Diagnostic and prognostic value of procalcitonin in community-acquired pneumonia

IntroductionThe value of measuring procalcitonin (PCT) in patients with community-acquired pneumonia (CAP) is unclear. The aim of this study was to determine the value of PCT as a marker for microbial etiology and a predictor of outcome in CAP patients.MethodsA single-center observational study was conducted with CAP patients. On admission, their leukocyte count, serum C-reactive protein level, and serum PCT level were determined, and microbiological tests were performed. Patients were classified into 4 groups according to the A-DROP scoring system, which assesses the severity of CAP.ResultsA total of 102 patients were enrolled. The pathogen was identified in 60 patients, and 31 patients had streptococcal pneumonia. The PCT levels were significantly higher in those patients with pneumococcal pneumonia than in those patients with other bacterial pneumonias (P < 0.0001). Multivariate regression analysis revealed that high PCT levels were associated with a pneumococcal etiology [odds ratio, 1.68; 95% confidence interval (CI): 1.02–2.81; P = 0.04] after adjustment for disease severity and demographic factors. The PCT levels were correlated with the A-DROP score (r = 0.49; P < 0.0001). The area under the curve for predicting mortality was highest for the A-DROP score (0.97; 95% CI: 0.92–0.99), followed by the area under the curve for PCT (0.82; 95% CI: 0.74–0.89) and C-reactive protein (0.77; 95% CI: 0.67–0.84).ConclusionsHigh PCT levels indicate that pneumococcal pneumonia and PCT levels depend on the severity of pneumonia. PCT measurements may provide important diagnostic and prognostic information for patients with CAP.     

The usefulness of serum procalcitonin,C-reactive protein,soluble triggering receptor expressed on myeloid cells 1 and Clinical Pulmonary Infection Score for evaluation of severity and prognosis of community-acquired pneumonia in elderly patients

AimsTo comparatively analyze the usefulness of serum procalcitonin (PCT), C-reactive protein (CRP), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) and Clinical Pulmonary Infection Score (CPIS) for assessing the severity and prognosis of community-acquired pneumonia (CAP) in the elderly.MethodsA total of 214 elderly patients with CAP and 106 healthy persons were enrolled in this prospective study. On the admission day, serum inflammatory markers, including CRP, PCT, sTREM-1, and CPIS were analyzed. By severity, the CAP patients were subdivided into non-severe CAP group and severe CAP group. By outcome, the patients were classified into survival group and death group. The efficiency of three inflammatory markers and CPIS on predicting prognosis of pneumonia patients was then analyzed.ResultsThe serum inflammatory markers and CPIS were significantly higher in CAP patients than in healthy controls. These biomarkers and CPIS were significantly higher in patients with severe CAP than in patients with non-severe CAP. Compared with patients who would survive, these markers and CPIS were significantly higher in patients who would die. Receiver operating characteristic curve analysis showed that the area under the curve and sensitivity were higher for serum sTREM-1 than for other indicators, while the specificity of serum PCT was the highest.ConclusionsSerum CRP, PCT, and sTREM-1 and CPIS determined on the admission day are effective indicators to evaluate the severity and prognosis of CAP in the elderly. The prognostic value of PCT and sTREM-1 is better than that of CRP and CPIS.     

A retrospective observational study of biomarker levels and severity assessment in pediatric community-acquired pneumonia

