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Original Research: Critical Care |

Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia

Wesley H. Self, MD, MPH; Carlos G. Grijalva, MD, MPH; Derek J. Williams, MD, MPH; Alison Woodworth, PhD; Robert A. Balk, MD; Sherene Fakhran, MD; Yuwei Zhu, MD; D. Mark Courtney, MD; James Chappell, MD, PhD; Evan J. Anderson, MD; Chao Qi, PhD; Grant W. Waterer, MD, PhD; Christopher Trabue, MD; Anna M. Bramley, MPH; Seema Jain, MD; Kathryn M. Edwards, MD; Richard G. Wunderink, MD
Author and Funding Information

FUNDING/SUPPORT: This work was supported by a cooperative agreement with the Centers for Disease Control and Prevention (U18 IP000299). Investigators from the Centers for Disease Control and Prevention participated in the study as authors. W.H.S. was supported in part by K23GM110469 from the National Institute of General Medical Sciences. Materials and funds to perform procalcitonin measurements were provided by BioMerieux, Inc.

aDepartment of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN

bDepartment of Health Policy, Vanderbilt University Medical Center, Nashville, TN

cDepartment of Pediatrics, Vanderbilt University Medical Center, Nashville, TN

dDepartment of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN

eDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, TN

fDepartment of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL

gDepartment of Medicine, Division of Pulmonary, John H. Stroger, Jr Hospital of Cook County, Chicago, IL

hDepartment of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL

iDepartment of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL

jDepartment of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL

kDepartment of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA

lDepartments of Medicine and Pharmacology, University of Western Australia, Perth, Australia

mDepartment of Medicine, University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN

nInfluenza Division of the National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA

CORRESPONDENCE TO: Wesley H. Self, MD, MPH, Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave S, 703 Oxford House, Nashville, TN 37232


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):819-828. doi:10.1016/j.chest.2016.04.010
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Background  Predicting the need for intensive care among adults with community-acquired pneumonia (CAP) remains challenging.

Methods  Using a multicenter prospective cohort study of adults hospitalized with CAP, we evaluated the association of serum procalcitonin (PCT) concentration at hospital presentation with the need for invasive respiratory or vasopressor support (IRVS), or both, within 72 h. Logistic regression was used to model this association, with results reported as the estimated risk of IRVS for a given PCT concentration. We also assessed whether the addition of PCT changed the performance of established pneumonia severity scores, including the pneumonia severity index and the American Thoracic Society minor criteria, for prediction of IRVS.

Results  Of 1,770 enrolled patients, 115 required IRVS (6.5%). Using the logistic regression model, PCT concentration had a strong association with IRVS risk. Undetectable PCT (< 0.05 ng/mL) was associated with a 4% (95% CI, 3.1%-5.1%) risk of IRVS. For concentrations < 10 ng/mL, PCT had an approximate linear association with IRVS risk: for each 1 ng/mL increase in PCT, there was a 1% to 2% absolute increase in the risk of IRVS. With a PCT concentration of 10 ng/mL, the risk of IRVS was 22.4% (95% CI, 16.3%-30.1%) and remained relatively constant for all concentrations > 10 ng/mL. When added to each pneumonia severity score, PCT contributed significant additional risk information for the prediction of IRVS.

Conclusions  Serum PCT concentration was strongly associated with the risk of requiring IRVS among adults hospitalized with CAP and is potentially useful for guiding decisions about ICU admission.

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