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Original Research: COMMUNITY-ACQUIRED PNEUMONIA |

Procalcitonin Levels Predict Bacteremia in Patients With Community-Acquired Pneumonia: A Prospective Cohort Trial

Fabian Müller, MD; Mirjam Christ-Crain, MD; Thomas Bregenzer, MD; Martin Krause, MD; Werner Zimmerli, MD; Beat Mueller, MD; Philipp Schuetz, MD; for the ProHOSP Study Group*
Author and Funding Information

From the Department of Internal Medicine (Drs Müller, Christ-Crain, and Schuetz), Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel, Basel, Switzerland; Department of Internal Medicine (Drs Bregenzer and Mueller), Kantonsspital Aarau, Aarau, Switzerland; Department of Internal Medicine (Dr Krause), Kantonsspital Münsterlingen, Münsterlingen , Switzerland; and Department of Internal Medicine (Dr Zimmerli), Kantonsspital Liestal, Liestal, Switzerland.

Correspondence to: Beat Mueller, MD, Department of Internal Medicine, Kantonsspital, Tellstrasse, CH-5001 Aarau, Switzerland; e-mail: happy.mueller@unibas.ch


A complete list of participants is located in the Appendix.

Funding/Support: This trial was supported in part by a grant from the Swiss National Science Foundation [SNF 3200BO-116177/1]; contributions from santésuisse and the Gottfried and Julia Bangerter-Rhyner Foundation, the University Hospital Basel, the Medical University Clinic Liestal, the Medical Clinic Buergerspital Solothurn, the Cantonal Hospitals Münsterlingen, Aarau, and Lucerne, respectively; the Swiss Society for Internal Medicine; and the Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel. Brahms, the manufacturer of the procalcitonin assay, provided all assay-related material.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(1):121-129. doi:10.1378/chest.09-2920
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Background:  Guidelines recommend blood culture sampling from hospitalized patients with suspected community-acquired pneumonia (CAP). However, the yield of true-positive results is low. We investigated the benefit of procalcitonin (PCT) on hospital admission to predict blood culture positivity in CAP.

Methods:  This was a prospective cohort study with a derivation and validation set including 925 patients with CAP who underwent blood culture sampling on hospital admission.

Results:  A total of 73 (7.9%) patients had true bacteremia (43 of 463 in the derivation cohort, 30 of 462 in the validation cohort). The area under the receiver operating characteristics curve of PCT in the derivation and validation cohorts was similar (derivation cohort, 0.83; 95% CI, 0.78-0.89; validation cohort, 0.79; 95% CI, 0.72-0.88). Overall, PCT was a significantly better predictor for blood culture positivity than WBC count, C-reactive protein, and other clinical parameters. In multivariate regression analysis, only antibiotic pretreatment (adjusted odds ratio, 0.25; P < .05) and PCT serum levels (adjusted odds ratio, 3.72; P < .001) were independent predictors. Overall, a PCT cutoff of 0.1 μg/L would enable reduction of the total number of blood cultures by 12.6% and still identify 99% of the positive blood cultures. Similarly, 0.25 μg/L and 0.5 μg/L cutoffs would enable reduction of blood cultures by 37% and 52%, respectively, and still identify 96% and 88%, respectively, of positive blood cultures.

Conclusions:  Initial PCT level accurately predicted blood culture positivity in patients with CAP. PCT measurement has the potential to reduce the number of drawn blood cultures in the emergency department and to implement a more targeted allocation of limited health-care resources.

Trial registration:  clinicaltrials.gov; Identifier: NCT00350987

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