Multiple studies have investigated the role of biomarkers in predicting pneumonia severity in adults but minimal conclusive research exists for children. This study aimed to determine if the following biomarker levels, collected within 72 hours of hospital arrival: white blood cell count (WBC), platelet count, C-reactive protein (CRP), procalcitonin (PCT), neutrophil-lymphocyte ratio, neutrophil count, or band count associated with community-associated pneumonia (CAP) severity in children.Methods:A retrospective chart review was conducted on children (aged 60 days to 18 years) diagnosed with CAP, and admitted to a regional, tertiary hospital (Charleston, WV, USA) for 3 years (2015–2018). Patients were stratified into 2 severity cohorts, mild (no ICU care), and moderate/severe (required ICU care). Biomarker values were then compared between the severity cohorts and area under the curve (AUC), and cut-off values and performance characteristics were calculated.Results:A total of 108 patients met inclusion criteria with 46% having moderate/severe CAP. Elevated levels of CRP (51.7 mg/L in mild vs. 104.8 mg/L in moderate/severe, P = .003, PCT (0.29 ng/ml in mild vs. 4.02 ng/mL in moderate/severe, P = .001) and band counts (8% in mild vs. 15% moderate/severe, P = .009) were associated with increased pneumonia severity. In predicting moderate/severe CAP, PCT had the highest AUC of 0.77 (P = .001) followed by bands AUC of 0.69 (P = .009) and CRP AUC of 0.67 (P = .003). Cut-off for PCT of 0.55 ng/mL had a sensitivity of 83% and a specificity of 65%. Cut-off level of 53.1 mg/L for CRP had a sensitivity of 79% and specificity of 52%. Cut off level of 12.5% bands had a sensitivity of 61% and specificity of 71%. In a multivariable model controlled for patient demographics and other biomarker levels, only PCT levels significantly predicted moderate/severe CAP (adjusted odds ratio: 1.40 [95% CI, 1.14–1.73], P = .002).Conclusion:Biomarkers, in particular PCT, obtained early in hospitalization may perform as possible predictors for CAP severity in children and be beneficial in guiding CAP management. However, biomarkers in pneumonia should not drive severity assessment or patient management independent of clinical presentation.     

Influence of Steroids on Procalcitonin and C-reactive Protein in Patients with COPD and Community-acquired Pneumonia

Abstract Background: The induction of C-reactive Protein (CRP) may be attenuated by corticosteroids, whereas Procalcitonin (PCT) appears to be unaltered. We investigated, whether in community-acquired pneumonia (CAP) a combined antibiotic-corticosteroid therapy may actually lead to different slopes of decline of these inflammatory markers. Patients and Methods: We studied the slopes of decline of PCT and CRP serum levels during 7 consecutive days as well as clinical parameters in a group of patients with CAP on or off corticosteroids. Patients with underlying COPD received systemic corticosteroids (n = 10), while non-COPD patients (n = 10) presenting with CAP alone formed the control group. All patients were treated with antibiotics. Results: At baseline, relevant clinical and laboratory characteristics of the two groups were similar. Regarding the decreasing shapes of the curves from PCT and CRP, no significant differences were found (p-value = 0.48 for the groups for CRP, respectively 0.64 for PCT). All patients showed an uneventful recovery. Conclusion: In patients with COPD and CAP, the time courses over 7 days of PCT and CRP showed a nearly parallel decline compared to non-COPD patients with CAP. Contrary to the induction phase, corticosteroids do not modify the time-dependent decay of PCT and CRP when the underlying infectious disease (CAP) is adequately treated.     

Diagnostic and Prognostic Values of Admission Procalcitonin Levels in Community–Acquired Pneumonia in an Intensive Care Unit

AbstractBackground: Measurement of procalcitonin (PCT) has been studied for several years in infectious diseases. Some studies have focused on community–acquired pneumonia (CAP) but only one was conducted in critically ill patients hospitalized in an intensive care unit (ICU).Patients and Methods: To determine the diagnostic and prognostic role of PCT in patients admitted in an intensive care unit for severe CAP, 110 patients hospitalized in our unit were prospectively studied. Within 48 hours following ICU admission, PCT serum level was measured with a quantitative method above a threshold value of 0.5 ng/ml.Results: Initially focusing on the diagnostic value of PCT, 20% of the patients had a serum PCT level < 0.5 ng/ml, 30% between 0.5 ng/ml and 2 ng/ml, and 50% ≥ 2 ng/ml. Serum PCT level was higher in microbiologically documented CAP (median = 4.9 ng/ml vs 1.5 ng/ml if no bacteria were found; p = 0.001), but was not predictive of any specific bacterial agent. Concerning the prognostic value, the serum PCT level was higher for bacteremic patients and/or septic shock patients (4.9 ng/ml vs 1.5 ng/ml; p = 0.0003). Moreover, PCT levels were increased in patients who developed, during their ICU stay, infection–related complications (septic shock, multiorgan dysfunction, acute respiratory distress syndrome and disseminated intravascular coagulation). Finally, the initial PCT level was significantly higher in patients who died during the ICU stay (5.6 ng/ml vs 1.5 ng/ml; p < 0.0001). Such a relationship was not found with C–reactive protein (CRP).Conclusion: In ICU patients admitted for severe CAP, initial PCT values could be an interesting predictor for complications and mortality.     

