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

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

Research output: Contribution to journalArticlepeer-review

21 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)819-828
Number of pages10
JournalCHEST
Volume150
Issue number4
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Keywords

  • biomarkers
  • pneumonia
  • prognosis
  • respiratory failure
  • septic shock

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia'. Together they form a unique fingerprint.

Cite this