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Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ.

Krüger S, Ewig S, Papassotiriou J, Kunde J, Marre R, von Baum H, Suttor N, Welte T, CAPNETZ Study Gro - Respir. Res. (2009)

Bottom Line: In patients with typical bacterial CAP, levels of PCT, CRP and WBC were significantly higher compared to CAP of atypical or viral etiology.There were no significant differences in PCT, CRP and WBC in patients with atypical or viral etiology of CAP.PCT, CRP and WBC are highest in typical bacterial etiology in CAP but do not allow individual prediction of etiology.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Clinic I, University Clinic RWTH Aachen, Germany. stkrueger@ukaachen.de

ABSTRACT

Background: Aim of this study was to evaluate the correlation of inflammatory markers procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count (WBC) with microbiological etiology of CAP.

Methods: We enrolled 1337 patients (62 +/- 18 y, 45% f) with proven CAP. Extensive microbiological workup was performed. In all patients PCT, CRP, WBC and CRB-65 score were determined. Patients were classified according to microbial diagnosis and CRB-65 score.

Results: In patients with typical bacterial CAP, levels of PCT, CRP and WBC were significantly higher compared to CAP of atypical or viral etiology. There were no significant differences in PCT, CRP and WBC in patients with atypical or viral etiology of CAP. In contrast to CRP and WBC, PCT markedly increased with severity of CAP as measured by CRB-65 score (p < 0.0001). In ROC analysis for discrimination of patients with CRB-65 scores > 1, AUC for PCT was 0.69 (95% CI 0.66 to 0.71), which was higher compared to CRP and WBC (p < 0.0001). CRB-65, PCT, CRP and WBC were higher (p < 0.0001) in hospitalised patients in comparison to outpatients.

Conclusion: PCT, CRP and WBC are highest in typical bacterial etiology in CAP but do not allow individual prediction of etiology. In contrast to CRP and WBC, PCT is useful in severity assessment of CAP.

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Admission levels of PCT (a), CRP (b) and WBC (c) in CAP patients with pneumococcal and atypical etiology of CAP. The scatterplots represent all data. Median values with interquartile ranges are shown. ns = no significant difference.
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Figure 3: Admission levels of PCT (a), CRP (b) and WBC (c) in CAP patients with pneumococcal and atypical etiology of CAP. The scatterplots represent all data. Median values with interquartile ranges are shown. ns = no significant difference.

Mentions: In the study population we identified 48 patients with Legionella pneumophila, 140 with Mycoplasma pneumoniae and only two patients with Chlamydia pneumoniae. In patients with CAP caused by Legionella pneumophila, Mycoplasma pneumoniae or Chlamydia pneumoniae, (Figure 3) there were no significant differences in PCT (0.20 ng/mL; 0.02 ng/mL – 41.77 ng/mL vs. 0.10 ng/mL; 0.01 ng/mL – 12.14 ng/mL vs. 0.03 ng/mL; 0.02 ng/mL – 0.04 ng/mL, n.s.), CRP (76.00 mg/mL; 0.50 mg/mL – 580.00 mg/mL vs. 74.75 mg/mL; 0.80 mg/mL – 480.00 mg/mL vs. 113.5 mg/mL; 3.00 mg/mL – 224.00 mg/mL, n.s.) and WBC (12.00 G/L; 2.80 G/L – 32.60 G/L vs. 10.70 G/L; 2.3 G/L – 28.40 G/L vs. 8.05 G/L; 5.1 G/L – 11.00 G/L, n.s.).


Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ.

Krüger S, Ewig S, Papassotiriou J, Kunde J, Marre R, von Baum H, Suttor N, Welte T, CAPNETZ Study Gro - Respir. Res. (2009)

Admission levels of PCT (a), CRP (b) and WBC (c) in CAP patients with pneumococcal and atypical etiology of CAP. The scatterplots represent all data. Median values with interquartile ranges are shown. ns = no significant difference.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2714042&req=5

Figure 3: Admission levels of PCT (a), CRP (b) and WBC (c) in CAP patients with pneumococcal and atypical etiology of CAP. The scatterplots represent all data. Median values with interquartile ranges are shown. ns = no significant difference.
Mentions: In the study population we identified 48 patients with Legionella pneumophila, 140 with Mycoplasma pneumoniae and only two patients with Chlamydia pneumoniae. In patients with CAP caused by Legionella pneumophila, Mycoplasma pneumoniae or Chlamydia pneumoniae, (Figure 3) there were no significant differences in PCT (0.20 ng/mL; 0.02 ng/mL – 41.77 ng/mL vs. 0.10 ng/mL; 0.01 ng/mL – 12.14 ng/mL vs. 0.03 ng/mL; 0.02 ng/mL – 0.04 ng/mL, n.s.), CRP (76.00 mg/mL; 0.50 mg/mL – 580.00 mg/mL vs. 74.75 mg/mL; 0.80 mg/mL – 480.00 mg/mL vs. 113.5 mg/mL; 3.00 mg/mL – 224.00 mg/mL, n.s.) and WBC (12.00 G/L; 2.80 G/L – 32.60 G/L vs. 10.70 G/L; 2.3 G/L – 28.40 G/L vs. 8.05 G/L; 5.1 G/L – 11.00 G/L, n.s.).

Bottom Line: In patients with typical bacterial CAP, levels of PCT, CRP and WBC were significantly higher compared to CAP of atypical or viral etiology.There were no significant differences in PCT, CRP and WBC in patients with atypical or viral etiology of CAP.PCT, CRP and WBC are highest in typical bacterial etiology in CAP but do not allow individual prediction of etiology.

View Article: PubMed Central - HTML - PubMed

Affiliation: Medical Clinic I, University Clinic RWTH Aachen, Germany. stkrueger@ukaachen.de

ABSTRACT

Background: Aim of this study was to evaluate the correlation of inflammatory markers procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count (WBC) with microbiological etiology of CAP.

Methods: We enrolled 1337 patients (62 +/- 18 y, 45% f) with proven CAP. Extensive microbiological workup was performed. In all patients PCT, CRP, WBC and CRB-65 score were determined. Patients were classified according to microbial diagnosis and CRB-65 score.

Results: In patients with typical bacterial CAP, levels of PCT, CRP and WBC were significantly higher compared to CAP of atypical or viral etiology. There were no significant differences in PCT, CRP and WBC in patients with atypical or viral etiology of CAP. In contrast to CRP and WBC, PCT markedly increased with severity of CAP as measured by CRB-65 score (p < 0.0001). In ROC analysis for discrimination of patients with CRB-65 scores > 1, AUC for PCT was 0.69 (95% CI 0.66 to 0.71), which was higher compared to CRP and WBC (p < 0.0001). CRB-65, PCT, CRP and WBC were higher (p < 0.0001) in hospitalised patients in comparison to outpatients.

Conclusion: PCT, CRP and WBC are highest in typical bacterial etiology in CAP but do not allow individual prediction of etiology. In contrast to CRP and WBC, PCT is useful in severity assessment of CAP.

Show MeSH