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Original Research |

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, MS; D. Mark Courtney, MD, MSCI; 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

Potential Conflicts of Interest: WHS reports grants from CDC; funds to conduct clinical research from BioMerieux, Affinium Pharmaceuticals, Astute Medical, BRAHMS GmbH, Pfizer, Rapid Pathogen Screening, and Venaxis; and personal fees from BioFire Diagnostics and Venaxis. DJW reports grants from CDC. AW reports funds to perform clinical research from Biomerieux. YW reports grants from CDC. JC reports grants from CDC; funds to conduct clinical research from BioMerieux; and patent US, 8,293, 498 B2 licensed to Vanderbilt University, and a patent 13/639564 pending. EJA reports grants from MedImmune; and non-financial support from Roche. CT reports personal fees from Saint Thomas Research Institute. KME reports grants from CDC and Novartis; and other from Novartis. RGW reports grants from CDC; funds to conduct clinical research from BioMerieux and Vertex Pharmaceuticals; and personal fees from BioMerieux and Visterra Inc. Other authors: nothing to disclose.

Funding/Role of the Sponsors: 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 Prevent participated in the study as authors. WHS 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, which had no role in: the design and conduct of the study; collection, management, analysis and interpretation of data; preparation of the manuscript; or decision to submit the manuscript for publication. BioMerieux, Inc did review the final manuscript before submission.

Previous Presentation: An abstract reporting preliminary data of this work was presented at the 2013 Society for Academic Emergency Medicine Annual Meeting; Atlanta, GA.

Corresponding Author: Wesley H. Self, MD, MPH. Address: Department of Emergency Medicine, Vanderbilt University Medical Center, 1313 21st Ave South, 703 Oxford House, Nashville, TN 37232.


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


Chest. 2016. doi:10.1016/j.chest.2016.04.010
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Abstract

Background  Predicting intensive care need 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 concentration at hospital presentation with the need for invasive respiratory and/or vasopressor support (IRVS) within 72 hours. Logistic regression was used to model this association, with results reported as the estimated risk of IRVS for a given procalcitonin concentration. We also assessed whether the addition of procalcitonin changed the performance of established pneumonia severity scores, including the pneumonia severity index and American Thoracic Society minor criteria, for prediction of IRVS.

Results  Of 1770 enrolled patients, 115 (6.5%) required IRVS. Using the logistic regression model, procalcitonin concentration had a strong association with IRVS risk. Undetectable procalcitonin (<0.05 ng/ml) was associated with a 4.0% (95% CI: 3.1%, 5.1%) risk of IRVS. For concentrations <10 ng/ml, procalcitonin had an approximate linear association with IRVS risk; for each 1 ng/ml increase in procalcitonin, there was a 1-2% absolute increase in the risk of IRVS. With a procalcitonin 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, procalcitonin contributed significant additional risk information for prediction of IRVS.

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


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