Change of Procalcitonin Kinetice in Patients with Severe Community-acquired Pneumonia and Its Clinic Value_West China Medical Journal

Authors：

 LIJi , HUANGYi-jiang

Department of Respiratory, People's Hospital of Hainan Province, Haikou, Hainan 570311, P. R. China;

Corresponding author：

Keywords：

Procalcitonin; C-reactive protein; White blood cell count; Severe community-acquired pneumonia

DOI：

10.7507/1002-0179.20140271

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Objective To explore procalcitonin (PCT) dynamically in severe community-acquired pneumonia (SCAP) patients to evaluate the effects of different kinds of medical treatments and assess the clinical significance of the change of PCT. Methods All of the selected 60 SCAP patients treated from January 2009 to April 2011 met the standards of IDSA/ATS Guidelines for CAP. There were 38 males and 22 females, with an average age of 66.3 years. The sterile venous blood specimen samples were collected from the patients at day 0 to day 5. PCT and C-reactive protein (CRP) were measured by enzyme linked immunosorbent assay throughout the research. At day six, based on oxygenation index (PaO₂/FiO₂) ratio higher than 250, inflammation absorption on chest X ray after vasoactive agents were stopped, Glasgow scores higher than 10 and urine volume equal to or higher than 0.5 mL/(kg·d), we divided the patients into recovery group and deterioration group. Data were analyzed by SAS 9.0 software, and P<0.05 was considered to be statistically significant. Results The analysis results showed that PCT and CRP bore a significantly positive relationship on day 0 (r=0.38, P=0.00). The research also indicated that PCT had a faster declining rate than CRP and white blood cells count throughout the clinical treatment. The average of PCT declined 29% in 48 hours. Following the criterion of PCT decrease by 30%, the research showed that PCT had a higher sensibility and specificity (66.87% and 85.50%, respectively) in 48 hours than 72 hours (70.05% and 100.00%), 96 hours (79.88% and 75.23%), and 120 hours (83.10% and 100.00%). Conclusion Following the criterion of PCT decrease by 30% after using antibiotics can be an clinical objective index to guide the use of antibiotics and provide the basis for clinical application and prognosis.

Citation： LIJi, HUANGYi-jiang. Change of Procalcitonin Kinetice in Patients with Severe Community-acquired Pneumonia and Its Clinic Value. West China Medical Journal, 2014, 29(5): 893-896. doi: 10.7507/1002-0179.20140271 Copy

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5.	Connert S, Stremmel W, Elsing C. Procalcitonin is a valid marker of infection in decompensated cirrhosis[J]. Z Gastroenterol, 2003, 41(2):165-170.
6.	Ho KM. Combining sequential organ failure assessment (SOFA) score with acute physiology and chronic health evaluation (APACHE)Ⅱ score to predict hospital mortality of critically ill patients[J]. Anaesth Intensive Care, 2007, 35(4):515-521.
7.	Vincent JL, Moreno R, Takala J, et al. The SOFA score to describe organ dysfunction/failure[J]. Intensive Care Med, 1996, 22(7):707-710.
8.	Ethan AH, Alvin S. Management of community-acquired pneumonia[J]. J Assoc Physicians India, 2013, 61(7 Suppl):20-23.
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10.	Casado FJ, Procalcitnin BQ. A new maker for bacterial infection[J]. An Esp Pediatr, 2001, 54(8):69.
11.	Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects[J]. J Clin Endocrinol Metab, 1994, 79(6):1605-1608.
12.	Christ-Crain M, Schuetz P, Huber AR, et al. Procalcitonin-importance for the diagnosis of bacterial infections[J]. Ther Umsch, 2008, 65(9):559-568.
13.	Oberhoffer M, Vogelsang H, Russwurm S, et al. Outcome prediction by traditional and new marks of inflammation in patients with sepsis[J]. J Clin Chem Lab Med, 1999, 37(3):363-368.
14.	杜斌, 陈德昌, 潘家绮, 等. 降钙素原与白介素-6的相关性优于传统的炎症指标[J]. 中国危重病急救医学, 2002, 14(8):474-477.
15.	Jereb M, Kotar T. Usefulness of procalcitonin to differentiate typical from atypical community-acquired pneumonia[J]. Wien Klin Wochenschr, 2006, 118(5/6):170-174.
16.	Jereb M, Lunaček NK, Kotar T, et al. Procalcitonin in hantavirus infections[J]. Scand J Clin Lab Invest, 2011, 71(4):287-291.
17.	Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care[J]. Arch Intern Med, 2008, 168(18):2000-2007.
18.	Charles PE, Dalle F, Aho S, et al. Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients[J]. Intensive Care Med, 2006, 32(10):1577-1583.
19.	Masiá M, Gutiérrez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index[J]. Chest, 2005, 128(4):2223-2229.
20.	Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia[J]. Intensive Care Med, 2006, 32(3):469-472.
21.	Reny JL, Vuagnat A, Ract C, et al. Diagnosis and follow-up of infections in intensive care patients:value of C-reactive protein compared with other clinical and biological variables[J]. Crit Care Med, 2002, 30(3):529-535.

