Tuberc Respir Dis.  2013 May;74(5):207-214. 10.4046/trd.2013.74.5.207.

Usefulness of Plasma Procalcitonin to Predict Severity in Elderly Patients with Community-Acquired Pneumonia

• Kim JH
• Seo JW
• Mok JH
• Kim MH
• Cho WH
• Lee K
• Kim KU
• Jeon D
• Park HK
• Kim YS
• Kim HH
• Lee MK

• KMID: 2050888
• DOI: http://doi.org/10.4046/trd.2013.74.5.207

Abstract

BACKGROUND
Community-acquired pneumonia (CAP) is one of the leading causes of death among the elderly. Several studies have reported the clinical usefulness of serum procalcitonin, a biomarker of bacterial infection. However, the association between the levels of procalcitonin and the severity in the elderly with CAP has not yet been reported. The aim of this study was to evaluate usefulness of procalcitonin as a predictor of severity and mortality in the elderly with CAP.
METHODS
This study covers 155 CAP cases admitted to Pusan National University Hospital between January 2010 and December 2010. Patients were divided into two groups (> or =65 years, n=99; <65 years, n=56) and were measured for procalcitonin, C-reactive protein (CRP), white blood cell, confusion, uremia, respiratory rate, blood pressure, 65 years or older (CURB-65) and pneumonia severity of index (PSI).
RESULTS
The levels of procalcitonin were significantly correlated with the CURB-65, PSI in totals. Especially stronger correlation was observed between the levels of procalcitonin and CURB-65 in the elderly (procalcitonin and CURB-65, rho=0.408 with p<0.001; procalcitonin and PSI, rho=0.293 with p=0.003; procalcitonin and mortality, rho=0.229 with p=0.023). The correlation between the levels of CRP or WBC and CAP severity was low. The existing cut-off value of procalcitonin was correlated with mortality rate, however, it was not correlated with mortality within the elderly.
CONCLUSION
The levels of procalcitonin are more useful than the levels of CRP or WBC to predict the severity of CAP. However, there was no association between the levels of procalcitonin and mortality in the elderly.

Keyword

Community-Acquired Infections; Aged; Pneumonia; Procalcitonin

MeSH Terms

Aged
Bacterial Infections
Blood Pressure
C-Reactive Protein
Calcitonin
Cause of Death
Community-Acquired Infections
Humans
Leukocytes
Plasma
Pneumonia
Protein Precursors
Respiratory Rate
Uremia
C-Reactive Protein
Calcitonin
Protein Precursors

Figure

• 

  Figure 1 Receiver operating characteristic curves of procalcitonin (AUC 0.663), CRP (AUC 0.556), WBC (AUC 0.597) for prediction of severe community-acquired pneumonia defined as PSI≥IV in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; PSI: pneumonia severity index; CAP: community-acquired pneumonia; PCT: procalcitonin.

• 

  Figure 2 Receiver operating characteristic curves comparing procalcitonin (AUC 0.741), CRP (AUC 0.567), WBC (AUC 0.644) for prediction of severe community-acquired pneumonia defined as CURB-65≥II in the elderly CAP patients (≥65 years). AUC: area under the curve; CRP: C-reactive protein; WBC: white blood cell; CAP: community-acquired pneumonia; PCT: procalcitonin.

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