Authors: J Haeuptle R Zaborsky R Fiumefreddo A Trampuz I Steffen R Frei M ChristCrain B Müller P Schuetz
Publish Date: 2008/08/02
Volume: 28, Issue: 1, Pages: 55-
Abstract
The diagnostic reliability and prognostic implications of procalcitonin PCT ng/ml on admission in patients with communityacquired pneumonia CAP due to Legionella pneumophila are unknown We retrospectively analysed PCT values in 29 patients with microbiologically proven LegionellaCAP admitted to the University Hospital Basel Switzerland between 2002 and 2007 and compared them to other markers of infection namely Creactive protein CRP mg/l and leukocyte count 109/l and two prognostic severity assessment scores PSI and CURB65 Laboratory analysis demonstrated that PCT values on admission were 01 in over 93 025 in over 86 and 05 in over 82 of patients with LegionellaCAP Patients with adverse medical outcomes 59 n = 17 including need for ICU admission 55 n = 16 and/or inhospital mortality 14 n = 4 had significantly higher median PCT values on admission 427 IQR 246–948 vs 097 IQR 029–244 p = 001 while the PSI 124 IQR 81–147 vs 94 IQR 75–116 p = 019 the CURB65 2 IQR 1–2 vs 1 1–3 p = 047 CRP values 282 IQR 218–343 p = 028 vs 201 IQR 147–279 p = 028 and leukocyte counts 12 IQR 10–21 vs 12 IQR 9–15 p = 058 were similar In receiver operating curves PCT concentrations on admission had a higher prognostic accuracy to predict adverse outcomes AUC 078 95CI 061–96 as compared to the PSI 064 95CI 043–086 p = 023 the CURB65 058 95CI 036–079 p = 021 CRP 061 95CI 039–084 p = 019 and leukocyte count 057 95CI 035–078 p = 012 KaplanMeier curves demonstrated that patients with initial PCT values above the optimal cutoff of 15 had a significantly higher risk of death and/or ICU admission log rank p = 0003 during the hospital stay In patients with CAP due to Legionella PCT levels on admission might be an interesting predictor for adverse medical outcomesAuthors PS MCC and BM received support from BRAHMS to attend meetings and fulfilled speaking engagements BM has served as a consultant and received research support to attend meetings and for travel expenses All other coauthors declare that they have no competing interestsAuthors PS JH RZ RF MCC and BM had the idea for the study and directed the study design data collection and analysis and writing of the report Authors RF IS and AT each had substantial contributions in planning of the study data collection interpretation of data and/or writing of the manuscript
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