Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia.
BACKGROUND
Predicting the need for intensive care among adults with community-acquired pneumonia (CAP) remains challenging.


METHODS
Using a multicenter prospective cohort study of adults hospitalized with CAP, we evaluated the association of serum procalcitonin (PCT) concentration at hospital presentation with the need for invasive respiratory or vasopressor support (IRVS), or both, within 72 h. Logistic regression was used to model this association, with results reported as the estimated risk of IRVS for a given PCT concentration. We also assessed whether the addition of PCT changed the performance of established pneumonia severity scores, including the pneumonia severity index and the American Thoracic Society minor criteria, for prediction of IRVS.


RESULTS
Of 1,770 enrolled patients, 115 required IRVS (6.5%). Using the logistic regression model, PCT concentration had a strong association with IRVS risk. Undetectable PCT (< 0.05 ng/mL) was associated with a 4% (95% CI, 3.1%-5.1%) risk of IRVS. For concentrations < 10 ng/mL, PCT had an approximate linear association with IRVS risk: for each 1 ng/mL increase in PCT, there was a 1% to 2% absolute increase in the risk of IRVS. With a PCT concentration of 10 ng/mL, the risk of IRVS was 22.4% (95% CI, 16.3%-30.1%) and remained relatively constant for all concentrations > 10 ng/mL. When added to each pneumonia severity score, PCT contributed significant additional risk information for the prediction of IRVS.


CONCLUSIONS
Serum PCT concentration was strongly associated with the risk of requiring IRVS among adults hospitalized with CAP and is potentially useful for guiding decisions about ICU admission.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: wesley.self@vanderbilt.edu.
Wesley H
WH
Self
Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN.
Carlos G
CG
Grijalva
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Derek J
DJ
Williams
Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
Alison
A
Woodworth
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL.
Robert A
RA
Balk
Department of Medicine, Division of Pulmonary, John H. Stroger, Jr Hospital of Cook County, Chicago, IL.
Sherene
S
Fakhran
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
Yuwei
Y
Zhu
Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
D Mark
DM
Courtney
Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN.
James
J
Chappell
Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA.
Evan J
EJ
Anderson
Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL.
Chao
C
Qi
Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
Grant W
GW
Waterer
Department of Medicine, University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN.
Christopher
C
Trabue
Influenza Division of the National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Anna M
AM
Bramley
Influenza Division of the National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
Seema
S
Jain
Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Kathryn M
KM
Edwards
Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.
Richard G
RG
Wunderink
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000150:complications / Q000628:therapy; D003422:Critical Care; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000097:blood* / Q000150:complications / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012131:Respiratory Insufficiency / Q000097:blood* / Q000209:etiology / Q000628:therapy; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000097:blood* / Q000188:drug therapy / Q000209:etiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D015415:Biomarkers; D014662:Vasoconstrictor Agents; D002116:Calcitonin
biomarkers; pneumonia; prognosis; respiratory failure; septic shock