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Procalcitonin predictive of need for ICU care, bacteremia in pneumonia
Serial procalcitonin measurements showed promise for the prediction of adverse clinical outcomes in patients with pneumonia, study data indicated.
“The ability of procalcitonin to distinguish bacterial from viral etiologies of lower respiratory tract infections is established. In addition, studies have demonstrated that the use of procalcitonin-guided algorithms can safely reduce antibiotic exposure in lower respiratory tract infections without an increase in adverse events,” Suzanne M. McCluskey, MD, of the department of medicine, division of infectious diseases at Massachusetts General Hospital, Boston, and colleagues wrote. “Although the role of procalcitonin in the initial evaluation of lower respiratory tract infections is recognized, the contribution of procalcitonin to clinical prognosis has yet to be defined.”
Researchers performed a prospective cohort study on patients at a Boston hospital from March to September 2013 (n = 317). McCluskey and colleagues measured patients’ procalcitonin on days 1 through 4. The primary endpoint was a “composite adverse outcome” including ICU admission, bacteremia and all-cause mortality. Researchers used regression models, measuring the prognostic value of procalcitonin using the area under the receiver operating characteristic curve (AUC).
Twenty-five percent of patients met the primary endpoint, researchers reported. Sixteen had bacteremia, 65 were moved to ICUs and 16 died. Procalcitonin measurements ranged from less than 0.05 ng/mL to 313.4 ng/mL. McCluskey and colleagues reported higher levels of procalcitonin in patients who had bacteremia or had to be admitted to the ICU, but procalcitonin was not predictive of all-cause mortality. Incorporating serial procalcitonin levels improved the prognostic capabilities of the Pneumonia Severity Index, for the primary composite endpoint (AUC range, 0.61-0.66), need for ICU care (AUC range, 0.58-0.64) and bacteremia (AUC range, 0.67-0.85). Procalcitonin also improved risk stratification for predicting adverse outcomes among the highest-risk class of patients, the researchers wrote. Overall, procalcitonin was a better indicator of adverse events for patients with community-acquired pneumonia than for those with health care-associated pneumonia.
McCluskey and colleagues wrote that the study was limited by the fact that it was carried out in a single tertiary care center on a heterogeneous patient population.
“Prospective studies in which providers have procalcitonin results available in real time will be required to define the number and frequency of procalcitonin measurements to predict prognosis,” the researchers wrote. “Additional research focused on applying procalcitonin-based prognostication to the effective utilization of health care services is needed.” – by Andy Polhamus
Disclosure: McCluskey reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.