Serum procalcitonin as a predicting value in severity and prognosis of CAP in sickle cell patients

Serum procalcitonin

Authors

  • Sherif Refaat Alsayed Department of Chest, Faculty of Medicine, El Fayoum University, Faiyum, Egypt
  • Samar Marzouk Department of Biochemistry, Faculty of Medicine, Cairo University, Giza, Egypt
  • Essam Mousa Department of Internal Medicine, Faculty of Medicine, Al Azhar Universty, Cairo, Egyp

Keywords:

Procalcitonin level, predicting value, sickle cell positive adult patient

Abstract

Background: The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia but have limitations. Materials and Methods: The study evaluated if procalcitonin in community-acquired pneumonia provides prognostic information with the PSI and CURB-65 in sickle cell adult patients. Twenty sickle cell positive adult patients with a clinical and radiographic diagnosis of community acquired pneumonia were scored using PSI and CRUB-65, and measured procalcitonin levels. Results: They were 12 female 60% and 8 males 40%with mean of age 46.0 ± 10.26 and were stratified with PSI, CRUB65 and sampled for procalcitonin level for PSI class I (3) patients 15%, class II (10) patients 50%,class III (3) patients 15%, class IV( one) patient 5% & class V (3) patients 15% with mean of 2.55 ± 1.276 were CRUB65 0 (2) patients 10% 1 (11) patients 55% two (3) patients 15%, three (4) patients 20%with mean of 1.45 ± 0.94 proclacitonin >0.25 (8) patients 40% and >0.50 are (12) patients 60% with mean of 1.098 ± 1.346. Conclusion: Procalcitonin levels on admission predict severity of community acquired pneumonia in sickle cell patients with a similar prognostic accuracy as PSI and CRUB65 and use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients as sickle cell positive patients, further studies must address whether adding PCT to risk scores can increase their safe implementation in clinical practice. This was the scope for patients with sickle cell.

References

Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, et al. American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia: Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001;163:1730-54.

Woodhead M, Blasi F, Ewig S, Huchon G, Ieven M, Ortqvist A, et al. European Respiratory Society, European Society of Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J 2005;26:1138-80.

Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.

Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: An international derivation and validation study. Thorax 2003;58:377-82.

Schuetz P, Koller M, Christ-Crain M, Steyerberg E, Stolz D, Müller C, et al. Predicting mortality with pneumonia severity scores: Importance of model recalibration to local settings. Epidemiol Infect 2008;136:1628-37.

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America, American Thoracic Society. Infectious diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44:S27-72.

Neill AM, Martin IR, Weir R, Anderson R, Chereshsky A, Epton MJ, et al. Community acquired pneumonia: Aetiology and usefulness of severity criteria on admission. Thorax 1996;51:1010-6.

Pencina MJ, D′Agostino RB Sr, D′Agostino RB Jr, Vasan RS. Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond. Stat Med 2008;27:157-72.

Schuetz P, Albrich W, Christ-Crain M, Chastre J, Mueller B. Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther 2010;8:575-87.

Schuetz P, Christ-Crain M, Wolbers M, Schild U, Thomann R, Falconnier C, et al. ProHOSP study group. Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: A prospective, multicenter, randomized controlled trial. BMC Health Serv Res 2007;7:102.

Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C, et al. PRORATA trial group. Use of procalcitonin to reduce patients′ exposure to antibiotics in intensive care units (PRORATA trial): A multicentre randomised controlled trial. Lancet 2010;375:463-74.

Briel M, Schuetz P, Mueller B, Young J, Schild U, Nusbaumer C, et al. Procalcitonin-guided antibiotic use vs. a standard approach for acute respiratory tract infections in primary care. Arch Int Med 2008;168:2000-7.

Masiá M, Gutiérrez F, Shum C, Padilla S, Navarro JC, Flores E, et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 2005;128:2223-9.

Beovic B, Kreft S, Osredkar J, Kese D, Bonac-Tuma B. Serum procalcitonin levels in patients with mild community-acquired pneumonia. Clin Microbiol Infect 2005;11:1050-1.

Nylen E, Muller B, Becker KL, Snider R. The future diagnostic role of procalcitonin levels: The need for improved sensitivity. Clin Infect Dis 2003;36:823-4.

Barret-Connor E. Acute pulmonary disease and sickle cell anemia. Am Rev Respir Dis 1971;104:159-65.

Henderson AB. Sickle cell anemia: Clinical study of 54 cases. Am J Med 1950;9:757-65.

Reynolds J. The roentgenological features of sickle cell disease and related hemoglobinopathies. Springfield, III, Charles C. Thomas Publisher; 1965.

Capelastegui A, Espana PP, Quintana JM, Areitio I, Gorordo I, Egurrola M, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 2006;27:151-7.

Petch MC, Serjeant GR. Clinical features of pulmonary lesions in sickle cell-anemia. Br Med J 1970;3:31.

Aujesky D, Auble TE, Yearly DM, Stone RA, Oborosky DS, Meehan TP, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005;118:384-92.

Ewig S, de Roux A, Bauer T, Garcia E, Mensa J, Niederman MS, et al. Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax 2004;59:421-7.

Krüger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, et al. CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across allCRB-65 classes. Eur Respir J 2008;31:349-55.

Huang DT, Weissfeld LA, Kellum JA, Yealy DM, Kong L, Martino M, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med 2008;52:48-58.

Menéndez R, Martinez R, Reyes S, Mensa J, Polverino E, Filella X, et al. Stability in community acquired pneumonia: One step forward with markers? Thorax 2009;64:987-92.

Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B. Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: A prospective study. Clin Infect Dis 2002;34:895-901.

Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: Correlation with etiology and prognosis. Infection 2000;28:68-73.

Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, et al. Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 2003;21:939-43.

Wenzel RP, Fowler AA 3rd. Clinical practice. Acute bronchitis. N Engl J Med 2006;355:2125-30.

Macfarlane JT, Boldy D. Update of BTS pneumonia guidelines: What′s new? Thorax 2004;59:364-6.

Marrie TJ, Huang JQ. Admission is not always necessary for patients with community-acquired pneumonia in risk classes IV and V diagnosed in emergency room. Can Respir J 2007;14:212-6.

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Published

2014-09-25

How to Cite

1.
Alsayed SR, Marzouk S, Mousa E. Serum procalcitonin as a predicting value in severity and prognosis of CAP in sickle cell patients: Serum procalcitonin. Community Acquir Infect. 2014;1. Accessed May 8, 2024. https://www.hksmp.com/journals/cai/article/view/203

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