Abstract
Objective
Community-acquired pneumonia (CAP) is a common presentation to the emergency department
(ED) and has high mortality rates. The aim of our study is to investigate the risk
stratification and prognostic prediction value of precalcitonin (PCT) and clinical
severity scores on patients with CAP in ED.
Methods
226 consecutive adult patients with CAP admitted in ED of a tertiary teaching hospital
were enrolled. Demographic information and clinical parameters including PCT levels
were analyzed. CURB65, PSI, SOFA and qSOFA scores were calculated and compared between
the severe CAP (SCAP) and non-severe CAP (NSCAP) group or the death and survival group.
Receiver-operating characteristic (ROC) curves for 28-day mortality were calculated
for each predictor using cut-off values. Logistic regression models and area under
the curve (AUC) analysis were performed to compare the performance of predictors.
Results
Fifty-one patients were classified as SCAP and forty-nine patients died within 28days. There was significant difference between either SCAP and NSCAP group or death
and survival group in PCT level and CURB65, PSI, SOFA, qSOFA scores (p < 0.001). The
AUCs of the PCT and CURB65, PSI, SOFA and qSOFA in predicting SCAP were 0.875, 0.805,
0.810, 0.852 and 0.724, respectively. PCT is superior in predicting SCAP and the models
combining PCT and SOFA demonstrated superior performance to those of PCT or the CAP
severity score alone. The AUCs of the PCT and CURB65, PSI, SOFA and qSOFA in predicting
28-day mortality were 0.822, 0.829, 0.813, 0.913 and 0.717, respectively. SOFA achieved
the highest AUC and the combination of PCT and SOFA had the highest superiority over
other combinations in predicting 28-day mortality.
Conclusion
Serum PCT is a valuable single predictor for SCAP. SOFA is superior in prediction
of 28-day mortality. Combination of PCT and SOFA could improve the performance of
single predictors. More further studies with larger sample size are warranted to validate
our results.
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Deaths: final data for 2006.Natl Vital Stat Rep. 2009; 57: 1-134
- Community-acquired pneumonia in the United Kingdom: a call to action.Pneumonia (Nathan). 2017; 9: 15
- Tools for outcome prediction in patients with community acquired pneumonia.Expert Rev Clin Pharmacol. 2017; 10: 201-211
- Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.Clin Infect Dis. 2007; 44: S27-72
- Severity assessment tools for predicting mortality in hospitalized patients with community-acquired pneumonia. Systematic review and meta-analysis.Thorax. 2010 Oct; 65: 878-883
- New Sepsis definition (Sepsis-3) and community-acquired pneumonia mortality. A validation and clinical decision-making study.Am J Respir Crit Care Med. 2017; 196: 1287-1297
- Prediction of prognosis by markers in community-acquired pneumonia.Expert Rev Anti Infect Ther. 2013; 11: 917-929
- Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia.Crit Care. 2010; 14: 203
- Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study.Crit Care. 2011; 15: R88
- Mortality prediction using serum biomarkers and various clinical risk scales in community-acquired pneumonia.Scand J Clin Lab Invest. 2017 Nov; 77: 486-492
- A prediction rule to identify low-risk patients with community-acquired pneumonia.N Engl J Med. 1997; 336: 243-250
- CRB-65 predicts death from community-acquired pneumonia.J Intern Med. 2006; 260: 93-101
- Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.Thorax. 2003; 58: 377-382
- Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis.Intensive Care Med. 2011; 37: 1409-1420
- Mortality prediction in community-acquired pneumonia requiring mechanical ventilation; values of pneumonia and intensive care unit severity scores.Tuberk Toraks. 2010; 58: 25-34
- Determining need for hospitalisation: evaluation of the utility of the CRB-65 score in patients with community-acquired pneumonia presenting to an emergency department.S Afr Med J. 2014; 104: 769-772
- A new method to predict hospital mortality in severe community acquired pneumonia.Eur J Intern Med. 2017; 40: 56-63
- How and when to use common biomarkers in community-acquired pneumonia.Pneumonia (Nathan). 2016; 8: 17
- Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia.Infect Dis (Lond). 2017; 49: 251-260
- Procalcitonin and CRP as biomarkers in discrimination of community-acquired pneumonia and exacerbation of COPD.J Med Biochem. 2017; 36: 122-126
- Clinical review: the role of biomarkers in the diagnosis and management of community-acquired pneumonia.Crit Care. 2010; 14: 203
- Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study.Crit Care. 2005; 9: R816-24
- Utility of Procalcitonin (PCT) and Mid regional pro-Adrenomedullin (MR-proADM)in risk stratification of critically ill febrile patients in Emergency Department (ED). A comparison with APACHE II score.BMC Infect Dis. 2012; 12: 184
- Prognostic performance of MR-pro-adrenomedullin in patients with community acquired pneumonia in the Emergency Department compared to clinical severity scores PSI and CURB.PLoS One. 2017; 12e0187702
- Usefulness of midregional proadrenomedullin to predict poor outcome in patients with community acquired pneumonia.PLoS One. 2015; 10e0125212
- Prognostic value of mid-regional pro-adrenomedullin (MR-pro-ADM) in patients with community-acquired pneumonia: a systematic review and meta-analysis.BMC Infect Dis. 2016; 16: 232
- The prognostic and risk-stratified value of heart-type fatty-acid-binding protein in communityacquired pneumonia in emergency department.Biomed Res Int. 2014; 2014753070
- Clinical usefulness of urinary fatty acid binding proteins in assessing the severity and predicting treatment response of pneumonia in critically ill patients: a cross-sectional study.Medicine (Baltimore). 2016; 95e3682
- The neutrophil-lymphocyte count ratio in patients with community-acquired pneumonia.PLoS One. 2012; 7e46561
- Inflammation biomarkers in blood as mortality predictors in community-acquired pneumoniaadmitted patients: importance of comparison with neutrophil count percentage or neutrophil-lymphocyte ratio.PLoS One. 2017; 12e0173947
- Comparison of the qSOFA and CRB-65 for risk prediction in patients with community-acquired pneumonia.Intensive Care Med. 2016; 42: 2108-2110
Article Info
Publication History
Published online: March 22, 2018
Accepted:
March 20,
2018
Received in revised form:
March 20,
2018
Received:
December 18,
2017
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
