Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis.

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.

• Authors: Roman Pfister, Matthias Kochanek, Timo Leygeber, Christian Brun-Buisson, Elise Cuquemelle, Mariana Benevides Machado, Enrique Piacentini, Naomi E Hammond, Paul R Ingram, Guido Michels
• Journal: Critical care (London, England) (Crit Care) Vol. 18 Issue 2 Pg. R44 (Mar 10 2014) ISSN: 1466-609X [Electronic] England
• PMID: 24612487 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• CALCA protein, human
• Protein Precursors
• Calcitonin
• Calcitonin Gene-Related Peptide

Topics

• Adult
• Aged
• Calcitonin (blood)
• Calcitonin Gene-Related Peptide
• Cohort Studies
• Critical Illness (epidemiology)
• Cross Infection (blood, diagnosis, epidemiology)
• Female
• Humans
• Influenza A Virus, H1N1 Subtype (isolation & purification)
• Influenza, Human (blood, diagnosis, epidemiology)
• Male
• Middle Aged
• Pandemics
• Pneumonia, Bacterial (blood, diagnosis, epidemiology)
• Prospective Studies
• Protein Precursors (blood)
• Retrospective Studies