PROGNOSTIC ROLE OF PROCALCITONIN PROGNOSTIC ROLE OF PROCALCITONIN AND C-REACTIVE PROTEIN IN HOSPITAL AND C-REACTIVE PROTEIN IN HOSPITAL

ACQUIRED PNEUMONIA IN THE INTENSIVE ACQUIRED PNEUMONIA IN THE INTENSIVE CARE UNITCARE UNIT

HAKAN TANRIVERDİ HAKAN TANRIVERDİ , MELTEM TOR, OLGUN KESKİN, , MELTEM TOR, OLGUN KESKİN, FIRAT UYGUR, VİLDAN SÜMBÜLOĞLU*, CEVAHİR ÇELİK FIRAT UYGUR, VİLDAN SÜMBÜLOĞLU*, CEVAHİR ÇELİK

Zonguldak Karaelmas University Faculty of Medicine Zonguldak Karaelmas University Faculty of Medicine Chest Diseases, *BiostatisticChest Diseases, *Biostatistic

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AimAim Procalcitonin (PCT), is a precursor of calcitonin Procalcitonin (PCT), is a precursor of calcitonin

and it is a better marker than other infection and it is a better marker than other infection markers for the prognosis and monitoring the markers for the prognosis and monitoring the response to the therapyresponse to the therapy

We aimed to asses the prognostic role of PCT in We aimed to asses the prognostic role of PCT in the ICU patients who developed nosocomial the ICU patients who developed nosocomial pneumonia and compare it with CRPpneumonia and compare it with CRP

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Material and methodMaterial and method Patients who admitted to Zonguldak Karaelmas Patients who admitted to Zonguldak Karaelmas

University Faculty of Medicine Hospital ICUs with University Faculty of Medicine Hospital ICUs with the diagnosis of other than pneumonia and who the diagnosis of other than pneumonia and who developed Hospital associated pneumonia or developed Hospital associated pneumonia or ventilatory associated pneumonia (VAP) were ventilatory associated pneumonia (VAP) were included the studyincluded the study

We obtained blood samples for PCT and CRP on We obtained blood samples for PCT and CRP on the day of pneumonia diagnosis, 3rd and 7th of the day of pneumonia diagnosis, 3rd and 7th of therapy and clinical features of patients were therapy and clinical features of patients were assesed assesed

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Diagnostic criterias of Diagnostic criterias of pneumoniapneumonia

New or persistent infiltrate on chest New or persistent infiltrate on chest radiography and at least two of followings radiography and at least two of followings

1. Body temperature >38 °C or < 36°C1. Body temperature >38 °C or < 36°C2. Leukocyte count (>11,000 ) or <4.000 ) 2. Leukocyte count (>11,000 ) or <4.000 ) 3. Purulant secretion3. Purulant secretion ETA 100.000 cfu/ml was considered as ETA 100.000 cfu/ml was considered as

positive culturepositive culture

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Patients followed 28 days after diagnosis.Patients followed 28 days after diagnosis. Patients who died before 28th day called Patients who died before 28th day called

as as Group 1Group 1 and patients who lived until and patients who lived until 28th day or discharged called as 28th day or discharged called as Group 2Group 2

We used SPSS 11.0 for Statistical analyseWe used SPSS 11.0 for Statistical analyse

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Features of patients included the Features of patients included the studystudy

45 cases45 cases Mean age 64±16 (range 19 -87)Mean age 64±16 (range 19 -87) 33 (73,3%) VAP33 (73,3%) VAP 12 (26,7%) HAP 12 (26,7%) HAP Gruop 1:Gruop 1: 22 (48,9%) (who died before 22 (48,9%) (who died before

28th day)28th day) Gruop 2:Gruop 2: 23 (51,1%) 23 (51,1%)

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Gruop 1 Gruop 1 (nonsurvivor)(nonsurvivor)

Gruop 2Gruop 2 (survivor)(survivor)

TotalTotal

nn 22 (48,9%) 22 (48,9%) 23 (51,1%) 23 (51,1%) 4545

* Age * Age 70,7±8,9 70,7±8,9 59,8±19,559,8±19,5 65,1 ±16,165,1 ±16,1

Gender (F/M)Gender (F/M) 8/148/14 9/149/14 17/2817/28

APACHE IIAPACHE II 21,0±5,821,0±5,8 20,3±6,920,3±6,9 20,6±4,320,6±4,3

SAPS IISAPS II 45,2±13,845,2±13,8 39,7±14,339,7±14,3 42,2±14,242,2±14,2

SOFASOFA 5,6±2,55,6±2,5 5,2±2,05,2±2,0 5,4±2,25,4±2,2

*P<0,05

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Comorbidity Comorbidity NN %%

COPDCOPD 2121 46,646,6DMDM 2121 46,646,6CHFCHF 77 15,515,5Chronic renal Chronic renal failurefailure

11 2,22,2

MalignancyMalignancy 11 2,22,2MiscallenousMiscallenous 11 2,22,2

NoneNone 77 15,15,55

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Yatış endikasyonuYatış endikasyonu NN %%

Acute excabertation of Acute excabertation of COPDCOPD

1414 31,131,1

Serebrovascular accidentSerebrovascular accident 1111 24,424,4

CHFCHF 66 13,313,3

TraTraumauma 44 8,98,9

ARFARF 22 4,44,4

Neuromucular diseasesNeuromucular diseases 22 4,44,4

Miscallenous Miscallenous 66 13,313,3

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Pathogens Pathogens NN %%Acinetobacter spp.Acinetobacter spp. 2323 51,151,1

