Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic ... View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2014-03-10

AUTHORS

Roman Pfister, Matthias Kochanek, Timo Leygeber, Christian Brun-Buisson, Elise Cuquemelle, Mariana Benevides Paiva Machado, Enrique Piacentini, Naomi E Hammond, Paul R Ingram, Guido Michels

ABSTRACT

INTRODUCTION: Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza. METHODS: Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search. RESULTS: PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1; n = 77) (median = 6.2 μg/L, interquartile range (IQR) = 0.9 to 20) than in patients with isolated H1N1 influenza pneumonia (n = 84; median = 0.56 μg/L, IQR = 0.18 to 3.33). The area under the curve of the receiver operating characteristic curve of PCT was 0.72 (95% confidence interval (CI) = 0.64 to 0.80; P < 0.0001) for diagnosis of bacterial pneumonia, but increased to 0.76 (95% CI = 0.68 to 0.85; P < 0.0001) when patients with hospital-acquired pneumonia and immune-compromising disorders were excluded. PCT at a cut-off of 0.5 μg/L had a sensitivity (95% CI) and a negative predictive value of 80.5% (69.9 to 88.7) and 73.2% (59.7 to 84.2) for diagnosis of bacterial pneumonia, respectively, which increased to 85.5% (73.3 to 93.5) and 82.2% (68.0 to 92.0) in patients without hospital acquired pneumonia or immune-compromising disorder. CONCLUSIONS: In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment. More... »

PAGES

r44-r44

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/cc13760

DOI

http://dx.doi.org/10.1186/cc13760

DIMENSIONS

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PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/24612487


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30 schema:description INTRODUCTION: Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza. METHODS: Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search. RESULTS: PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1; n = 77) (median = 6.2 μg/L, interquartile range (IQR) = 0.9 to 20) than in patients with isolated H1N1 influenza pneumonia (n = 84; median = 0.56 μg/L, IQR = 0.18 to 3.33). The area under the curve of the receiver operating characteristic curve of PCT was 0.72 (95% confidence interval (CI) = 0.64 to 0.80; P < 0.0001) for diagnosis of bacterial pneumonia, but increased to 0.76 (95% CI = 0.68 to 0.85; P < 0.0001) when patients with hospital-acquired pneumonia and immune-compromising disorders were excluded. PCT at a cut-off of 0.5 μg/L had a sensitivity (95% CI) and a negative predictive value of 80.5% (69.9 to 88.7) and 73.2% (59.7 to 84.2) for diagnosis of bacterial pneumonia, respectively, which increased to 85.5% (73.3 to 93.5) and 82.2% (68.0 to 92.0) in patients without hospital acquired pneumonia or immune-compromising disorder. CONCLUSIONS: In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment.
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40 ICU
41 ICU admission
42 ICU patients
43 PCT levels
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45 admission
46 antibiotic treatment
47 area
48 bacterial infections
49 bacterial pneumonia
50 characteristic curve
51 characteristics
52 clinical characteristics
53 cohort study
54 community-acquired disease
55 curves
56 data
57 detection
58 diagnosis
59 diagnostic utility
60 disease
61 disorders
62 hospital
63 hospital-acquired pneumonia
64 hours
65 ill patients
66 immune-compromising disorders
67 individual patient data
68 infection
69 influenza
70 influenza pandemic
71 influenza pneumonia
72 influenza season
73 isolated H1N1 influenza pneumonia
74 levels
75 literature search
76 markers
77 medical ICU
78 negative predictive value
79 pandemic
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81 patient data
82 patients
83 pneumonia
84 predictive value
85 procalcitonin
86 prospective cohort study
87 receiver
88 review
89 search
90 season
91 sensitivity
92 stand-alone marker
93 study
94 systematic literature search
95 systematic review
96 treatment
97 utility
98 values
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