Tuberc Respir Dis.  2009 Sep;67(3):205-211.

Semi-quantitative Procalcitonin Assay in Critically ill Patients with Respiratory infections

• Kim JY
• Kim CH
• Park S
• Lee CY
• Hwang YI
• Choi JH
• Shin T
• Park YB
• Jang SH
• Lee JY
• Park SM
• Kim DG
• Lee MG
• Hyun IG
• Jung KS

Abstract

BACKGROUND
Serum procalcitonin level has been considered prognostic during sepsis and septic shock. We investigated the significance of procalcitonin in critically ill patients with respiratory infections. METHODS: The patients who had radiographically diagnosed diffuse lung infiltrations were enrolled on a prospective basis. Bronchoalveolar lavage (BAL) fluid for the purpose of quantitative cultures (> or =10(4) cfu/mL) was obtained from all patients. Serum procalcitonin levels determined by PCT-Q kit were measured on BAL day and classified as follows; <0.5 ng/mL, 0.5~2.0 ng/mL, 2.0~10.0 ng/mL and >10.0 ng/mL. We analyzed the patient's characteristics according to outcome; favorable or unfavorable, defined as death. RESULTS: Patients from the following categories were included: medical 17 (47.2%), surgical 9 (25%), and burned 10 (27.8%). APACHE II scores on admission to intensive care unit were 11.5+/-6.89 and 11 (30.6%) had unfavorable outcomes. A procalcitonin level > or =0.5 ng/mL was in 17 (47.2%) of all. On univariate analysis, the frequencies of burn injury, mechanical ventilation, multiple organ failure, and a procalcitonin level > or =0.5 ng/mL were more often increased in patients with unfavorable outcomes than in those with favorable outcomes (p<.05). Also, a higher procalcitonin range and ventilator-associated pneumonia (VAP) were more closely associated with an unfavorable outcome (p<.05). However in multivariate analysis, a strong predictor of unfavorable outcome was burn injury (p<.05). A procalcitonin level > or =0.5 ng/mL was more sensitive in predicting VAP than unfavorable outcome. CONCLUSION: A higher procalcitonin level seems to be associated with VAP, but further study is required to know that procalcitonin would be a prognostic marker in critically ill patients with respiratory infections.

Keyword

Bronchoaveolar lavage; Procalcitonin; Respiratory infections; Ventilator-associated pneumonia

MeSH Terms

APACHE
Bronchoalveolar Lavage
Burns
Calcitonin
Critical Illness
Humans
Intensive Care Units
Lung
Multiple Organ Failure
Multivariate Analysis
Pneumonia, Ventilator-Associated
Prospective Studies
Protein Precursors
Respiration, Artificial
Respiratory Tract Infections
Sepsis
Shock, Septic
Calcitonin
Protein Precursors

Figure

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  Figure 1 Receiver operating characteristics (ROC) curves of markers to predict ventilator-associated pneumonia. Areas under the ROC curves for WBC count, CRP, ESR, modified clinical pulmonary infection score (mCPIS) and serum procalcitonin (≥0.5 ng/mL) were 0.681 (95% confidence interval [CI]; 0.474, 0.888), 0.699 (95% CI; 0.491, 0.907), 0.541 (95% CI; 0.312, 0.770), 0.745 (95% CI; 0.552, 0.937) and 0.750 (95% CI; 0.562, 0.938), respectively.

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  Figure 2 Receiver operating characteristics (ROC) curves of factors to predict unfavorable outcome. Areas under the ROC curves for burn injury, mechanical ventilation (MV), number (No.) of organ failure and serum procalcitonin (≥0.5 ng/mL) were 0.758 (95% confidence interval [CI]; 0.569, 0.947), 0.735 (95% CI; 0.566, 0.903), 0.735 (95% CI; 0.543, 0.926) and 0.684 (95% CI; 0.493, 0.874), respectively.

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