Serum Procalcitonin: An Independent Predictor of Clinical Outcome in Health Care-Associated Pneumonia.
BACKGROUND
Early prediction of the clinical outcomes for health care-associated pneumonia (HCAP) patients is challenging.


OBJECTIVE
This is the first study to evaluate procalcitonin (PCT) as a predictor of outcomes in HCAP patients.


METHODS
We conducted an observational study based on data for HCAP patients prospectively collected between 2011 and 2014. Outcome variables were intensive care unit (ICU) admission and 30-day mortality. PCT was categorized into three groups: <0.5, 0.5-2.0, and >2.0 ng/ml. We analysed multiple variables including age, sex, comorbidities, clinical findings, and PCT group to assess their association with outcomes.


RESULTS
Of 245 HCAP patients, 99 (40.4%) were admitted to an ICU and 44 (18.0%) died within 30 days. The median PCT level was significantly higher in the ICU admission (1.19 vs. 0.4 ng/ml; p < 0.001) and 30-day mortality (3.3 vs. 0.4 ng/ml; p < 0.001) groups. In multivariate analysis, high PCT (>2.0 ng/ml) was strongly associated with ICU admission [odds ratio 3.734, 95% confidence interval (CI) 1.753-7.951; p = 0.001] and 30-day mortality (hazard ratio 2.254, 95% CI 1.250-5.340; p = 0.035). In receiver operating characteristic analysis, PCT had a poor discrimination power regarding ICU admission [0.695 of the area under the curve (AUC)] and a fair discrimination power regarding 30-day mortality in HCAP patients (0.768 of the AUC).


CONCLUSIONS
High PCT on admission was strongly associated with ICU admission and 30-day mortality in HCAP patients. However, application of PCT alone seems to be limited to predicting outcomes.
Department of Emergency Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea.
Dae Young
DY
Hong
Sang O
SO
Park
Jong Won
JW
Kim
Kyeong Ryong
KR
Lee
Kwang Je
KJ
Baek
Ji Ung
JU
Na
Pil Cho
PC
Choi
Young Hwan
YH
Lee
D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001794:Blood Pressure; D002116:Calcitonin / Q000097:blood*; D003428:Cross Infection / Q000097:blood* / Q000401:mortality; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D009026:Mortality; D015999:Multivariate Analysis; D011014:Pneumonia / Q000097:blood* / Q000401:mortality; D011379:Prognosis; D012372:ROC Curve; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies
D002116:Calcitonin