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. 2014 Mar 10;18(2):R44
Authors: Pfister R, Kochanek M, Leygeber T, Brun-Buisson C, Cuquemelle E, Paiva Machado MB, Piacentini E, Hammond NE, Ingram PR, Michels G
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 a medical ICU during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed combining our data with data from five studies on the diagnostic utility of PCT in ICU patients with suspected 2009 H1N1 influenza identified through a systematic literature search.
RESULTS: PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial (isolated or co-infection with H1N1, n = 77) pneumonia (median 6.2 mug/L, interquartile range (IQR) 0.9 to 20) than patients with isolated H1N1 influenza pneumonia (n = 84, 0.56 mug/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. A cut-off of PCT of 0.5 mug/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), 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 reasonably accurate for detection of bacterial pneumonia particularly in patients with community acquired disease and without immune-compromising disorders, but might not be sufficient as a stand-alone marker to withhold antibiotic treatment.
PMID: 24612487 [PubMed - as supplied by publisher]