masiá M, Papassotiriou J, Morgenthaler NG, Hernández I, Shum C, Gutiérrez F (2007) Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia. Clin Chem 53(12):2193–2201PubMedCrossRef

38.

Müller B, Süess E, Schuetz P, Müller C, Bingisser R, Bergmann A, Stolz D, Tamm M, Morgenthaler NG, Christ-Crain M (2006) Circulating levels of pro-atrial natriuretic peptide in lower respiratory tract infections. J Intern Med 260(6):568–576PubMedCrossRef

39.

Schuetz P, Christ-Crain M, Müller B (2007) Biomarkers to improve diagnostic and prognostic accuracy in systemic infections. Curr Opin Crit Care 13(5):578–585PubMedCrossRef

40.

Masiá M, Gutiérrez F, Shum C, Padilla S, Navarro JC, Flores E, Hernández I (2005) Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 128(4):2223–2229PubMedCrossRef

41.

Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Müller B (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 174(1):84–93PubMedCrossRef

42.

Krüger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, Suttorp N, Welte T; CAPNETZ Study Group (2008) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 31(2):349–355PubMedCrossRef

43.

Schuetz P, Suter-Widmer I, Chaudri A, Christ-Crain M, Zimmerli W, Mueller B; Procalcitonin-Guided Antibiotic Therapy and Hospitalisation in Patients with Lower Respiratory Tract Infections (ProHOSP) Study Group (2011) Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J 37(2):384–392PubMedCrossRef

44.

Claessens YE, Mathevon T, Kierzek G, Grabar S, Jegou D, Batard E, Loyer C, Davido A, Hausfater P, Robert H, Lavagna-Perez L, Bernot B, Plaisance P, Leroy C, Renaud B (2010) Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia. Intensive Care Med 36(5):799–809PubMedCrossRef

45.

Krüger S, Ewig S, Kunde J, Hartmann O, Suttorp N, Welte T; CAPNETZ Study Group (2010) Pro-atrial natriuretic peptide and pro-vasopressin for predicting short-term and long-term survival in community-acquired pneumonia: results from the German Competence Network CAPNETZ. Thorax 65(3):208–214PubMedCrossRef

46.

Bruns AH, Oosterheert JJ, Hak E, Hoepelman AI (2008) Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 32(3):726–732PubMedCrossRef

47.

Menéndez R, Cavalcanti M, Reyes S, Mensa J, Martínez R, Marcos MA, Filella X, Niederman M, Torres A (2008) Markers of treatment failure in hospitalised community acquired pneumonia. Thorax 63(5):447–452PubMedCrossRef

48.

de Jager CP, de Wit NC, Weers-Pothoff G, van der Poll T, Wever PC (2009) Procalcitonin kinetics in Legionella pneumophila pneumonia. Clin Microbiol Infect 15(11):1020–1025PubMedCrossRef

Title: Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia
Authors: A. Lacoma
N. Rodríguez
C. Prat
J. Ruiz-Manzano
F. Andreo
A. Ramírez
A. Bas
M. Pérez
V. Ausina
J. Domínguez
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: European Journal of Clinical Microbiology & Infectious Diseases / Issue 5/2012
Print ISSN: 0934-9723
Electronic ISSN: 1435-4373
DOI: https://doi.org/10.1007/s10096-011-1381-0

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