The predictive value of epicardial fat volume for clinical severity of COVID-19

IntroductionEpicardial adipose tissue serves as a source of inflammatory cytokines and mediators. Cytokine storm is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19).ObjectivesTo investigate the association between epicardial fat volume (EFV), inflammatory biomarkers and clinical severity of COVID-19.MethodsThis retrospective study included 101 patients who were infected with COVID-19. Serum inflammatory biomarkers including C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and ferritin levels were measured. Computed tomography images were analyzed and semi-automated measurements for EFV were obtained. The primary composite endpoint was admission to the intensive care unit (ICU) or death.ResultsThe primary composite endpoint occurred in 25.1% (n=26) of patients (mean age 64.8±14.8 years, 14 male). A total of 10 patients died. EFV, CRP, PCT, ferritin and IL-6 levels were significantly higher in ICU patients. Moreover, a positive correlation was determined between EFV and CRP (r: 0.494, p<0.001), PCT (r: 0.287, p=0.005), ferritin (r: 0.265, p=0.01) and IL-6 (r: 0.311, p=0.005). On receiver operating characteristic analysis, patients with EFV >102 cm³ were more likely to have severe complications. In multivariate logistic regression analysis, EFV independently predicted admission to the ICU at a significant level (OR: 1.02, 95% CI: 1.01-1.03, p=0.025).ConclusionEFV and serum CRP, IL-6, PCT and ferritin levels can effectively assess disease severity and predict the outcome in patients with COVID-19. EFV is an independent predictor of admission to the ICU in hospitalized COVID-19 patients.     

血清血管生成素-2与老年人社区获得性肺炎严重程度的相关性研究

目的:探讨血清血管生成素-2(Ang-2)在老年社区获得性肺炎(CAP)患者中的表达,并评估其与CAP严重程度的相关性。方法:采用病例对照研究,选取老年CAP住院患者共118例,根据病情严重程度将所有患者分为普通肺炎组(67例)和重症肺炎组(51例),同时选取40例老年无肺炎健康体检者作为对照组。检测血清Ang-2、白...     

Correlation between procalcitonin and intra-abdominal pressure and their role in prediction of the severity of acute pancreatitis

Background/aimsEarly assessment of disease severity and vigilant patient monitoring are key factors for adequate treatment of acute pancreatitis (AP). The aim of this study was to determine the correlation of procalcitonin (PCT) serum concentrations and intra-abdominal pressure (IAP) as prognostic markers in early stages of AP.MethodsThis prospective observational study included 51 patients, of which 29 had severe AP (SAP). Patients were evaluated with the Acute Physiology And Chronic Health Evaluation (APACHE II) score, C-reactive protein (CRP) and PCT serum concentrations and IAP at 24 h from admission. PCT was measured three times in the 1st week of disease and three times afterward, while IAP was measured daily. PCT and IAP values correlated with each other, and also compared with APACHE II score and CRP values.ResultsPCT, IAP, CRP values and APACHE II score at 24 h after hospital admission were significantly elevated in patients with SAP. There was significant correlation between PCT and IAP values measured at 24 h of admission, and between maximal PCT and IAP values. Sensitivity/specificity for predicting AP severity at 24 h after admission was 89%/69% for APACHE II score, 75%/86% for CRP, 86%/63% for PCT and 75%/77% for IAP.ConclusionsIncreased IAP was accompanied by increased PCT serum concentration in patients with AP. PCT and IAP can both be used as early markers of AP severity.     

