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Comparative Study
. 2008 Feb;31(2):349-55.
doi: 10.1183/09031936.00054507. Epub 2007 Oct 24.

Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes

S Krüger  1 , S Ewig, R Marre, J Papassotiriou, K Richter, H von Baum, N Suttorp, T Welte; CAPNETZ Study Group
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Free article
Comparative Study

Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes

S Krüger et al. Eur Respir J. 2008 Feb.
Free article

Abstract

The aim of the present study was to investigate the prognostic value, in patients with community-acquired pneumonia (CAP), of procalcitonin (PCT) compared with the established inflammatory markers C-reactive protein (CRP) and leukocyte (WBC) count alone or in combination with the CRB-65 (confusion, respiratory rate >or=30 breaths x min(-1), low blood pressure (systolic value <90 mmHg or diastolic value <or=60 mmHg) and age >or=65 yrs) score. In total, 1,671 patients with proven CAP were enrolled in the study. PCT, CRP, WBC and CRB-65 score were all determined on admission and patients were followed-up for 28 days for survival. In contrast to CRP and WBC, PCT levels markedly increased with the severity of CAP, as measured by the CRB-65 score. In 70 patients who died during follow-up, PCT levels on admission were significantly higher compared with levels in survivors. In receiver operating characteristic analysis for survival, the area under the curve (95% confidence interval) for PCT and CRB-65 was comparable (0.80 (0.75-0.84) versus 0.79 (0.74-0.84)), but each significantly higher compared with CRP (0.62 (0.54-0.68)) and WBC (0.61 (0.54-0.68)). PCT identified low-risk patients across CRB classes 0-4. In conclusion, procalcitonin levels on admission predict the severity and outcome of community-acquired pneumonia with a similar prognostic accuracy as the CRB-65 score and a higher prognostic accuracy compared with C-reactive protein and leukocyte count. Procalcitonin levels can provide independent identification of patients at low risk of death within CRB-65 (confusion, respiratory rate >or=30 breaths x min(-1), low blood pressure (systolic value <90 mmHg or diastolic value <or=60 mmHg) and age >or=65 yrs) risk classes.

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