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Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia.

Christ-Crain M, Opal SM - Crit Care (2010)

Bottom Line: It can therefore be viewed as a diagnostic, prognostic, and perhaps even theragnostic test.It more closely matches the criteria for usefulness than other candidate biomarkers such as C-reactive protein, which is rather a nonspecific marker of acute phase inflammation, and proinflammatory cytokines such as plasma IL-6 levels that are highly variable, cumbersome to measure, and lack specificity for systemic infection.None should be used on its own; and none is anything more than an aid in the exercise of clinical judgment based upon a synthesis of available clinical, physiologic and laboratory features in each patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. mirjam.christ-crain@unibas.ch

ABSTRACT
In patients with community-acquired pneumonia, traditional criteria of infection based on clinical signs and symptoms, clinical scoring systems, and general inflammatory indicators (for example, leukocytosis, fever, C-reactive protein and blood cultures) are often of limited clinical value and remain an unreliable guide to etiology, optimal therapy and prognosis. Procalcitonin is superior to other commonly used markers in its specificity for bacterial infection (allowing alternative diagnoses to be excluded), as an indicator of disease severity and risk of death, and mainly as a guide to the necessity for antibiotic therapy. It can therefore be viewed as a diagnostic, prognostic, and perhaps even theragnostic test. It more closely matches the criteria for usefulness than other candidate biomarkers such as C-reactive protein, which is rather a nonspecific marker of acute phase inflammation, and proinflammatory cytokines such as plasma IL-6 levels that are highly variable, cumbersome to measure, and lack specificity for systemic infection. Elevated levels of pro-adrenomedullin, copeptin (which is produced in equimolar amounts to vasopressin), natriuretic peptides and cortisol are significantly related to mortality in community-acquired pneumonia, as are other prohormones such as pro-atrial natriuretic peptide, coagulation markers, and other combinations of inflammatory cytokine profiles. However, all biomarkers have weaknesses as well as strengths. None should be used on its own; and none is anything more than an aid in the exercise of clinical judgment based upon a synthesis of available clinical, physiologic and laboratory features in each patient.

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Related in: MedlinePlus

Diagnostic accuracy of different biomarkers for community-acquired pneumonia. Receiver operating characteristics (ROC) curves for diagnostic accuracy to predict radiographically suspected community-acquired pneumonia (CAP) including other non-infectious diagnoses initially diagnosed as CAP plus patients without a clinically relevant bacterial etiology of CAP. Values show areas under the ROC curve with 95% confidence intervals. CRP, C-reactive protein; PCT, procalcitonin.
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Figure 1: Diagnostic accuracy of different biomarkers for community-acquired pneumonia. Receiver operating characteristics (ROC) curves for diagnostic accuracy to predict radiographically suspected community-acquired pneumonia (CAP) including other non-infectious diagnoses initially diagnosed as CAP plus patients without a clinically relevant bacterial etiology of CAP. Values show areas under the ROC curve with 95% confidence intervals. CRP, C-reactive protein; PCT, procalcitonin.

Mentions: The diagnostic and prognostic accuracy of clinical signs and symptoms and a range of laboratory markers were recently assessed in a planned post hoc analysis of 545 patients with suspected lower respiratory tract infection admitted to the emergency department [2]. In a receiver operating characteristic analysis to determine the diagnostic accuracy for CAP, the area under the curve of a clinical model including fever, cough, sputum production, abnormal chest auscultation and dyspnea was 0.79. Including values for procalcitonin (PCT) and highly sensitive C-reactive protein (CRP) increased the area under the curve to 0.92, which was significantly better than the areas under the curve for PCT, CRP and clinical signs and symptoms alone (Figure 1). The contribution to diagnostic reliability made by PCT was substantially greater than that made by CRP, which in turn performed better than the total leukocyte count. Clinical criteria such as sputum production and physical examination with chest auscultation were surprisingly poor predictors for the diagnosis of CAP. The added value of the PCT biomarker as a clinical decision-making tool is evidenced in the present study and many other studies involving PCT measurement [3-9].


Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia.