CD64、CRP、PCT及NLR对儿童社区获得性肺炎的诊断价值

目的探讨中性粒细胞CD64、C反应蛋白(CRP)、降钙素原(PCT)及中性粒细胞与淋巴细胞比值(NLR)在儿童社区获得性肺炎(CAP)中的诊断价值。方法选取海口市人民医院收治的CAP患儿186例,依据病原体不同分为细菌性肺炎组(95例),支原体肺炎组(43例)和病毒性肺炎组(48例)。细菌性肺炎患儿依据入院病情严重程度分为轻症组(75例)和重症组(20例)。采用流式细胞术检测外周血中性粒细胞CD64的表达,同时检测CRP、PCT及NLR水平。应用ROC曲线分析CD64、CRP、PCT及NLR水平对细菌性肺炎的诊断价值。结果细菌性肺炎组治疗前CD64(8.85±3.40 vs 2.26±0.74,2.42±0.95,2.38±0.80)、CRP(38.62±8.50 vs 3.25±0.96,3.42±1.15,4.16±1.53,mg/L)、PCT(6.17±1.40 vs 0.15±0.03,0.34±0.12,0.62±0.28,ng/mL)及NLR(7.84±3.25 vs 2.05±0.96,1.37±0.62,2.48±1.16)水平均明显高于对照组、病毒性肺炎组和支原体肺炎组(P<0.01)。细菌性肺炎患儿治疗后CD64(2.70±1.06 vs 8.85±3.40)、CRP(4.63±1.58 vs 38.62±8.50,mg/L)、PCT(0.21±0.06 vs 6.17±1.40,ng/mL)及NLR(2.28±1.07 vs 7.84±3.25)水平均明显低于治疗前(P<0.01)。重症细菌性肺炎患儿CD64(10.42±4.36 vs 7.60±2.58)、CRP(43.25±10.47 vs 34.85±8.16,mg/L)、PCT(9.26±2.18 vs 4.62±1.15,ng/mL)及NLR(9.75±4.12 vs 6.53±2.90)水平均明显高于轻症细菌性肺炎(P<0.01)。ROC曲线分析显示,CD64、CRP、PCT及NLR单项指标诊断细菌性肺炎的最佳截值分别为3.25、14.80 mg/L、1.83 ng/mL、4.37,四项联合诊断细菌性肺炎的AUC(0.948,95%CI:0.887~0.992)最大,其敏感度和特异度为96.2%和89.3%。Pearson相关分析显示,细菌性肺炎患儿CD64与CRP、PCT及NLR呈正相关(r=0.573、0.729、0.536,P<0.01),CRP与PCT及NLR呈正相关(r=0.602、0.497,P<0.01),PCT与NLR呈正相关(r=0.514,P<0.01)。结论CD64、CRP、PCT及NLR四项联合检测有助于提高细菌性肺炎的诊断价值,并可作为判断CAP患儿病情严重程度的实验室指标。     

Diagnostic and Prognostic Value of Inflammatory Parameters Including Neopterin in the Setting of Pneumonia,COPD, and Acute Exacerbations

Acute exacerbations and community-acquired pneumonia (CAP) are severe complications in patients with chronic obstructive pulmonary disease (COPD). In this study, we analyzed inflammatory parameters in serum including C-reactive protein (CRP), procalcitonin (PCT), and serum neopterin (NPT) to determine their potential to differentiate between patients with CAP+COPD and with acute exacerbations of COPD (AECOPD) without pneumonia. 102 (39 women and 63 men) patients were included in this retrospective study, of whom 48 presented with CAP without underlying COPD, 20 with CAP+COPD and 34 with AECOPD. CRP, PCT, and blood counts were determined by routine automated tests, and NPT concentrations were determined by ELISA. The ratios of CRP to NPT levels were calculated. Upon patient admission, CRP, PCT, and NPT levels were significantly higher in patients with CAP compared to those in AECOPD patients. CRP/NPT ratio was lower in AECOPD compared to CAP (+/?COPD) patients. Positive correlations were found between duration of hospitalization and CRP levels and the CRP/NPT ratio at study entry. Patients who were readmitted within 30 days tended to have higher NPT levels at initial presentation. Patients under ongoing corticosteroid treatment presented with lower inflammatory parameters. The CRP/NPT-ratio was suited well to discriminate between AECOPD and CAP on the basis of COPD, a CRP/NPT cutoff of 0.346 provided a sensitivity of 65% and a specificity of 79%. The combinatory use of inflammatory patterns might help to differentiate patients with AECOPD from those with CAP on the basis of COPD.     

C-reactive protein velocity following antibiotics in patients with chronic obstructive pulmonary disease exacerbation and community acquired pneumonia

