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Tuberculosis & Respiratory Diseases

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Vol.67 No.3
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Semi-quantitative Procalcitonin Assay in Critically ill Patients with Respiratory infections

Tuberculosis & Respiratory Diseases / Tuberculosis & Respiratory Diseases,
2009, v.67 no.3, pp.205-211















& (2009). Semi-quantitative Procalcitonin Assay in Critically ill Patients with Respiratory infections. Tuberculosis & Respiratory Diseases, 67(3), 205-211.
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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 (≥104 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 ≥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 ≥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 ≥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.

keywords
Bronchoaveolar lavage, Procalcitonin, Respiratory infections, Ventilator-associated pneumonia

Reference

1.

Vincent JL. Nosocomial infections in adult intensivecare units. Lancet 2003;361:2068-77.

2.

Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341:515-8.

3.

Aouifi A, Piriou V, Bastien O, Blanc P, Bouvier H, Evans R, et al. Usefulness of procalcitonin for diagnosis of infection in cardiac surgical patients. Crit Care Med 2000;28:3171-6.

4.

Dandona P, Nix D, Wilson MF, Aljada A, Love J, Assicot M, et al. Procalcitonin increase after endotoxin injection in normal subjects. J Clin Endocrinol Metab 1994;79:1605-8.

5.

Wanner GA, Keel M, Steckholzer U, Beier W, Stocker R, Ertel W. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med 2000;28:950-7.

6.

Nylén ES, Snider RH Jr, Thompson KA, Rohatgi P, Becker KL. Pneumonitis-associated hyperprocalcitoninemia. Am J Med Sci 1996;312:12-8.

7.

Oberhoffer M, Stonans I, Russwurm S, Stonane E, Vogelsang H, Junker U, et al. Procalcitonin expression in human peripheral blood mononuclear cells and its modulation by lipopolysaccharides and sepsis-related cytokines in vitro. J Lab Clin Med 1999;134:49-55.

8.

Duflo F, Debon R, Monneret G, Bienvenu J, Chassard D, Allaouchiche B. Alveolar and serum procalcitonin: diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology 2002;96:74-9.

9.

Chastre J, Fagon JY, Bornet-Lecso M, Calvat S, Dombret MC, al Khani R, et al. Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia. Am J Respir Crit Care Med 1995;152:231-40.

10.

Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; eighteenth informational supplement. CLSI document M100-S18. Wayne: Clinical and Laboratory Standards Institute;2008.

11.

Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia: diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001;163:1730-54.

12.

American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. Am J Respir Crit Care Med 2005;171:388-416.

13.

Luna CM, Blanzaco D, Niederman MS, Matarucco W, Baredes NC, Desmery P, et al. Resolution of ventilator- associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med 2003;31:676-82.

14.

Chastre J, Fagon JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867-903.

15.

Dennesen PJ, van der Ven AJ, Kessels AG, Ramsay G, Bonten MJ. Resolution of infectious parameters after antimicrobial therapy in patients with ventilator-associated pneumonia. Am J Respir Crit Care Med 2001;163:1371-5.

16.

Ioanas M, Ferrer M, Cavalcanti M, Ferrer R, Ewig S, Filella X, et al. Causes and predictors of nonresponse to treatment of intensive care unit-acquired pneumonia. Crit Care Med 2004;32:938-45.

17.

Luyt CE, Guérin V, Combes A, Trouillet JL, Ayed SB, Bernard M, et al. Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 2005;171:48-53.

18.

Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein(CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 1999;3:45-50.

19.

Shirani KZ, Pruitt BA Jr, Mason AD Jr. The influence of inhalation injury and pneumonia on burn mortality. Ann Surg 1987;205:82-7.

20.

von Heimburg D, Stieghorst W, Khorram-Sefat R, Pallua N. Procalcitonin: a sepsis parameter in severe burn injuries. Burns 1998;24:745-50.

21.

Mandi Y, Farkas G, Takacs T, Boda K, Lonovics J. Diagnostic relevance of procalcitonin, IL-6, and sICAM- 1 in the prediction of infected necrosis in acute pancreatitis. Int J Pancreatol 2000;28:41-9.

22.

Nylen ES, O'Neill W, Jordan MH, Snider RH, Moore CF, Lewis M, et al. Serum procalcitonin as an index of inhalation injury in burns. Horm Metab Res 1992;24:439-43.

23.

Jensen JU, Heslet L, Jensen TH, Espersen K, Steffensen P, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med 2006;34:2596-602.

24.

Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 2004;350:451-8.

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