It is a common practice nowadays to do procalcitonin (PCT) testing to diagnose and prognosticate bacterial infections. The aim of this study is to look at the trend in procalcitonin levels done 24 hours after clinical improvement amongst survivors of severe pneumonia.
This was a retrospective study of patients admitted to the intensive care unit with a dignosis of severe pneumonia and who survived the ICU stay. All patients who had a PCT level done 24 hours after clinical improvement were included in the study. Clinical improvement was defined as patients meeting at least 2 of 3 criteria; 1) fever settling 2) improved leucocytosis 3) reduction in purulence and volume of endotracheal secretions or sputum.
Fifteen pneumonia patients were included in the study. Twelve were community-acquired, 2 were healthcare-associated and one was hospital-acquired. Fourteen patients were intubated and mechanically ventilated. The median age was 72 years, the median SAPS II score was 41 and the median initial PCT level was 2.44 ng/ml. All except one patient had decreasing levels of PCT done 24 hours after clinical improvement. Inspite of an increasing level, this patient remained well and was discharged from the hospital 4 days later.
It seems that in severe pneumonia patients who have clinically improved, the clinician can expect the 24 hour-PCT levels to fall.
In severe pneumonia patients, if the PCT levels done 24 hours after clinical recovery do not fall, it may be prudent for the clinician to look for other sites of bacterial infection.
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