Christ-Crain M, Opal SM - Crit Care (2010)

Diagnostic accuracy of different biomarkers for community-acquired pneumonia. Receiver operating characteristics (ROC) curves for diagnostic accuracy to predict radiographically suspected community-acquired pneumonia (CAP) including other non-infectious diagnoses initially diagnosed as CAP plus patients without a clinically relevant bacterial etiology of CAP. Values show areas under the ROC curve with 95% confidence intervals. CRP, C-reactive protein; PCT, procalcitonin.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2875480&req=5

Figure 1: Diagnostic accuracy of different biomarkers for community-acquired pneumonia. Receiver operating characteristics (ROC) curves for diagnostic accuracy to predict radiographically suspected community-acquired pneumonia (CAP) including other non-infectious diagnoses initially diagnosed as CAP plus patients without a clinically relevant bacterial etiology of CAP. Values show areas under the ROC curve with 95% confidence intervals. CRP, C-reactive protein; PCT, procalcitonin.
Mentions: The diagnostic and prognostic accuracy of clinical signs and symptoms and a range of laboratory markers were recently assessed in a planned post hoc analysis of 545 patients with suspected lower respiratory tract infection admitted to the emergency department [2]. In a receiver operating characteristic analysis to determine the diagnostic accuracy for CAP, the area under the curve of a clinical model including fever, cough, sputum production, abnormal chest auscultation and dyspnea was 0.79. Including values for procalcitonin (PCT) and highly sensitive C-reactive protein (CRP) increased the area under the curve to 0.92, which was significantly better than the areas under the curve for PCT, CRP and clinical signs and symptoms alone (Figure 1). The contribution to diagnostic reliability made by PCT was substantially greater than that made by CRP, which in turn performed better than the total leukocyte count. Clinical criteria such as sputum production and physical examination with chest auscultation were surprisingly poor predictors for the diagnosis of CAP. The added value of the PCT biomarker as a clinical decision-making tool is evidenced in the present study and many other studies involving PCT measurement [3-9].

Bottom Line: It can therefore be viewed as a diagnostic, prognostic, and perhaps even theragnostic test.It more closely matches the criteria for usefulness than other candidate biomarkers such as C-reactive protein, which is rather a nonspecific marker of acute phase inflammation, and proinflammatory cytokines such as plasma IL-6 levels that are highly variable, cumbersome to measure, and lack specificity for systemic infection.None should be used on its own; and none is anything more than an aid in the exercise of clinical judgment based upon a synthesis of available clinical, physiologic and laboratory features in each patient.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Petersgraben 4, CH-4031 Basel, Switzerland. mirjam.christ-crain@unibas.ch

ABSTRACT
In patients with community-acquired pneumonia, traditional criteria of infection based on clinical signs and symptoms, clinical scoring systems, and general inflammatory indicators (for example, leukocytosis, fever, C-reactive protein and blood cultures) are often of limited clinical value and remain an unreliable guide to etiology, optimal therapy and prognosis. Procalcitonin is superior to other commonly used markers in its specificity for bacterial infection (allowing alternative diagnoses to be excluded), as an indicator of disease severity and risk of death, and mainly as a guide to the necessity for antibiotic therapy. It can therefore be viewed as a diagnostic, prognostic, and perhaps even theragnostic test. It more closely matches the criteria for usefulness than other candidate biomarkers such as C-reactive protein, which is rather a nonspecific marker of acute phase inflammation, and proinflammatory cytokines such as plasma IL-6 levels that are highly variable, cumbersome to measure, and lack specificity for systemic infection. Elevated levels of pro-adrenomedullin, copeptin (which is produced in equimolar amounts to vasopressin), natriuretic peptides and cortisol are significantly related to mortality in community-acquired pneumonia, as are other prohormones such as pro-atrial natriuretic peptide, coagulation markers, and other combinations of inflammatory cytokine profiles. However, all biomarkers have weaknesses as well as strengths. None should be used on its own; and none is anything more than an aid in the exercise of clinical judgment based upon a synthesis of available clinical, physiologic and laboratory features in each patient.

Show MeSH
Related in: MedlinePlus