期刊
EUROPEAN RESPIRATORY JOURNAL
卷 31, 期 2, 页码 349-355出版社
EUROPEAN RESPIRATORY SOC JOURNALS LTD
DOI: 10.1183/09031936.00054507
关键词
community-acquired pneumonia; CRB-65(confusion, respiratory rate >= 30 breaths-min(-1), low blood pressure (systolic value < 90 mmHg or diastolic value <= 60 mmHg) and age >= 65 yrs) score; C-reactive protein; mortality; procalcitonin; prognosis
The aim of the present study was to investigate the prognostic value, in patients with community-acquired pneumonia (CAP), of procalcitonin (PCT) compared with the established inflammatory markers C-reactive protein (CRP) and leukocyte (WBC) count alone or in combination with the CRB-65 (confusion, respiratory rate >= 30 breaths-min(-1), low blood pressure (systolic value <90 mmHg or diastolic value <= 60 mni and age >= 65 yrs) score. In total, 1,671 patients with proven CAP were enrolled in the study. PCT, CRP, WBC and CRB-65 score were all determined on admission and patients were followed-up for 28 days for survival. In contrast to CRP and WBC, PCT levels markedly increased with the severity of CAP, as measured by the CRB-65 score. In 70 patients who died during follow-up, PCT levels on admission were significantly higher compared with levels in survivors. In receiver operating characteristic analysis for survival, the area under the curve (95% confidence interval) for PCT and CRB-65 was comparable (0.80 (0.75-0.84) versus 0.79 (0.74-0.84)), but each significantly higher compared with CRP (0.62 (0.54-0.68)) and WBC (0.61 (0.54-0.68)). PCT identified low-risk patients across CRB classes 0-4. In conclusion, procalcitonin levels on admission predict the severity and outcome of community-acquired pneumonia with a similar prognostic accuracy as the CRB-65 score and a higher prognostic accuracy compared with C-reactive protein and leukocyte count. Procalcitonin levels can provide independent identification of patients at low risk of death within CRB-65 (confusion, respiratory rate >= 30 breaths-min(-1), low blood pressure (systolic value <90 mmHg or diastolic value <= 60 mmHg) and age >= 65 yrs) risk classes.
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