Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community‐Acquired Pneumonia in Hospitalized Adults
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Abstract:
Community-acquired pneumonia (CAP) accounts for more than 1.5 million adult hospitalizations and 100,000 deaths each year in the United States.1 Antibiotic overuse in the hospital setting is an important contributor to the rise of antibiotic resistance, prompting increased efforts to limit inappropriate antibiotic use in hospitals.2 Procalcitonin, a precursor of the hormone calcitonin, is upregulated in bacterial infections and downregulated in viral infections. The US Food and Drug Administration has approved it as a serum biomarker to assist clinicians with decisions about using antibiotics.3 There is no consensus on how to best use procalcitonin in the management of CAP. We provide a practical update that includes a review of recent literature, added secondary analysis, and expert opinion surrounding the use of procalcitonin in the diagnosis and management of CAP in hospitalized adults.Keywords:
Procalcitonin
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Objective To investigate the applicative value of serum procalcitonin in non-responding community-acquired pneumonia.Methods Retrospectively analysis of non-responding pneumonia between January 1st 2009 and June 1st 2010.Results Causes of non-responding pneumonia were antibiotic failure(55.9%),mis-diagnosis(29.4%),and 5 cases with unidentified origin.Conclusion Serum procalcitonin is implicative of causes and therapy of non-responding pneumonia.
Procalcitonin
Antibiotic Therapy
Value (mathematics)
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Objective To explore the clinical diagnostic value of procalcitonin( PCT) and C-reactive protein( CRP) in bacterial community acquired pneumonia( CAP). Methods We included patients suffering from community acquired pneumonia from January 2010 to December 2012 in our hospital. The serum CRP and PCT levels were compared between patients diagnosed as bacterial CAP and those with non-bacterial CAP. Results The level of CRP was( 62. 73 ± 15. 36) mg / L and that of PCT was( 9. 35 ± 4. 02) μg / L in patients with bacterial CAP, which were significantly higher than those in patients with non-bacterial CAP( P 0. 05). The area under ROC curve was 0. 854 for CRP and 0. 835 for PCT in bacterial CAP patients,which showed good sensitivity and specificity for bacterial CAP. Conclusion The serum CRP and PCT have a good clinical diagnostic value for bacterial CAP,which could be used in pathogen diagnosis,assessment and prognosis.
Procalcitonin
Bacterial pneumonia
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A relevant problem in the management of pulmonary infections is the low specificity of clinical symptoms for the exact diagnosis and the need of antibiotic therapy. An ideal biomarker for bacterial pulmonary infections should allow a rapid diagnosis, have a prognostic value and facilitate therapeutic decision making. The two biomarkers currently needed in clinical use are C-reactive protein and procalcitonin. C-reactive protein is very unspecific and elevated in bacterial as well as viral infections. Today, procalcitonin is the best validated biomarker for pulmonary infections. In several interventional studies procalcitonin-guided therapy has proven to allow a significant reduction of duration and frequency of antibiotic therapy. However, for the evaluation of prognosis in community-acquired pneumonia, new cardiovascular biomarkers are superior compared with inflammatory markers, especially for the determination of long-term mortality. The combination of several biomarkers reflecting different pathophysiological pathways has the potential to improve the management of community-acquired pneumonia in the future.
Procalcitonin
Antibiotic Therapy
Biomarker Discovery
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Objective To study the procalcitonin(PCT)in elderly community-acquired pneumonia(CAP)severity assessed value.Methods 317 cases of community-acquired pneumonia in elderly patients with severe pneumonia group set(111 cases)and ordinary pneumonia group(206 cases),and 67 cases of healthy elderly controls,observed the PCT testing and to study the PCT and PSI,CURB-65 relevance score.Results Severe pneumonia group,ordinary pneumonia group and the normal control group,PCT of the three groups decreased,the difference was statistically significant(P0.05);the levels of PCT in patients with PSI,CURB-65 scores were statistically significant(P0.05);PCT was positively correlated with PSI(r=0.689,P0.05),PCT and CURB-65 score was positively correlated(r=0.511,P0.05),correlation coefficient PSI high.Conclusion PCT can better reflect the severity of patients with CAP,the CAP patients with PCT monitoring of clinical treatment options and prognosis assessment has important clinical value.
