Tuberc Respir Dis.  2010 Apr;68(4):205-211.

Procalcitonin in 2009 H1N1 Influenza Pneumonia: Role in Differentiating from Bacterial Pneumonia

• Ahn S
• Kim WY
• Yoon JY
• Sohn CH
• Seo DW
• Kim SH
• Hong SB
• Lim CM
• Koh YS
• Kim W

Abstract

BACKGROUND
Procalcitonin is a well known marker in infection that plays a role in distinguishing between bacterial and viral infections in screening. The aim of the present study was to evaluate the role of procalcitonin in differentiating between 2009 H1N1 influenza pneumonia and community acquired pneumonia of bacterial origin, or mixed bacterial origin and 2009 H1N1 influenza infection.
METHODS
A retrospective observational study was performed over the 6-month winter period during the 2009 H1N1 influenza pandemic. Ninety-six patient-subjects were enrolled, all of whom had been diagnosed with community acquired pneumonia in emergency department during the study period. On admission, laboratory studies were performed, which included 2009 H1N1 influenza real-time polymerase chain reaction of nasal secretions and procalcitonin on serum; the laboratory values were compared between the study groups. Receiver operating characteristic curve analyses were performed on the resulting data.
RESULTS
Compared to those with bacterial or mixed infections (n=62) and bacterial pneumonia with confirmed organisms (n=30), patients with 2009 H1N1 pneumonia (n=34) were significantly more likely to have low procalcitonin levels (p=0.008, 0.001). Using cutoff of value >0.3 ng/mL, the sensitivity and specificity of procalcitonin for detection of patients with confirmed bacterial pneumonia were 76.2% and 60.6%, respectively. A significant difference in procalcitonin was found between 2009 H1N1 pneumonia and pneumonia caused by mixed influenza viral and bacterial infections (0.15 [0.05~0.84] vs. 10.3 [0.05~22.87] ng/mL, p=0.045).
CONCLUSION
Serum procalcitonin measurement may assist in the discrimination between pneumonia of bacterial and of 2009 H1N1 influenza origin. High values of procalcitonin suggest that bacterial infection or mixed infection of bacteria and 2009 H1N1 influenza is more likely.

Keyword

Influenza A Virus, H1N1 Subtype; Procalcitonin; Pneumonia

MeSH Terms

Bacteria
Bacterial Infections
Calcitonin
Coinfection
Discrimination (Psychology)
Emergencies
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human
Mass Screening
Pandemics
Pneumonia
Pneumonia, Bacterial
Protein Precursors
Real-Time Polymerase Chain Reaction
Retrospective Studies
ROC Curve
Calcitonin
Protein Precursors

Figure

• 

  Figure 1 Receiver-operating characteristics curve for discriminating between 2009 H1N1 pneumonia and bacterial/mixed community acquired pneumonia for procalcitonin. Cutoff of >0.3 ng/mL for procalciton best identified patients with bacterial/mixed pneumonia (sensitivity 61.9%, specificity 60.6%, positive predictive value 75.0%, negative predictive value 45.5%).

• 

  Figure 2 Receiver-operating characteristics curve for discriminating between 2009 H1N1 pneumonia and microorganism confirmed bacterial community acquired pneumonia for procalcitonin. Cutoff of >0.3 ng/mL for procalciton best identified patients with microorganism confirmed bacterial pneumonia (sensitivity 76.2%, specificity 60.6%, positive predictive value 55.2%, negative predictive value 80.0%).

• 

  Figure 3 Box plot of procalcitonin levels between 2009 H1N1 pneumonia and bacterial pneumonia with confirmed organisms.

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