Pseudomonas aureginosaPseudomonas aureginosa 66 13,313,3

E. ColiE. Coli 44 8,98,9Klebsiella pnömoniaKlebsiella pnömonia 44 8,98,9

MRSEMRSE 33 6,76,7MSSAMSSA 11 2,22,2AcinAcinetobacter + E. Colietobacter + E. Coli 11 2,22,2No No 33 6,76,7

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Group 1 Group 1 (nonsurvivor)(nonsurvivor)

Group 2 Group 2 (survivor)(survivor)

PP

PCT1 PCT1 4,614,61 ± ± 8,358,35 2,492,49 ± ± 3,913,91 0,1370,137

PCT3*PCT3* 5,71 5,71 ±± 5,13 5,13 0,650,65 ± ± 0,780,78 <0,001*<0,001*

PCT7*PCT7* 8,438,43 ± ± 11,3211,32 0,660,66 ± ± 1,371,37 0,002*0,002*

CRP1CRP1 146,3146,3 ± ± 50,250,2 142,5142,5 ± ± 48,248,2 >0,05>0,05

CRP3CRP3 156,6156,6 ± ± 2,122,12 119,9119,9 ± ± 52,252,2 >0,05>0,05

CRP7CRP7 120,3 120,3 ± ± 46,946,9 108,4 108,4 ±± 49,5 49,5 >0,05>0,05

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2322N =

AKIBET

10

CR

P1

300

200

100

0

15

There was no significant difference between two There was no significant difference between two groups for PCT and CRP valuesgroups for PCT and CRP values

OutcoOutcome me

OutcoOutcome me

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Yaşayan hastalarla eksitus olan hastalar Yaşayan hastalarla eksitus olan hastalar arasında 3. ve 7. günlerde bakılan PCT arasında 3. ve 7. günlerde bakılan PCT

düzeyleri arasında istatistiksel olarak anlamlı düzeyleri arasında istatistiksel olarak anlamlı fark saptandı (p<0.001).fark saptandı (p<0.001).

OutcoOutcome me

OutcoOutcome me

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1, 3 ve 7. günlerde bakılan CRP düzeyleri 1, 3 ve 7. günlerde bakılan CRP düzeyleri açısından ise iki grup arasında istatistiksel açısından ise iki grup arasında istatistiksel

olarak anlamlı fark saptanmadı.olarak anlamlı fark saptanmadı.

2317N =

AKIBET

10C

RP7

300

200

100

0

-100

2

138N =

AKIBET

10

CR

P3

300

200

100

0

-100

OutcoOutcome me

OutcoOutcome me

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Group 1Group 1 Group 2Group 2 ppAPACHE IIAPACHE II - 1 - 1 26,77 26,77 ± ± 5,315,31 22,39 22,39 ± ± 6,286,28 <0,05<0,05APACHE II -APACHE II - 3 3 25,86 25,86 ± ± 6,406,40 20,00 20,00 ± ± 8,198,19 <0,001<0,001APACHE II -APACHE II - 77 25,76 25,76 ± ± 6,426,42 19,70 19,70 ± ± 9,439,43 <0,05<0,05SAPSII -1SAPSII -1 51,6 51,6 ± ± 13,213,2 44,7 44,7 ± ± 11,611,6 >0,05>0,05SAPSII – 3SAPSII – 3 52,0 52,0 ± ± 13,713,7 41,7 41,7 ± ± 15,815,8 >0,05>0,05SAPSII – 7SAPSII – 7 52,8 52,8 ± ± 13,913,9 40,2 40,2 ± ± 14,614,6 <0,05<0,05SOFA -1SOFA -1 7,50 7,50 ± ± 2,062,06 6,78 6,78 ± ± 2,502,50 >0,05>0,05SOFA – 3SOFA – 3 7,45 7,45 ± ± 2,322,32 5,43 5,43 ± ± 1,901,90 <0,05<0,05SOFA – 7SOFA – 7 7,41 7,41 ± ± 2,802,80 4,65 4,65 ± ± 1,771,77 <0,05<0,05

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APACHE1

403020100C

RP1

300

200

100

0

APACHE1

403020100

PCT

1

40

30

20

10

0

-10

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APACHE3

403020100

PCT

3

30

20

10

0

-10

APACHE3

403020100C

RP3

200

100

0

-100

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APACHE7

50403020100

PCT

7

50

40

30

20

10

0

-10

APACHE7

50403020100C

RP7

200

100

0

-100

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Conclusion Conclusion PCT, is a better marker than CRP for the PCT, is a better marker than CRP for the

prognosis of HAPprognosis of HAP Differences in the PCT values can be used Differences in the PCT values can be used

for the prediction of prognosisfor the prediction of prognosis Decreasing levels of PCT is a finding that Decreasing levels of PCT is a finding that

shows improvement of infectious clinicshows improvement of infectious clinic İncreasing levels of PCT should be İncreasing levels of PCT should be

considered as a poor prognostic sign considered as a poor prognostic sign

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Overall accuracy of PCT markers is higher than that of CRP markers both to differentiate bacterial infections from viral infections and to differentiate bacterial infections from other noninfective causes of systemic inflammation

Serum Procalcitonin and C-Reactive Protein Levels as Markers of Bacterial Infection: A Systematic Review and Meta-analysis

CID 2004:39 (15 July) • Simon et al.

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