Universität zu Köln

Pfister, Roman, Kochanek, Matthias, Leygeber, Timo, Brun-Buisson, Christian, Cuquemelle, Elise, Paiva Machado, Mariana Benevides, Piacentini, Enrique, Hammond, Naomi E., Ingram, Paul R. and Michels, Guido (2014). Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis. Crit. Care, 18 (2). LONDON: BMC. ISSN 1466-609X

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Abstract

Introduction: Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza. Methods: Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search. Results: PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1; n = 77) (median = 6.2 g/L, interquartile range (IQR) = 0.9 to 20) than in patients with isolated H1N1 influenza pneumonia (n = 84; median = 0.56 g/L, IQR = 0.18 to 3.33). The area under the curve of the receiver operating characteristic curve of PCT was 0.72 (95% confidence interval (CI) = 0.64 to 0.80; P < 0.0001) for diagnosis of bacterial pneumonia, but increased to 0.76 (95% CI = 0.68 to 0.85; P < 0.0001) when patients with hospital-acquired pneumonia and immune-compromising disorders were excluded. PCT at a cut-off of 0.5 g/L had a sensitivity (95% CI) and a negative predictive value of 80.5% (69.9 to 88.7) and 73.2% (59.7 to 84.2) for diagnosis of bacterial pneumonia, respectively, which increased to 85.5% (73.3 to 93.5) and 82.2% (68.0 to 92.0) in patients without hospital acquired pneumonia or immune-compromising disorder. Conclusions: In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pfister, Roman UNSPECIFIED UNSPECIFIED UNSPECIFIED Kochanek, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Leygeber, Timo UNSPECIFIED UNSPECIFIED UNSPECIFIED Brun-Buisson, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Cuquemelle, Elise UNSPECIFIED UNSPECIFIED UNSPECIFIED Paiva Machado, Mariana Benevides UNSPECIFIED UNSPECIFIED UNSPECIFIED Piacentini, Enrique UNSPECIFIED UNSPECIFIED UNSPECIFIED Hammond, Naomi E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ingram, Paul R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Michels, Guido UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-451973
DOI:	10.1186/cc13760
Journal or Publication Title:	Crit. Care
Volume:	18
Number:	2
Date:	2014
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1466-609X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COMMUNITY-ACQUIRED PNEUMONIA; C-REACTIVE PROTEIN; ANTIBIOTIC-THERAPY; ADULT PATIENTS; A VIRUS; INFECTION; MARKERS; UTILITY; GUIDANCE; TRIALS Multiple languages Critical Care Medicine Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/45197