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ERJ Open Res. 2019 Mar 11;5(1). pii: 00014-2019. doi: 10.1183/23120541.00014-2019. eCollection 2019 Feb.

Inflammatory biomarkers are associated with aetiology and predict outcomes in community-acquired pneumonia: results of a 5-year follow-up cohort study.

Siljan WW1,2,3, Holter JC1,2,3, Michelsen AE2,3, Nymo SH2,3, Lauritzen T4, Oppen K2,3,4, Husebye E1,3, Ueland T2,3,5, Mollnes TE5,6,7,8,9, Aukrust P2,3,8,10, Heggelund L1,3.

Author information

1
Dept of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
2
Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
3
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
4
Dept of Medical Biochemistry, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.
5
Faculty of Health Sciences, K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway.
6
Research Laboratory, Nordland Hospital, Bodø, Norway.
7
Dept of Immunology, Faculty of Medicine, University of Oslo, Oslo, Norway.
8
K.G. Jebsen Inflammatory Research Center, University of Oslo, Oslo, Norway.
9
Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway.
10
Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital Rikshospitalet, Oslo, Norway.

Abstract

Background:

Biomarkers may facilitate clinical decisions in order to guide antimicrobial treatment and prediction of prognosis in community-acquired pneumonia (CAP). We measured serum C-reactive protein, procalcitonin (PCT) and calprotectin levels, and plasma pentraxin 3 (PTX3) and presepsin levels, along with whole-blood white cell counts, at three time-points, and examined their association with microbial aetiology and adverse clinical outcomes in CAP.

Methods:

Blood samples were obtained at hospital admission, clinical stabilisation and 6-week follow-up from 267 hospitalised adults with CAP. Adverse short-term outcome was defined as intensive care unit admission and 30-day mortality. Long-term outcome was evaluated as 5-year all-cause mortality.

Results:

Peak levels of all biomarkers were seen at hospital admission. Increased admission levels of C-reactive protein, PCT and calprotectin were associated with bacterial aetiology of CAP, while increased admission levels of PCT, PTX3 and presepsin were associated with adverse short-term outcome. In univariate and multivariate regression models, white blood cells and calprotectin at 6-week follow-up were predictors of 5-year all-cause mortality.

Conclusions:

Calprotectin emerges as both a potential early marker of bacterial aetiology and a predictor for 5-year all-cause mortality in CAP, whereas PCT, PTX3 and presepsin may predict short-term outcome.

Conflict of interest statement

Conflict of interest: W.W. Siljan has nothing to disclose. Conflict of interest: J.C. Holter has nothing to disclose. Conflict of interest: A.E. Michelsen has nothing to disclose. Conflict of interest: S.H. Nymo has nothing to disclose. Conflict of interest: T. Lauritzen has nothing to disclose. Conflict of interest: K. Oppen has nothing to disclose. Conflict of interest: E. Husebye has nothing to disclose. Conflict of interest: T. Ueland has nothing to disclose. Conflict of interest: T.E. Mollnes has nothing to disclose. Conflict of interest: P. Aukrust has nothing to disclose. Conflict of interest: L. Heggelund has nothing to disclose.

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