IntroductionDistinguishing community acquired pneumonia (CAP) from chronic obstructive pulmonary disease (COPD) exacerbation is a challenging task, since fever, productive cough, dyspnea, and leukocytosis are all common features of both conditions. Moreover, chest X-ray might not be sensitive enough. It is therefore quite common for physicians to prescribe unnecessary antibiotics for COPD exacerbation, leading to resistant bacteria and other related adverse affects.AimTo study whether CRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment, could provide an efficient tool for distinguishing CAP from COPD exacerbation.MethodsThe study group included 36 COPD exacerbation and 49 CAP patients, admitted to a single Internal Medicine department during the years 2004–2006. All patients were treated with cephalosporins and macrolides upon admission.ResultsCRP levels upon admission were significantly higher among CAP patients than among COPD exacerbation patients (111.5 ± 104.4 vs. 34.9 ± 28.6 mg/l, p < 0.0001). CRP levels on the second day of hospitalization, following antibiotic administration to all patients, made a sharp incline in 36.7% of CAP patients compared to only 5.9% of COPD exacerbation patients (p = 0.005), and remained unchanged in 61.8% of COPD patients compared to 16.3% of CAP patients (p = 0.0006).ConclusionsCRP levels upon admission and the delta in CRP levels following initiation of antibacterial treatment could provide an efficient tool for distinguishing CAP from COPD exacerbation.     

Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia

Background and objective: The solid‐phase immunoassay, semi‐quantitative procalcitonin (PCT) test (B R A H M S PCT‐Q) can be used to rapidly categorize PCT levels into four grades. However, the usefulness of this kit for determining the prognosis of adult patients with community‐acquired pneumonia (CAP) is unclear. Methods: A prospective study was conducted in two Japanese hospitals to evaluate the usefulness of this PCT test in determining the prognosis of adult patients with CAP. The accuracy of the age, dehydration, respiratory failure, orientation disturbance, pressure (A‐DROP) scale proposed by the Japanese Respiratory Society for prediction of mortality due to CAP was also investigated. Hospitalized CAP patients (n = 226) were enrolled in the study. Comprehensive examinations were performed to determine PCT and CRP concentrations, disease severity based on the A‐DROP, pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB‐65) scales and the causative pathogens. The usefulness of the biomarkers and prognostic scales for predicting each outcome were then examined. Results: Twenty of the 170 eligible patients died. PCT levels were strongly positively correlated with PSI (ρ = 0.56, P < 0.0001), A‐DROP (ρ = 0.61, P < 0.0001) and CURB‐65 scores (ρ = 0.58, P < 0.0001). The areas under the receiver operating characteristic curves (95% CI) for prediction of survival, for CRP, PCT, A‐DROP, CURB‐65, and PSI were 0.54 (0.42–0.67), 0.80 (0.70–0.90), 0.88 (0.82–0.94), 0.88 (0.82–0.94), and 0.89 (0.85–0.94), respectively. The 30‐day mortality among patients who were PCT‐positive (≥0.5 ng/mL) was significantly higher than that among PCT‐negative patients (log–rank test, P < 0.001). Conclusions: The semi‐quantitative PCT test and the A‐DROP scale were found to be useful for predicting mortality in adult patients with CAP.     

Coagulation and inflammation biomarkers may help predict the severity of community‐acquired pneumonia

Background and objective: There are limited data on the relationship between the severity of community‐acquired pneumonia (CAP) and biomarkers of inflammation and coagulation. The aim of this study was to evaluate the association between the severity of CAP and serum levels of antithrombin III (AT‐III), protein C (P‐C), D‐dimers (D‐D) and CRP, at hospital admission. Methods: This was a prospective observational study in 77 adults (62.3% men), who were hospitalized for CAP. The severity of CAP was assessed using the confusion, uraemia, respiratory rate ≥30 breaths/min, low blood pressure, age ≥65 years (CURB‐65) score. Results: Forty patients (52%) had severe CAP (CURB‐65 score 3–5). Serum levels of AT‐III were lower and levels of D‐D and CRP were higher in patients with severe CAP than in patients with mild CAP (CURB‐65 score 0–2) (P < 0.001 for all comparisons). Levels of P‐C were lower in patients with severe CAP compared with those with mild CAP, but the difference was not significant (P = 0.459). At a cut‐off point of 85%, AT‐III showed a sensitivity of 80% and a specificity of 75%, as a determinant of the need for hospitalization. At a cut‐off point of 600 ng/mL, D‐D showed a sensitivity of 90% and a specificity of 75% and at a cut‐off point of 110 mg/L, CRP showed a sensitivity of 83% and a specificity of 79%, as determinants of the need for hospitalization. Conclusions: Serum levels of AT‐III, D‐D and CRP at admission appear to be useful biomarkers for assessing the severity of CAP.     

Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP.

