Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2008 Jul;52(1):48-58.e2.
doi: 10.1016/j.annemergmed.2008.01.003. Epub 2008 Mar 17.

Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia

David T Huang  1 , Lisa A Weissfeld, John A Kellum, Donald M Yealy, Lan Kong, Michael Martino, Derek C Angus; GenIMS Investigators
Affiliations
Multicenter Study

Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia

David T Huang et al. Ann Emerg Med. 2008 Jul.

Abstract

Study objective: The Pneumonia Severity Index and CURB-65 predict outcomes in community-acquired pneumonia but have limitations. Procalcitonin, a biomarker of bacterial infection, may provide prognostic information in community-acquired pneumonia. Our objective is to describe the pattern of procalcitonin in community-acquired pneumonia and determine whether procalcitonin provides prognostic information beyond the Pneumonia Severity Index and CURB-65.

Methods: We conducted a multicenter prospective cohort study in 28 community and teaching emergency departments. Patients presenting with a clinical and radiographic diagnosis of community-acquired pneumonia were enrolled. We stratified procalcitonin levels a priori into 4 tiers: I: less than 0.1; II: greater than 0.1 to less than 0.25; III: greater than 0.25 to less than 0.5; and IV: greater than 0.5 ng/mL. Primary outcome was 30-day mortality.

Results: One thousand six hundred fifty-one patients formed the study cohort. Procalcitonin levels were broadly spread across tiers: 32.8% (I), 21.6% (II), 10.2% (III), and 35.4% (IV). Used alone, procalcitonin had modest test characteristics: specificity (35%), sensitivity (92%), positive likelihood ratio (1.41), and negative likelihood ratio (0.22). Adding procalcitonin to the Pneumonia Severity Index in all subjects minimally improved performance. Adding procalcitonin to low-risk Pneumonia Severity Index subjects (classes I to III) provided no additional information. However, subjects in procalcitonin tier I had low 30-day mortality, regardless of clinical risk, including those in higher risk classes (1.5% versus 1.6% for those in Pneumonia Severity Index classes I to III versus classes IV/V). Among high-risk Pneumonia Severity Index subjects (classes IV/V), one quarter (126/546) were in procalcitonin tier I, and the negative likelihood ratio of procalcitonin tier I was 0.09. Procalcitonin tier I was also associated with lower burden of other adverse outcomes. Similar results were observed with CURB-65 stratification.

Conclusion: Selective use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high-risk patients.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Flow diagram of study
Figure 2
Figure 2. Kaplan-Meier survival curves, by PSI Class and procalcitonin tier
In PSI Class I–III, mortality was low, and stratification by procalcitonin tier did not provide additional information. In PSI Class IV/V, patients with a procalcitonin < 0.1 ng/mL had the lowest 30-day mortality. PSI – Pneumonia Severity Index. PCT – procalcitonin.
Figure 3
Figure 3. Kaplan-Meier survival curves, by CURB-65 Group and procalcitonin tier
In CURB-65 Group 1 patients, mortality was low, and and stratification by procalcitonin tier did not provide additional information. In CURB-65 Groups 2/3, patients with a procalcitonin < 0.1 ng/mL had the lowest 30-day mortality. PCT – procalcitonin.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. DeFrances CJ, Podgornik MN. 2004 National Hospital Discharge Survey. Adv Data. 2006;(371):1–19. - PubMed
    1. Niederman MS, McCombs JS, Unger AN, et al. The cost of treating community-acquired pneumonia. Clinical Therapeutics. 1998;20(4):820–837. - PubMed
    1. Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care. Crit Care Med. 2001;29(7):1303–1310. - PubMed
    1. Kaplan V, Angus DC, Griffin MF, et al. Hospitalized community-acquired pneumonia in the elderly: Age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med. 2002;165(6):766–772. - PubMed
    1. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243–250. - PubMed

Publication types

-