title: Prognostic value of procalcitonin in respiratory tract infections across clinical settings.
abstract: BACKGROUND
  Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population.
  
  
  METHODS
  We analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results' consistency.
  
  
  RESULTS
  Overall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found.
  
  
  CONCLUSIONS
  Admission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting.
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. kutz.alexander@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kutz
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. mbriel@uhbs.ch.
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.affiliation: Division of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. mirjam.christ-crain@unibas.ch.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
authors.affiliation: Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. dstolz@uhbs.ch.
authors.forename: Daiana
authors.initials: D
authors.lastname: Stolz
authors.affiliation: Service de Réanimation Médicale, Université Paris 7-Denis Diderot, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Huchard Paris Cedex 18, Paris, 75877, France. lila.bouadma@bch.aphp.fr.
authors.forename: Lila
authors.initials: L
authors.lastname: Bouadma
authors.affiliation: Service de Réanimation Médicale, Université Paris 7-Denis Diderot, Hôpital Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Huchard Paris Cedex 18, Paris, 75877, France. michel.wolff@bch.aphp.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Wolff
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. kristina@dadlnet.dk.
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Kristoffersen
authors.affiliation: Department of Internal and Geriatric Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Huan Hu Xi San Road, Pudong New Area, Shanghai, 201306, China. longwei2290@163.com.
authors.forename: Long
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Pulmonary Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30659, Germany. burkhardt.olaf@mh-hannover.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Burkhardt
authors.affiliation: Department of Pulmonary Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30659, Germany. welte.tobias@mh-hannover.de.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Düren Hospital, Roonstraße 30, Düren, 52351, Germany. stefan.schroeder@krankenhaus-dueren.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Schroeder
authors.affiliation: Intensive Care, Universidade Federal de Minas Gerais, 6627 - Pampulha, Belo Horizonte - MG, 31270-901, Brazil. vandack@gmail.com.
authors.forename: Vandack
authors.initials: V
authors.lastname: Nobre
authors.affiliation: Clinic of Pneumology and Pulmonary Cell Research, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. mtamm@uhbs.ch.
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S4L8, Canada. bhatnag@mcmaster.ca.
authors.forename: Neera
authors.initials: N
authors.lastname: Bhatnagar
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Hebelstrasse 10, Basel, 4031, Switzerland. hbucher@uhbs.ch.
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.affiliation: Service de Réanimation Médicale, Université Paris 6-Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, Paris, 75651, France. charles-edouard.luyt@psl.aphp.fr.
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.affiliation: Service de Réanimation Médicale, Université Paris 6-Pierre et Marie Curie, Hôpital Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, Paris, 75651, France. jean.chastre@psl.aphp.fr.
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.affiliation: AP-HP, Hôpitaux Universitaires Paris Nord Val de Seine, Département d'Epidémiologie Biostatistique et Recherche Clinique, Université Paris Diderot, Sorbonne Paris Cité, UMR 738, INSERM, UMR 738, INSERM, CIE801, 5 Rue Thomas Mann, Paris, Cedex 13, 75013, France. florence.tubach@bch.aphp.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. happy.mueller@unibas.ch.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. schuetzph@gmail.com.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood*; D012141:Respiratory Tract Infections / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D017211:Treatment Failure
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide