Usefulness of Procalcitonin Levels in Assessing Severity in Patients with Healthcare-associated Pneumonia

Park, Jong Ho; Kim, Jong Won; Park, Sang Min; Lee, Kyeong Ryong; Park, Sang O; Baek, Kwang Je; Hong, Dae Young

Abstract

PURPOSE
Healthcare-associated pneumonia (HCAP) has been proposed as a new category of pneumonia. However, studies of HCAP patients in Korea are limited. The aim of this study was to investigate the usefulness of procalcitonin (PCT) in assessment of the severity of HCAP patients.
METHODS
We conducted a retrospective study of patients with HCAP who were hospitalized between August 2009 and July 2013. We evaluated white blood cell, C-reactive protein, and PCT, along with the pneumonia severity index score and CURB-65 in HCAP patients.
RESULTS
The mean age of the 78 patients was 77.5 years. The PSI and CURB-65 scores showed similar trends of increasing mortality with worsening risk class in HCAP patients. The median PCT level was significantly higher in the non-survival group than in the survival group (3.1 ng/mL vs 0.4 ng/mL, p=0.003). The PCT level was significantly higher in patients with positive blood cultures (0.95 ng/mL vs 0.36 ng/mL, p=0.010). PCT levels rose consistently as PSI class advanced from class I/II/III to class V (p<0.001). In receiver operating characteristic curves analysis for prediction of mortality, PCT level had an area under the curve (AUC) of 0.655 (95% confidence interval 0.523-0.786).
CONCLUSION
We found that measurement of PCT in the emergency department may provide helpful information for use in assessment of HCAP patients.