• Akihiro Ito, Isao Ito, Daiki Inoue, Satoshi Marumo, Tetsuya Ueda, Hiroaki Nakagawa, Masato Taki, Atsushi Nakagawa, Shuji Tatsumi, Takashi Nishimura, Tetsuhiro Shiota, and Tadashi Ishida.
• Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan. Electronic address: ai12306@kchnet.or.jp.
• Int. J. Infect. Dis. 2020 Mar 1; 92: 228-233.

ObjectivesThe usefulness of serial procalcitonin (PCT) measurements for predicting the prognosis and treatment efficacy for hospitalised community-acquired pneumonia (CAP) patients was investigated.MethodsThis prospective, multicentre, cohort study enrolled consecutive CAP patients who were hospitalised at 10 hospitals in western Japan from September 2013 to September 2016. PCT and C-reactive protein (CRP) were measured on admission (PCT D1 and CRP D1), within 48-72 h after admission (PCT D3 and CRP D3), and within 144-192 h after admission. CURB-65 and the Pneumonia Severity Index (PSI) were assessed on admission. The primary outcome was 30-day mortality; secondary outcomes were early and late treatment failure rates.ResultsA total of 710 patients were included. The 30-day mortality rate was 3.1%. On multivariate analysis, only PCT D3/D1 ratio >1 [odds ratio (95% confidence interval): 4.33 (1.46-12.82),P = 0.008] and PSI [odds ratio (95% confidence interval): 2.32 (1.07-5.03), P = 0.03] were significant prognostic factors. Regarding treatment efficacy, PCT D3/D1 >1 was a significant predictor of early treatment failure on multivariate analysis. PCT D3/D1 with the PSI significantly improved the prognostic accuracy over that of the PSI alone.ConclusionsPCT should be measured consecutively, not only on admission, to predict the prognosis and treatment efficacy in CAP.Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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