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Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia.

Kim JH, Seo JW, Mok JH, Kim MH, Cho WH, Lee K, Kim KU, Jeon D, Park HK, Kim YS, Kim HH, Lee MK - Tuberc Respir Dis (Seoul) (2013)

Bottom Line: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010.The correlation between the levels of CRP or WBC and CAP severity was low.The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

ABSTRACT

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP.

Methods: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (≥65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI).

Results: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ρ=0.408 with p<0.001; procalcitonin and PSI, ρ=0.293 with p=0.003; procalcitonin and mortality, ρ=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly.

Conclusion: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

No MeSH data available.


Related in: MedlinePlus

Receiver operating characteristic curves of procalcitonin (AUC 0.663), CRP (AUC 0.556), WBC (AUC 0.597) for prediction of severe community-acquired pneumonia defined as PSI≥IV in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; PSI: pneumonia severity index; CAP: community-acquired pneumonia; PCT: procalcitonin.
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Figure 1: Receiver operating characteristic curves of procalcitonin (AUC 0.663), CRP (AUC 0.556), WBC (AUC 0.597) for prediction of severe community-acquired pneumonia defined as PSI≥IV in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; PSI: pneumonia severity index; CAP: community-acquired pneumonia; PCT: procalcitonin.

Mentions: Based on a positive correlation between procalcitonin, white blood cells and PSI, CURB-65, ROC curve analysis was performed. When PSI class of IV or above was defined as severe community-acquired pneumonia, area under the ROC curve (AUC) was 0.663 for procalcitonin (Figure 1). With the cutoff value of 2 in CURB-65, AUC increased to 0.741 for procalcitonin while AUC was 0.644 for white blood cell count. Thus procalcitonin level demonstrated more effectively to predict pneumonia severity, compared with white blood cell count. A cutoff value of 0.265 ng/mL showed a sensitivity of 88.9% and specificity of 52.4% for procalcitonin (Figure 2).


Usefulness of plasma procalcitonin to predict severity in elderly patients with community-acquired pneumonia.

Kim JH, Seo JW, Mok JH, Kim MH, Cho WH, Lee K, Kim KU, Jeon D, Park HK, Kim YS, Kim HH, Lee MK - Tuberc Respir Dis (Seoul) (2013)

Receiver operating characteristic curves of procalcitonin (AUC 0.663), CRP (AUC 0.556), WBC (AUC 0.597) for prediction of severe community-acquired pneumonia defined as PSI≥IV in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; PSI: pneumonia severity index; CAP: community-acquired pneumonia; PCT: procalcitonin.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672412&req=5

Figure 1: Receiver operating characteristic curves of procalcitonin (AUC 0.663), CRP (AUC 0.556), WBC (AUC 0.597) for prediction of severe community-acquired pneumonia defined as PSI≥IV in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; PSI: pneumonia severity index; CAP: community-acquired pneumonia; PCT: procalcitonin.
Mentions: Based on a positive correlation between procalcitonin, white blood cells and PSI, CURB-65, ROC curve analysis was performed. When PSI class of IV or above was defined as severe community-acquired pneumonia, area under the ROC curve (AUC) was 0.663 for procalcitonin (Figure 1). With the cutoff value of 2 in CURB-65, AUC increased to 0.741 for procalcitonin while AUC was 0.644 for white blood cell count. Thus procalcitonin level demonstrated more effectively to predict pneumonia severity, compared with white blood cell count. A cutoff value of 0.265 ng/mL showed a sensitivity of 88.9% and specificity of 52.4% for procalcitonin (Figure 2).

Bottom Line: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010.The correlation between the levels of CRP or WBC and CAP severity was low.The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.

ABSTRACT

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP.

Methods: This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (≥65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI).

Results: The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, ρ=0.408 with p<0.001; procalcitonin and PSI, ρ=0.293 with p=0.003; procalcitonin and mortality, ρ=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly.

Conclusion: The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

No MeSH data available.


Related in: MedlinePlus