SETTING: Procalcitonin (PCT), a propeptide of the hormone calcitonin, is a novel marker of the inflammatory response to infection. It has been used to discriminate between infectious and non-infectious causes of inflammation, and as a marker of severe sepsis in the intensive care unit. OBJECTIVE: To evaluate the utility of PCT in distinguishing community-acquired pneumonia (CAP) due to common bacteria, Mycobacterium tuberculosis and Pneumocystis jirovecii in a high human immunodeficiency virus (HIV) prevalence setting. METHODS: Two hundred and sixty-six patients admitted with a diagnosis of CAP were investigated. Serum samples for PCT were collected on admission. PCT levels were measured using a commercial immunoluminometric assay. RESULTS: A microbiological diagnosis was obtained in 169/266 patients: 44 pulmonary tuberculosis (PTB), 31 P. jirovecii pneumonia (PJP), and 35 bacterial pneumonia. The PCT levels were PTB 4.16 ng/ml (SEM 1.197; 95% CI 1.749-6.579); PJP 1.138 ng/ml (SEM 0.2911; 95% CI 0.543-1.734); and bacterial pneumonia 19.48 ng/ml (SEM 5.64; 95% CI 8.021-30.938, P < 0.0004). Thirty-six had co-infections. CONCLUSION: PCT levels differ significantly in patients with CAP due to TB, PJP and bacteria. PCT may be important in distinguishing M. tuberculosis and PJP in a high HIV prevalence setting where atypical presentations often confound the empirical clinical diagnosis.     

PCT与CRP在社区获得性肺炎中的诊断价值

目的探讨降钙素原(PCT)及C反应蛋白(CRP)在社区获得性肺炎临床诊断中的价值。方法选符合CAP诊断标准的患者89例,并分为重症肺炎组(A组)25例,一般肺炎组(B组)64例和18例(健康者)为对照组(C组),对入选患者的血清PCT和CRP进行分析。结果 PCT在A组为(14.770±6.141)ng/ml,B组(1.504±0.655)ng/ml、对照组(0.047±0.009)ng/ml,差异有统计学意义(P0.05);而CRP虽然在重症肺炎组中明显升高,且其敏感性较PCT高,但其特异性较PCT低;取0.11ng/ml为截断值,降钙素原诊断社区活动性肺炎中的敏感度为88%,特异度为95%。结论降钙素原在社区获得性肺炎诊断中具有重要价值,尤其对重症肺炎诊断及病情严重程度评估,是一个可靠的指标。     

血清降钙素原在肺炎诊断及严重程度判断中的研究

目的:评价血清降钙素原(PCT)对肺炎诊断及严重程度评估中的应用价值。方法:本研究为前瞻性,收集肺炎患者51例,检测患者的血清PCT、C-反应蛋白(CRP)、内毒素(LPS)、白细胞(WBC)计数及白细胞介素-6(IL-6)。结果:1.痰细菌培养阳性肺炎组PCT水平较支原体肺炎或衣原体肺炎组高,差异有统计学意义(P<0.01),较病原学检测阴性肺炎组高,差异有统计学意义(P<0.01),病原学检测阴性肺炎组PCT水平较支原体肺炎或衣原体肺炎组高,差异无统计学意义(P>0.05)。2.有并发症组的PCT水平较无并发症组高,差异有统计学意义(P<0.05)。PCT水平在中高危组较低危组高,差异有统计学意义(P<0.05);PCT阳性率在中高危组较低危组高,差异有统计学意义(P<0.05)结论:血清PCT水平对肺炎的病原学诊断有一定的预测价值,而CRP、内毒素、WBC计数及IL-6组间,差异无统计学意义;血清PCT作为肺炎患者严重程度的一项评价指标可能具有一定意义。     

Correlation of inflammatory and cardiovascular biomarkers with pneumonia severity scores

Purpose

To assess the correlation of procalcitonin (PCT), C-reactive protein (CRP), neopterin, mid-regional pro-atrial natriuretic peptide (MR-proANP), and mid-regional pro-adrenomedullin (MR-proADM) with severity risk scores: severe CAP (SCAP) and SMART-COP in patients with community-acquired pneumonia (CAP), as well as short term prognosis and to determine the correlation with mortality risk scores.

Methods

Eighty-five patients with a final diagnosis of pneumonia were consecutively included during a two month period. Epidemiological, clinical, microbiological, and radiological data were recorded. Patients were stratified according to the PSI, CURB-65, SCAP and SMART-COP. Complications were defined as respiratory failure/shock, need of ICU, and death. Plasma samples were collected at admission.

