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Crit Care. 2015 Mar 6;19:74. doi: 10.1186/s13054-015-0792-1.

Prognostic value of procalcitonin in respiratory tract infections across clinical settings.

Author information

1
University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. kutz.alexander@gmail.com.
2
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. mbriel@uhbs.ch.
3
Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. mirjam.christ-crain@unibas.ch.
4
Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. dstolz@uhbs.ch.
5
Service de Réanimation Médicale, Université Paris 7-Denis Diderot, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Huchard Paris Cedex 18, Paris, 75877, France. lila.bouadma@bch.aphp.fr.
6
Service de Réanimation Médicale, Université Paris 7-Denis Diderot, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Huchard Paris Cedex 18, Paris, 75877, France. michel.wolff@bch.aphp.fr.
7
Department of Infectious Diseases, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. kristina@dadlnet.dk.
8
Department of Internal and Geriatric Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Huan Hu Xi San Road, Pudong New Area, Shanghai, 201306, China. longwei2290@163.com.
9
Department of Pulmonary Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30659, Germany. burkhardt.olaf@mh-hannover.de.
10
Department of Pulmonary Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30659, Germany. welte.tobias@mh-hannover.de.
11
Department of Anesthesiology and Intensive Care Medicine, Düren Hospital, Roonstraße 30, Düren, 52351, Germany. stefan.schroeder@krankenhaus-dueren.de.
12
Intensive Care, Universidade Federal de Minas Gerais, 6627 - Pampulha, Belo Horizonte - MG, 31270-901, Brazil. vandack@gmail.com.
13
Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. mtamm@uhbs.ch.
14
Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. bhatnag@mcmaster.ca.
15
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. hbucher@uhbs.ch.
16
Service de Réanimation Médicale, Université Paris 6-Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, Paris, 75651, France. charles-edouard.luyt@psl.aphp.fr.
17
Service de Réanimation Médicale, Université Paris 6-Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, Paris, 75651, France. jean.chastre@psl.aphp.fr.
18
AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Département d'Epidémiologie Biostatistique et Recherche Clinique, Université Paris Diderot, Sorbonne Paris Cité, UMR 738, INSERM, UMR 738, INSERM, CIE801, 5 Rue Thomas Mann, Paris, Cedex 13, 75013, France. florence.tubach@bch.aphp.fr.
19
University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. happy.mueller@unibas.ch.
20
University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. schuetzph@gmail.com.

Abstract

INTRODUCTION:

Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population.

METHODS:

We analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results' consistency.

RESULTS:

Overall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found.

CONCLUSIONS:

Admission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting.

PMID:
25887979
PMCID:
PMC4383063
DOI:
10.1186/s13054-015-0792-1
[Indexed for MEDLINE]
Free PMC Article

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