title: Diagnostic use of serum procalcitonin levels in pulmonary aspiration syndromes.
abstract: OBJECTIVE
  To assess the predictive accuracy of serum procalcitonin in distinguishing bacterial aspiration pneumonia from aspiration pneumonitis.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Intensive care unit of a university-affiliated hospital.
  
  
  METHODS
  Sixty-five consecutive patients admitted with pulmonary aspiration and seven control subjects intubated for airway protection.
  
  
  METHODS
  None.
  
  
  RESULTS
  Quantitative cultures from bronchoalveolar lavage fluid were conducted on all participants at the time of admission. Serial serum procalcitonin levels were measured on day 1 and day 3 using the procalcitonin enzyme-linked fluorescent assay. There were no differences in the median serum concentrations of procalcitonin between patients with positive bronchoalveolar lavage cultures (n = 32) and patients with negative bronchoalveolar lavage cultures (n = 33) on either day 1 or day 3 postadmission. The areas under the receiver operator characteristic curves were 0.59 (95% confidence interval, 0.47-0.72) and 0.63 (95% confidence interval, 0.5-0.75), respectively (p = .74). However, duration of mechanical ventilation and antibiotic therapy were shorter in those who had a decrease in their procalcitonin levels on day 3 from baseline compared with those who did not (6.7 ± 7.1 days and 11.1 ± 13.5 days, p = .03; and 8.2 ± 2.6 days vs. 12.8 ± 4.6 days; p < .001, respectively). Hospital mortality was associated with radiographic multilobar disease (adjusted odds ratio, 1.14; 95% confidence interval, 1.01-1.31; p = .04) and increasing procalcitonin levels (adjusted odds ratio, 5.63; 95% confidence interval, 1.56-20.29; p = .008).
  
  
  CONCLUSIONS
  Serum procalcitonin levels had poor diagnostic value in separating bacterial aspiration pneumonia from aspiration pneumonitis based on quantitative bronchoalveolar lavage culture. However, serial measurements of serum procalcitonin may be helpful in predicting survival from pulmonary aspiration.
authors.affiliation: Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA. solh@buffalo.edu
authors.forename: Ali A
authors.initials: AA
authors.lastname: El-Solh
authors.forename: Hardik
authors.initials: H
authors.lastname: Vora
authors.forename: Paul R
authors.initials: PR
authors.lastname: Knight
authors.forename: Jahan
authors.initials: J
authors.lastname: Porhomayon
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000097:blood* / Q000175:diagnosis*; D018410:Pneumonia, Bacterial / Q000097:blood* / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide