Akihiro Ito1, Isao Ito2, Daiki Inoue3, Satoshi Marumo4, Tetsuya Ueda5, Hiroaki Nakagawa6, Masato Taki7, Atsushi Nakagawa8, Shuji Tatsumi9, Takashi Nishimura10, Tetsuhiro Shiota11, Tadashi Ishida12. 1. 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. 2. Department of Respiratory Medicine, Kyoto University Hospital, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto, Kyoto 606-8507, Japan. Electronic address: isaoito@kuhp.kyoto-u.ac.jp. 3. Department of Respiratory Medicine, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, 2-4-20 Ougimachi, Kita-ku, Osaka, Osaka 530-8480, Japan. Electronic address: d-inoue@kitano-hp.or.jp. 4. Department of Respiratory Medicine, Tazuke Kofukai Foundation, Medical Research Institute, Kitano Hospital, 2-4-20 Ougimachi, Kita-ku, Osaka, Osaka 530-8480, Japan. Electronic address: marumosatoshi@gmail.com. 5. Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, Osaka 530-0012, Japan. Electronic address: t-ueda@nakatsu.saiseikai.or.jp. 6. Department of Respiratory Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan. Electronic address: hiroaki@belle.shiga-med.ac.jp. 7. Department of Respiratory Medicine, Osaka Red Cross Hospital, 5-30 Fudegasaki, Tennoji-ku, Osaka, Osaka 543-8555, Japan. Electronic address: masatotaki@osaka-med.jrc.or.jp. 8. Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan. Electronic address: nkgwats0918@gmail.com. 9. Department of Airway Medicine, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Saikyo-ku, Kyoto, Kyoto 615-8087, Japan. Electronic address: tatsumi.shuji@gmail.com. 10. Department of Respiratory Medicine, Kyoto Katsura Hospital, 17 Yamadahirao-cho, Saikyo-ku, Kyoto, Kyoto 615-8256, Japan. Electronic address: tnishi85@katsura.com. 11. Department of Internal Medicine, Yoka Hospital, 1878-1 Yoka, Yoka-cho, Yabu, Hyogo 667-8555, Japan; Department of Respiratory Medicine, Shiga General Hospital, 5-4-30 Moriyama, Moriyama, Shiga 524-8524, Japan. Electronic address: sot.agp0131@mdc.med.shiga-pref.jp. 12. Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan. Electronic address: ishidat@kchnet.or.jp.
Abstract
OBJECTIVES: The usefulness of serial procalcitonin (PCT) measurements for predicting the prognosis and treatment efficacy for hospitalised community-acquired pneumonia (CAP) patients was investigated. METHODS: This 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. RESULTS: A 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. CONCLUSIONS: PCT should be measured consecutively, not only on admission, to predict the prognosis and treatment efficacy in CAP.
OBJECTIVES: The usefulness of serial procalcitonin (PCT) measurements for predicting the prognosis and treatment efficacy for hospitalised community-acquired pneumonia (CAP) patients was investigated. METHODS: This 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. RESULTS: A 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. CONCLUSIONS: PCT should be measured consecutively, not only on admission, to predict the prognosis and treatment efficacy in CAP.