Chest
Volume 128, Issue 4, October 2005, Pages 2223-2229
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Clinical Investigations
Usefulness of Procalcitonin Levels in Community-Acquired Pneumonia According to the Patients Outcome Research Team Pneumonia Severity Index

https://doi.org/10.1378/chest.128.4.2223Get rights and content

Study objectives

To evaluate the usefulness of procalcitonin serum levels as a predictor of etiology and prognosis in adult patients with community-acquired pneumonia (CAP) when they are stratified according to severity.

Design

One-year, population-based, prospective study.

Setting

University teaching hospital.

Patients

All adult patients who received a diagnosis of CAP throughout the study period.

Interventions and measurements

An extensive noninvasive microbiological workup was performed. In patients who gave informed consent, a blood sample was collected at the time the diagnosis of CAP was established to measure biological markers. Procalcitonin levels were measured by a commercially available monoclonal immunoluminometric assay (limit of detection, 0.1 μg/L). Patients were classified according to microbial diagnosis, Patients Outcome Research Team pneumonia severity index (PSI), and outcome measures, and procalcitonin levels were compared among groups.

Results

Of 240 patients who received a diagnosis of CAP during the study period, procalcitonin concentrations were measured in 185 patients (77.1%). Levels were higher in patients with high-severity risk classes (PSI classes III-V) [p = 0.01] and in those with complications (p = 0.03) or death (p < 0.0001). Among patients classified into PSI low-severity risk classes (classes I-II), levels tended to be higher in those with bacterial etiology (p = 0.08); in this group, a serum procalcitonin level ≥ 0.15 μg/L was more frequently found in patients with bacterial pneumonia than in those with nonbacterial pneumonia (p = 0.03). In patients with higher-severity risk classes, no significant differences were observed in procalcitonin levels among etiologic groups, but higher concentrations were associated with development of complications (p = 0.01) and death (p < 0.0001).

Conclusions

Procalcitonin contribution to the evaluation of CAP varies according to severity. While procalcitonin may have a role to predict the microbial etiology in patients with a low PSI score, in patients classified within high PSI risk classes, it is a prognostic marker rather than a predictor of etiology.

Section snippets

Setting and Population Studied

A prospective, population-based investigation of CAP was conducted over a 24-month period (October 15, 1999, through October 14, 2001) at Hospital Universitario de Elche, a 430-bed teaching hospital covering a population of 239,335 people living in three municipalities of the “Health Authority of Bajo Vinalopó,” on the Mediterranean coast of Spain. All adult patients (≥ 15 years old) from this health authority with signs and symptoms compatible with pneumonia over the 24-month study period were

Results

Of 251 patients evaluated from October 15, 1999, to October 14, 2000, 11 patients were subsequently found not to have CAP, leaving 240 patients in the study cohort. The mean age was 59 years (range, 15 to 93 years), and 62.5% were male. In 115 patients (48%), there was one or more underlying disease, mostly diabetes mellitus (n = 55) and COPD (n = 51). Sixty patients (25%) had previously been treated with antibiotics.

The causative pathogen was found in 131 of the 240 patients (54.6%) [56

Discussion

The results of this study suggest that procalcitonin contribution to the evaluation of patients with CAP varies according to severity of pneumonia. While procalcitonin may have a role to predict the microbial etiology in patients with a low PSI score, in patients classified within high PSI risk classes it is a prognostic marker rather than a predictor of etiology.

To our knowledge, this is the largest study to date performed in adults with CAP in which procalcitonin serum levels have been

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    This work was performed at Hospital General Universitario de Elche, Alicante, Spain.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

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