Procalcitonin predicts mortality in HIV-infected Ugandan adults with lower respiratory tract infections.
OBJECTIVE
In low and middle-income countries where HIV infection is prevalent, identifying patients at high risk of dying from lower respiratory tract infections is challenging and validated prognostic models are lacking. Serum procalcitonin may be a useful prognostic tool in these settings. We sought to determine if elevated serum procalcitonin is associated with increased in-hospital mortality and to combine serum procalcitonin with available clinical characteristics to create a clinically useful prognostic model.


METHODS
We conducted a prospective, nested case-control study of 241 HIV-infected adults admitted to Mulago Hospital in Kampala, Uganda with cough ≥2 weeks in duration. We collected demographic and clinical information, baseline serum for procalcitonin analysis, and followed patients to determine in-hospital mortality.


RESULTS
Serum procalcitonin was a strong and independent predictor of inpatient mortality (aOR = 7.69, p = 0.01, sensitivity = 93%, negative predictive value = 97%). Best subset multivariate analysis identified 3 variables that were combined into a prognostic model to risk stratify patients; these variables included respiratory rate ≥30 breaths/minute (aOR = 2.07, p = 0.11), oxygen saturation <90% (aOR = 3.07, p = 0.02), and serum procalcitonin >0.5 ng/ml (aOR = 7.69, p = 0.01). The predicted probability of inpatient mortality ranged from 1% when no variables were present, to 42% when all variables were present.


CONCLUSIONS
Elevated serum procalcitonin >0.5 ng/ml is an independent predictor of in-hospital mortality. Elevated serum procalcitonin, tachypnea, and hypoxemia may be combined into a prognostic model to identify patients at high risk of dying in the hospital. This model may be used to estimate the probability of death and to guide triage and treatment decisions.
Department of Internal Medicine, University of California, San Francisco, CA, USA; Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, CA, USA.
Sofya
S
Tokman
Christopher F
CF
Barnett
Leah G
LG
Jarlsberg
Pam R
PR
Taub
Saskia
S
den Boon
J Lucian
JL
Davis
Adithya
A
Cattamanchi
William
W
Worodria
Alan
A
Maisel
Laurence
L
Huang
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D016022:Case-Control Studies; D005188:False Negative Reactions; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood*; D012141:Respiratory Tract Infections / Q000097:blood / Q000401:mortality*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology
D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide
human immunodeficiency virus; pneumonia; procalcitonin; prognosis; tuberculosis