Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia.
OBJECTIVE
Procalcitonin (PCT) kinetics is a good prognosis marker in infectious diseases, but few studies of community-acquired pneumonia (CAP) have been performed in intensive care units (ICU). We analyzed the relationship between PCT kinetics and outcome in ICU patients with severe CAP.


METHODS
Prospective observational study in a 16-bed university hospital ICU.


METHODS
100 critically ill patients with community-acquired pneumonia.


RESULTS
Median PCT was 5.2 ng/ml on day 1 and 2.9 ng/ml on day 3. It increased from day 1 to day 3 in nonsurvivors but decreased in survivors. In multivariate analysis four variables were associated with death: invasive ventilation (odds ratio 10-), multilobar involvement (5.6-), LOD score (6.9-), and PCT increase from day 1 to day 3 (4.5-). In intubated patients with a PCT level below 0.95 ng/ml on day 3 the survival rate was 95%.


CONCLUSIONS
Increased PCT from day 1 to day 3 in severe CAP is a poor prognosis factor. A PCT level less than 0.95 ng/ml on day 3 in intubated patients is associated with a favorable outcome.
Boussekey
Nicolas
N
Tourcoing Hospital, Intensive Care and Infectious Disease Unit, 135 rue du Président Coty BP 619, 59208, Tourcoing cedex, France. nboussekey@ch-tourcoing.fr
Leroy
Olivier
O
Alfandari
Serge
S
Devos
Patrick
P
Georges
Hugues
H
Guery
Benoit
B
D000368:Aged; D002116:Calcitonin / Q000032:analysis / Q000493:pharmacokinetics*; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000503:physiopathology; D005602:France; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis*; D011446:Prospective Studies; D011498:Protein Precursors / Q000032:analysis / Q000493:pharmacokinetics*; D012720:Severity of Illness Index
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide