Tuberculosis and Respiratory Diseases

  • 제67권5호
  • /
  • Pages.430-435
  • /
  • 2009
  • /
  • 1738-3536(pISSN)
  • /
  • 2005-6184(eISSN)
대한결핵및호흡기학회 (The Korean Academy of Tuberculosis and Respiratory Diseases)
권호 표지
DOI QR코드

DOI QR Code

지역사회획득폐렴 환자의 중증도 평가에서 Procalcitonin 유용성

Usefulness of Procalcitonin in the Assessing the Severity of Community-Acquired Pneumonia Patient

  • Park, Hun-Pyo (Department of Respiratory Medicine, Changwon Fatima Hospital) ;
  • Lee, Jung-Soo (Department of Respiratory Medicine, Daegu Fatima Hospital) ;
  • Jang, Ye-Su (Department of Respiratory Medicine, Daegu Fatima Hospital) ;
  • Kim, Min-Su (Department of Respiratory Medicine, Changwon Fatima Hospital)
  • 투고 : 2009.09.09
  • 심사 : 2009.09.29
  • 발행 : 2009.11.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Thus far, research studies on community-acquired pneumonia (CAP) have focused on its clinical severity. Recently, it has been determined that procalcitonin (PCT) level is correlated with severity of CAP. A retrospective study conducted at our hospital used risk predictability and PCT to determine whether or no PCT is useful in assessing the severity of CAP. Methods: This study covered 92 CAP cases that were admitted to the respiratory department at Changwon Fatima Hospital between July 1, 2008 and June 30, 2009. All enrolled subjects were measured for infection markers and risk predictability. Results: Based on hospital admission data, enrolled subjects had Pneumonia Severity Index (PSI) scores serving as risk predictors showed that both PCT and white blood cell (WBC) were statistically significant as infection markers (p=0.001, 0.037). Thus, this study used ROC curves in PSI for data analysis. As a result, it was determined that the area under curve (AUC) of PCT and WBC was 0.694 and 0.593 respectively, indicating that PCT has a higher test value for WBC, when PCT was higher than 0.745 ng/mL. In addition, it was found that PCT levels higher than 0.745 ng/mL had higher PSI scores than the group with PCT lower than 0.745 ng/mL (p=0.032). Conclusion: In order to predict risk of pneumonia cases admitted due to symptoms of CAP, it is important to consider PCT as well as PSI, and follow-up monitoring of PCT cases.

키워드

참고문헌

  1. Fine MJ, Smith MA, Carson CA, Mutha SS, Sankey SS, Weissfeld LA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. A meta-analysis. JAMA 1996;275:134-41 https://doi.org/10.1001/jama.275.2.134
  2. Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community- acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002;165:766-72 https://doi.org/10.1164/ajrccm.165.6.2103038
  3. The British Thoracic Society Research Committee and The Public Health Laboratory Service. The aetiology, management and outcome of severe community-acquired pneumonia on the intensive care unit. Respir Med 1992;86:7-13 https://doi.org/10.1016/S0954-6111(06)80141-1
  4. Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax 1996;51:1010-6 https://doi.org/10.1136/thx.51.10.1010
  5. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82 https://doi.org/10.1136/thorax.58.5.377
  6. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify lowrisk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50 https://doi.org/10.1056/NEJM199701233360402
  7. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44 Suppl 2:S27-72 https://doi.org/10.1086/511159
  8. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000;28: 68-73 https://doi.org/10.1007/s150100050049
  9. Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis 2002;34:895-901 https://doi.org/10.1086/339198
  10. Masia M, Gutierrez F, Shum C, Padilla S, Navarro JC, Flores E, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 2005;128:2223-9 https://doi.org/10.1378/chest.128.4.2223
  11. Kruger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008;31:349-55 https://doi.org/10.1183/09031936.00054507
  12. Huang DT, Weissfeld LA, Kellum JA, Yealy DM, Kong L, Martino M, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med 2008;52:48-58.e2 https://doi.org/10.1016/j.annemergmed.2008.01.003
  13. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260:93-101 https://doi.org/10.1111/j.1365-2796.2006.01657.x
  14. Niederman MS. Recent advances in community-acquired pneumonia: inpatient and outpatient. Chest 2007; 131:1205-15 https://doi.org/10.1378/chest.06-1994
  15. Tateda K, Kusano E, Matsumoto T, Kimura K, Uchida K, Nakata K, et al. Semi-quantitative analysis of Streptococcus pneumoniae urinary antigen: kinetics of antigen titers and severity of diseases. Scand J Infect Dis 2006; 38:166-71 https://doi.org/10.1080/00365540500400944
  16. Christ-Crain M, Morgenthaler NG, Stolz D, Muller C, Bingisser R, Harbarth S, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care 2006;10:R96 https://doi.org/10.1186/cc4443
  17. Muller B, Becker KL, Schachinger H, Rickenbacher PR, Huber PR, Zimmerli W, et al. Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit. Crit Care Med 2000;28:977-83 https://doi.org/10.1097/00003246-200004000-00011
  18. Linscheid P, Seboek D, Schaer DJ, Zulewski H, Keller U, Muller B. Expression and secretion of procalcitonin and calcitonin gene-related peptide by adherent monocytes and by macrophage-activated adipocytes. Crit Care Med 2004;32:1715-21 https://doi.org/10.1097/01.CCM.0000134404.63292.71
  19. Reinhart K, Karzai W, Meisner M. Procalcitonin as a marker of the systemic inflammatory response to infection. Intensive Care Med 2000;26:1193-200 https://doi.org/10.1007/s001340000624
  20. Becker KL, Nylen ES, White JC, Muller B, Snider RH Jr. Clinical review 167: Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors. J Clin Endocrinol Metab 2004;89:1512-25 https://doi.org/10.1210/jc.2002-021444
  21. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341: 515-8 https://doi.org/10.1016/0140-6736(93)90277-N
  22. Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B. Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care 2007;11:R60 https://doi.org/10.1186/cc5926
  23. Kim HC, Kim KM, Lee SM, Lee SJ, Ham HS, Cho YJ, et al. Measuring serum procalcitonin in patients with fever in the ICU to differentiate infectious causes from non-infectious causes. Tuberc Respir Dis 2006;61:20-5 https://doi.org/10.4046/trd.2006.61.1.20
  24. Holm A, Pedersen SS, Nexoe J, Obel N, Nielsen LP, Koldkjaer O, et al. Procalcitonin versus C-reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care. Br J Gen Pract 2007;57:555-60
  25. Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Muller C, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007;131:9-19 https://doi.org/10.1378/chest.06-1500
  26. Nobre V, Harbarth S, Graf JD, Rohner P, Pugin J. Use of procalcitonin to shorten antibiotic treatment duration in septic patients: a randomized trial. Am J Respir Crit Care Med 2008;177:498-505 https://doi.org/10.1164/rccm.200708-1238OC
  27. Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174: 84-93 https://doi.org/10.1164/rccm.200512-1922OC
  28. Nyamande K, Lalloo UG. Serum procalcitonin distinguishes CAP due to bacteria, Mycobacterium tuberculosis and PJP. Int J Tuberc Lung Dis 2006;10:510-5

피인용 문헌

  1. 지역사회 획득 폐렴환자의 중증도 평가에서 혈청 코티졸의 유용성 vol.69, pp.6, 2009, https://doi.org/10.4046/trd.2010.69.6.450
  2. 박테리아성 지역사회획득 폐렴과 2009 H1N1 바이러스성 감염의 감별에 있어 C-Reactive Protein, Procalcitonin, Lipopolysaccharide-Binding Protein의 역할 vol.70, pp.6, 2009, https://doi.org/10.4046/trd.2011.70.6.490