Serial quantification of procalcitonin (PCT) predicts clinical outcome and prognosis in patients with community-acquired pneumonia (CAP).
Procalcitonin (PCT), a calcitonin precursor, is commonly measured in the setting of community-acquired pneumonia (CAP). However, the clinical significance of serial PCT changes has not been established. We conducted a prospective observational study of 122 patients with CAP. Thirty-day mortality was the primary endpoint. Secondary endpoints included: (1) initial treatment failure, (2) 30-day mortality and/or initial treatment failure, and (3) intensive care unit (ICU) admission. In subgroup analysis, we classified patients into pneumococcal pneumonia and non-pneumococcal pneumonia groups. The baseline frequency of 30-day mortality was 10.7%. Increases in serum PCT levels from admission to Day 3 were observed with statistically higher frequency in patients with 30-day mortality (P = 0.002). For secondary endpoints, only the 30-day mortality and/or initial treatment failure group was statistically significant (P = 0.007). Subgroup analysis revealed statistically significant changes in the non-pneumococcal pneumonia group (N = 85) across several endpoints, including 30-day mortality (P = 0.001), initial treatment failure (P = 0.013), and 30-day mortality and/or initial treatment failure (P < 0.001). No significant changes in endpoint measurements were found in the pneumococcal pneumonia group (N = 28). Interestingly, serum PCT levels at the time of diagnosis were higher in patients with pneumococcal pneumonia than those with non-pneumococcal pneumonia (P = 0.006), and this positively correlated with disease severity scores for all patients (PCT vs. PSI: R = 0.380, P < 0.001; PCT vs.
R = 0.422, P < 0.001) and for non-pneumococcal pneumonia (PCT vs. PSI: R = 0.468, P < 0.001; PCT vs.
R = 0.448, P < 0.001), but not for pneumococcal pneumonia. In conclusion, serial quantification of PCT can predict clinical outcomes for patients with CAP.
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Masaki
M
Tamura
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Masato
M
Watanabe
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Akira
A
Nakajima
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Daisuke
D
Kurai
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Haruyuki
H
Ishii
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Saori
S
Takata
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Keitaro
K
Nakamoto
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Erei
E
Sohara
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Koujirou
K
Honda
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Masuo
M
Nakamura
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Toshiya
T
Inui
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Hiroo
H
Wada
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan.
Hajime
H
Takizawa
Department of Respiratory Medicine, Kyorin University School of Medicine, Tokyo 181-8612, Japan. Electronic address: h510@ks.kyorin-u.ac.jp.
Hajime
H
Goto
D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011018:Pneumonia, Pneumococcal / Q000097:blood* / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D016896:Treatment Outcome
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
Biomarker; Community-acquired pneumonia (CAP); Procalcitonin (PCT)