Results

MR-proANP and MR-proADM showed significantly higher levels in high risk SCAP group in comparison to low risk. When considering SMART-COP none of the biomarkers showed statistical differences. MR-proADM levels were high in patients with high risk of needing intensive respiratory or vasopressor support according to SMRT-CO. Neopterin and MR-proADM were significantly higher in patients that developed complications. PCT and MR-proADM showed significantly higher levels in cases of a definite bacterial diagnosis in comparison to probable bacterial, and unknown origin. MR-proANP and MR-proADM levels increased statistically according to PSI and CURB-65.

Conclusions

Biomarker levels are higher in pneumonia patients with a poorer prognosis according to SCAP and SMART-COP indexes, and to the development of complications.     

Effect of hyperglycaemia on inflammatory and stress responses and clinical outcome of pneumonia in non-critical-care inpatients: results from an observational cohort study

Aims/hypothesis

Despite the condition’s high prevalence, the influence of hyperglycaemia on clinical outcomes in non-critical-care inpatients with infections remains ill defined. In this study, we analysed associations of glucose levels at admission and during initial inpatient treatment with the inflammatory response and clinical outcome in community-acquired pneumonia (CAP) patients.

Methods

This secondary observational analysis included 880 confirmed CAP patients. We used severity-adjusted multivariate regression models to investigate associations of initial and 96 h mean glucose levels with serially measured biomarker levels over 7 days (C-reactive protein [CRP], procalcitonin, white blood cell count [WBC], pro-adrenomedullin [ProADM]) and adverse clinical course (death and intensive-care unit admission).

Results

In the 724 non-diabetic patients (82.3% of the study population), moderate or severe hyperglycaemia (glucose 6–11 mmol/l and >11 mmol/l, respectively) was associated with increased risk for adverse clinical course (adjusted OR [95% CI] 1.4 [0.8, 2.4] and 3.0 [1.1, 8.0], respectively) and with higher CRP, WBC and ProADM levels over 7 days (p?<?0.05, ANOVA, all days). In diabetic patients (n?=?156), no similar associations were found for initial hyperglycaemia, although mean 96 h glucose levels ?≥?9 mmol/l were associated with adverse clinical course (adjusted OR 5.4 [1.1, 25.8]; p?=?0.03). No effect modification by insulin treatment was detected (interaction terms p?>?0.2 for all analyses).

Conclusions/interpretation

Initial hyperglycaemia in non-diabetic CAP patients, and prolonged hyperglycaemia in diabetic or non-diabetic CAP patients, are associated with a more pronounced inflammatory response and CAP-related adverse clinical outcome. Optimal glucose targets for insulin treatment of hyperglycaemia in non-critical-care settings should be defined.     

Serum procalcitonin and C-reactive protein for differentiating bacterial infection from disease activity in patients with systemic lupus erythematosus

Abstract

Objective. To study the clinical value of procalcitonin (PCT) and C-reactive protein (CRP) in differentiating bacterial infection from disease activity in systemic lupus erythematosus (SLE) patients.

Method. PCT and CRP in active SLE patients complicated with and without bacterial infection were retrospectively studied. Bacterial infection was diagnosed by positive culture results or typical symptoms and signs combined with positive response to antibiotics. Disease activity of SLE was assessed by systemic lupus erythematosus disease activity index (SLEDAI).

Result. One hundred and fourteen active SLE patients were recruited, 47 of which were with bacterial infection and 67 were non-infected. PCT and CRP levels were significantly elevated in patients with bacterial infection (P < 0.05). The ideal cutoff value for PCT was 0.38 ng/ml, at which the sensitivity (74.5%) and specificity (95.5%) combined the best. The negative predictive value and positive predictive value to detect bacterial infection were 84.2% and 92.1%, respectively. PCT but not the CRP level in the septic patients was significantly higher than that of non-septic ones. Meanwhile, in patients with SLEDAI score of > 10, both PCT and CRP levels were higher in patients with bacterial infection, but the difference was only statistically significant for PCT (P < 0.05). PCT was significantly reduced after anti-bacterial treatment.

Conclusion. PCT test is superior to CRP test in detecting superimposed bacterial infection in active SLE patients. The levels of PCT are correlated with the severity of bacterial infection and can be used to monitor the response to antibiotic treatment.