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Prognostic value of procalcitonin in respiratory tract infections across clinical settings.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author Kutz Alexander, Briel Matthias, Christ-Crain Mirjam, Stolz Daiana, Bouadma Lila, Wolff Michel, Kristoffersen Kristina B, Wei Long, Burkhardt Olaf, Welte Tobias, Schroeder Stefan, Nobre Vandack, Tamm Michael, Bhatnagar Neera, Bucher Heiner C, Luyt Charles-Edouard, Chastre Jean, Tubach Florence, Mueller Beat, Schuetz Philipp,
Project Preventing viral exacerbation of chronic obstructive pulmonary disease in upper respiratory tract infection - The PREVENT study
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Original article (peer-reviewed)

Journal Critical care (London, England)
Volume (Issue) 19(1)
Page(s) 74 - 74
Title of proceedings Critical care (London, England)
DOI 10.1186/s13054-015-0792-1

Abstract

INTRODUCTION Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population. METHODS We analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results' consistency. RESULTS Overall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found. CONCLUSIONS Admission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting.
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