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Observational Study
Procalcitonin kinetics and nosocomial pneumonia in older patients.
- Yan Shi, Ying-chun Xu, Xi Rui, Hong-min Zhang, Yao Wang, and Wei Du.
- Respir Care. 2014 Aug 1;59(8):1258-66.
BackgroundEarly identification of treatment failure for nosocomial pneumonia remains a major challenge. The goal of this study was to test whether procalcitonin kinetics can be used to assess the clinical efficacy in older critically ill patients with nosocomial pneumonia.MethodsA prospective observational study was conducted with 60 subjects (≥ 65 y old) admitted to the ICU with severe nosocomial pneumonia. Serum procalcitonin was measured on days 0, 3, and 7 and at the end of treatment. The procalcitonin time course was analyzed according to the therapeutic efficacy.ResultsProcalcitonin levels were elevated in all subjects (n = 60) on day 0, and the median level (range) was 2.5 (0.8-42.7) μg/L. There were no differences in procalcitonin between the improved subjects (n = 41) and those without improvement (n = 19) on day 0 (P > .05). However, lower procalcitonin levels on days 3 and 7 and at the end of treatment (all P < .05) and greater rates of procalcitonin decline between days 0 and 3 (ΔPCT(d3)%; 29.5 ± 10.8% vs 15.1 ± 5.9%, P = .009) were observed in the improved subjects compared with those with no improvement. ΔPCT(d3)% was the best single predictor of efficacy (area under the curve of 0.79, P < .001) and had a sensitivity of 75.7% and a specificity of 72.0% with a threshold of 26.2%. By comparison, traditional parameters and absolute procalcitonin failed to predict treatment response (P > .05). Indeed, the combination of ΔPCT(d3)% > 26.2% and a modified Clinical Pulmonary Infection Score of < 6 points improved the predictive value (area under the curve of 0.89, sensitivity of 81.3%, specificity of 86.5%).ConclusionsProcalcitonin levels were not influenced by aging, and procalcitonin kinetics might help to identify treatment failure. ΔPCT(d3)% in combination with the Clinical Pulmonary Infection Score has been shown to be a marker of clinical efficacy at an earlier stage.
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