Wesley H Self1, Carlos G Grijalva2, Derek J Williams3, Alison Woodworth4, Robert A Balk5, Sherene Fakhran6, Yuwei Zhu7, D Mark Courtney8, James Chappell4, Evan J Anderson9, Chao Qi10, Grant W Waterer11, Christopher Trabue12, Anna M Bramley13, Seema Jain13, Kathryn M Edwards3, Richard G Wunderink14. 1. Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN. Electronic address: wesley.self@vanderbilt.edu. 2. Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN. 3. Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN. 4. Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN. 5. Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rush University Medical Center, Chicago, IL. 6. Department of Medicine, Division of Pulmonary, John H. Stroger, Jr Hospital of Cook County, Chicago, IL. 7. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN. 8. Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. 9. Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA. 10. Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL. 11. Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL; Departments of Medicine and Pharmacology, University of Western Australia, Perth, Australia. 12. Department of Medicine, University of Tennessee Health Science Center/Saint Thomas Health, Nashville, TN. 13. Influenza Division of the National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. 14. Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL.
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.
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.
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