Respiratory Care |

Serum Procalcitonin and C-Reactive Protein Levels as Indicators of Treatment Success in Patients With Community-Acquired Pneumonia FREE TO VIEW

Abdullah Sayiner; M. Sezai Tasbakan; Canan Gunduz; Aykut Cilli; Burcu Celenk; Aysin Sakar; Feride Durmaz
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Ege University Faculty of Medicine, Izmir, Turkey

Chest. 2014;146(4_MeetingAbstracts):920A. doi:10.1378/chest.1988466
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SESSION TITLE: Respiratory Infections Posters II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Fever, leukocyte count, C-reactive protein (CRP) and procalcitonin (PCT) levels are used in the follow-up of patients with community-acquired pneumonia (CAP). The aim of this study was to determine the prognostic value of these parameters.

METHODS: Data of patients who had been admitted to the hospital and who had been registered to the Turkish Thoracic Society Pneumonia Database (TURCAP) were retrospectively evaluated. For each parameter - fever, leukocyte count, serum CRP and PCT level - the values recorded at baseline and on days 3-5 (D3-5) were retrieved for analysis. Treatment success was defined as clinical cure and no need for a second and/or different course of antibiotics within 30 days.

RESULTS: One hundred and three hospitalized CAP patients (57 males, mean age 61.5 ± 16.7) were included in the study. Treatment failure was observed in 20 patients (19.4%). Pneumonia Severity Index (PSI), CRP and PCT levels at admission were found to be significantly higher in the treatment failure group. A baseline CRP level of <17.5 mg/dl was found to predict treatment success with sensitivity and specificity of 78.8% and 59.7%, respectively. A fall in CRP level on D3-5 by 50% predicted treatment success with sensitivity and specificity of 82.4% and 41.2%. These values were 71.4% and 69.6%, respectively, for a baseline PCT level of <2 ng/dl and 91.7% and 54.5% for a decrease in PCT level by >30% on D3-5. No cut-off value for baseline fever or leukocyte count was found that would predict treatment success. When areas below ROC curves for all these parameters were examined, the parameters that would best predict treatment success were CRP ve PCT levels at admission and a decrease in PCT levels at D3-5.

CONCLUSIONS: CRP and PCT levels at admission and the course of PCT levels during antibiotic treatment appear to be the best predictors of treatment success.

CLINICAL IMPLICATIONS: In community-acquired pneumonia, fever and the leukocyte count may not optimally reflect the response to antibiotic treatment. Use of two biomarkers, CRP and PCT at admission and on days 3-5, may help clinicans better manage their patients.

DISCLOSURE: The following authors have nothing to disclose: Abdullah Sayiner, M. Sezai Tasbakan, Canan Gunduz, Aykut Cilli, Burcu Celenk, Aysin Sakar, Feride Durmaz

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