1. Bohuon C. A brief history of procalcitonin[J]. Intensive Care Med, 2000, 26(Suppl 2):S146-S147.
2. Assicot M, Gendrel D, Carsin H, et al. High serum procalcitonin concentrations in patients with sepsis and infection[J]. Lancet, 1993, 341(8844):515-518.
3. Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects[J]. J Clin Endocrinol Metab, 1994, 79(6):1605-1608.
4. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults[J]. Clin Infect Dis, 2007, 44(Suppl 2):S27-S72.
5. Connert S, Stremmel W, Elsing C. Procalcitonin is a valid marker of infection in decompensated cirrhosis[J]. Z Gastroenterol, 2003, 41(2):165-170.
6. Ho KM. Combining sequential organ failure assessment (SOFA) score with acute physiology and chronic health evaluation (APACHE)Ⅱ score to predict hospital mortality of critically ill patients[J]. Anaesth Intensive Care, 2007, 35(4):515-521.
7. Vincent JL, Moreno R, Takala J, et al. The SOFA score to describe organ dysfunction/failure[J]. Intensive Care Med, 1996, 22(7):707-710.
8. Ethan AH, Alvin S. Management of community-acquired pneumonia[J]. J Assoc Physicians India, 2013, 61(7 Suppl):20-23.
9. Vincent JL. Procalcitonin:THE marker of sepsis?[J]. Crit Care Med, 2000, 28(4):1226-1228.
10. Casado FJ, Procalcitnin BQ. A new maker for bacterial infection[J]. An Esp Pediatr, 2001, 54(8):69.
11. Dandona P, Nix D, Wilson MF, et al. Procalcitonin increase after endotoxin injection in normal subjects[J]. J Clin Endocrinol Metab, 1994, 79(6):1605-1608.
12. Christ-Crain M, Schuetz P, Huber AR, et al. Procalcitonin-importance for the diagnosis of bacterial infections[J]. Ther Umsch, 2008, 65(9):559-568.
13. Oberhoffer M, Vogelsang H, Russwurm S, et al. Outcome prediction by traditional and new marks of inflammation in patients with sepsis[J]. J Clin Chem Lab Med, 1999, 37(3):363-368.
14. 杜斌, 陈德昌, 潘家绮, 等. 降钙素原与白介素-6的相关性优于传统的炎症指标[J]. 中国危重病急救医学, 2002, 14(8):474-477.
15. Jereb M, Kotar T. Usefulness of procalcitonin to differentiate typical from atypical community-acquired pneumonia[J]. Wien Klin Wochenschr, 2006, 118(5/6):170-174.
16. Jereb M, Lunaček NK, Kotar T, et al. Procalcitonin in hantavirus infections[J]. Scand J Clin Lab Invest, 2011, 71(4):287-291.
17. Briel M, Schuetz P, Mueller B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care[J]. Arch Intern Med, 2008, 168(18):2000-2007.
18. Charles PE, Dalle F, Aho S, et al. Serum procalcitonin measurement contribution to the early diagnosis of candidemia in critically ill patients[J]. Intensive Care Med, 2006, 32(10):1577-1583.
19. Masiá M, Gutiérrez F, Shum C, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index[J]. Chest, 2005, 128(4):2223-2229.
20. Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia[J]. Intensive Care Med, 2006, 32(3):469-472.
21. Reny JL, Vuagnat A, Ract C, et al. Diagnosis and follow-up of infections in intensive care patients:value of C-reactive protein compared with other clinical and biological variables[J]. Crit Care Med, 2002, 30(3):529-535.

West China Medical Journal

Change of Procalcitonin Kinetice in Patients with Severe Community-acquired Pneumonia and Its Clinic Value

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