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Objective To evaluate the value of serum procalcitonin( PCT) and C-reaction protein( CRP)in clinical diagnosis of community acquired pneumonia. Methods From January 2012 to September 2013,a total of107 patients include 89 patients with CAP and 18 controls were assigned into three groups: 25 severe pneumonia patients,64 mild pneumonia patients and 18 controls. The levels of serum PCT and CRP,number of white blood cells,percentage of neutrophils were measured after admission. Results The serum PCT level was( 14. 770 ± 6. 141) ng /ml in severe pneumonia patients,which was significantly higher than that in mild pneumonia patients( 130 ±17. 350) ng / ml and controls( 83. 670 ± 8. 047) ng / ml( P 0. 05). Although the CRP level was higher in pneumonia patients,and their sensitivity was taller than PCT,their specificity were lower than those of PCT. PCT had a good diagnostic value to pneumonia,with the optimal cut-off of 0. 11ng / ml,the sensitivity of 88% and the specificity of95%. Conclusion Serum PCT plays an important diagnosis value in community acquired pneumonia and assessment of its severity,especially in severe pneumonia,thus it could be used as an effective indicator.
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Bacterial pneumonia
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Objective To explore the application value of procalcitonin in the diagnosis,treatment and prognosis of patients with community-acquired pneumonia.Methods 111 patients with community-acquired pneumonia were divide into two groups by the level of procalcitonin.WBC DC,blood serum C-reactive protein,duration of hospital stay,total hospitalization expense,days of using antibiotics and the number of deaths were compared between the two groups.Results WBC DC,blood serum C-reactive protein,duration of hospital stay,total hospitalization expense,days of using antibiotics and the number of deaths were obviously higher in the increased procalcitonin group than in the normal group.Conclusion Procalcitonin has a high application value in the diagnosis and treatment of patients with community-acquired pneumonia,which can improve the effectiveness and efficiency and achieve the health-economics targets.
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Objective To evaluate the value of serum procalcitonin to the diagnosis and therapy of pneumonia in the elderly patients.Methods 60 elderly patients with pneumonia were divided into low-risk group (n =20),medium-risk group (n =20) and high-risk group (n =20) according to CURB-65 criteria.And another 20 patients with non-infective bronchial disease were as controls (control group).Results Serum pneumonia and C reactive protein levels were higher in pneumonia patients than the control group,and the procalcitonin levels in the patients with medium-risk group and high-risk group were higher than the low-risk group.Conclusions Serum pneumonia plays an important role in the diagnosis and prognosis assessment of pneumonia in the elderly patients.The sensitivity of procalcitonin is better than that of C-reactive protein.
Key words:
Pneumonia in the elderly patients; Procalcitonin; C-reactive protein
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Objective To evaluatethe clinical value of procalcitonin(PCT)in the diagnosis and assessment of community-acquired pneumonia(CAP).Methods Ninety-six patients with CAP(CAP group)who hospitahzed during the period of November 2005 to August 2006 were admitted.Meanwhile,30 people were taken as control group.The levels of PCT,CRP and WBC were detected on the next day and the 8th day of hospitalization.Results(1)The receiver operating characteristic(ROC)curve was made through setting the threshold value of PCT,CRP and WBC as 1.5 μg/L,10 md/L and 10×109/L respectively in AP group and control group.The RFea undering ROC curve was 0.979.0.831 and 0.736 respectively.(2) The mean value of PCT in the patients of bacterial pneumonia.atypical pathogen pneumonia and viral pneumonia was(9.74±6.20),(7.81±5.70)and(12.20±6.50)μg/L respectively.There were no statistical differences in those patients.(3)There was correlation between PCT and CURB-65 score(r=0.258.P=0.011).The value of serum PCT showed significant differences in the patients with mild pneumonia.moderate pneumonia and severe pneumonia. Conclusions Serum PCT has higher sensitivity and specificity than CRP and WBC in the diagnosis of CAP.There is correlation between PCT and the severity of CAP,so it indicates that PCT has a certain practical value in the iudgement of the condition of CAP.
Key words:
Pneumonia; Community-acquired infections; Procalcitonin; CURB-65 score
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Objective To evaluate the predictive value of serum procalcitonin(PCT) for the severity of community acquired pneumonia(CAP) in adult and elderly patients. Methods 86 hospitalized patients with CAP from May 2013 to May 2014 were selected,and they were divided into the adult group(65 years old,n=38) and the elderly group(≥65years old,n=48).The relationship between PCT level and severity of CAP, and the correlation between PCT and pneumonia severity index(PSI) and CRUB-65 score were analyzed retrospectively in each group. Results PCT level,PSI,and CURB-65 score in adult and elderly patients with severe pneumonia were higher than those in patients with nonsevere pneumonia of corresponding age group(P0.05 or P0.01).Moreover,PCT had significantly positive correlation with PSI and CURB-65 scroe in the elderly group,but not in the adult group. Conclusion Serum PCT may be a useful marker to evaluate the severity of CAP,and had a higher predictive value in elderly patients with CAP.
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Pneumonia severity index
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