title: Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia.
abstract: OBJECTIVE
  The solid-phase immunoassay, semi-quantitative procalcitonin (PCT) test (B R A H M S PCT-Q) can be used to rapidly categorize PCT levels into four grades. However, the usefulness of this kit for determining the prognosis of adult patients with community-acquired pneumonia (CAP) is unclear.
  
  
  METHODS
  A prospective study was conducted in two Japanese hospitals to evaluate the usefulness of this PCT test in determining the prognosis of adult patients with CAP. The accuracy of the age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scale proposed by the Japanese Respiratory Society for prediction of mortality due to CAP was also investigated. Hospitalized CAP patients (n = 226) were enrolled in the study. Comprehensive examinations were performed to determine PCT and CRP concentrations, disease severity based on the A-DROP, pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) scales and the causative pathogens. The usefulness of the biomarkers and prognostic scales for predicting each outcome were then examined.
  
  
  RESULTS
  Twenty of the 170 eligible patients died. PCT levels were strongly positively correlated with PSI (ρ = 0.56, P < 0.0001), A-DROP (ρ = 0.61, P < 0.0001) and CURB-65 scores (ρ = 0.58, P < 0.0001). The areas under the receiver operating characteristic curves (95% CI) for prediction of survival, for CRP, PCT, A-DROP, CURB-65, and PSI were 0.54 (0.42-0.67), 0.80 (0.70-0.90), 0.88 (0.82-0.94), 0.88 (0.82-0.94), and 0.89 (0.85-0.94), respectively. The 30-day mortality among patients who were PCT-positive (≥0.5 ng/mL) was significantly higher than that among PCT-negative patients (log-rank test, P < 0.001).
  
  
  CONCLUSIONS
  The semi-quantitative PCT test and the A-DROP scale were found to be useful for predicting mortality in adult patients with CAP.
authors: Department of Respiratory Medicine, Matsushita Memorial Hospital, Japan. yu-gyne@mail.goo.ne.jp
authors: Yu
authors: Y
authors: Kasamatsu
authors: Toshimasa
authors: T
authors: Yamaguchi
authors: Takashi
authors: T
authors: Kawaguchi
authors: Nagaaki
authors: N
authors: Tanaka
authors: Hiroko
authors: H
authors: Oka
authors: Tomoyuki
authors: T
authors: Nakamura
authors: Keiko
authors: K
authors: Yamagami
authors: Katsunobu
authors: K
authors: Yoshioka
authors: Masahito
authors: M
authors: Imanishi
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006023:Glycoproteins; D006801:Humans; D007118:Immunoassay; D007564:Japan / Q000453:epidemiology; D008297:Male; D018410:Pneumonia, Bacterial / Q000097:blood / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D006023:Glycoproteins; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide