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Prognostic value of procalcitonin in respiratory tract infections across clinical settings

INTRODUCTION: Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predic...

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Autores principales: Kutz, Alexander, Briel, Matthias, Christ-Crain, Mirjam, Stolz, Daiana, Bouadma, Lila, Wolff, Michel, Kristoffersen, Kristina B, Wei, Long, Burkhardt, Olaf, Welte, Tobias, Schroeder, Stefan, Nobre, Vandack, Tamm, Michael, Bhatnagar, Neera, Bucher, Heiner C, Luyt, Charles-Edouard, Chastre, Jean, Tubach, Florence, Mueller, Beat, Schuetz, Philipp
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383063/
https://www.ncbi.nlm.nih.gov/pubmed/25887979
http://dx.doi.org/10.1186/s13054-015-0792-1
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author Kutz, Alexander
Briel, Matthias
Christ-Crain, Mirjam
Stolz, Daiana
Bouadma, Lila
Wolff, Michel
Kristoffersen, Kristina B
Wei, Long
Burkhardt, Olaf
Welte, Tobias
Schroeder, Stefan
Nobre, Vandack
Tamm, Michael
Bhatnagar, Neera
Bucher, Heiner C
Luyt, Charles-Edouard
Chastre, Jean
Tubach, Florence
Mueller, Beat
Schuetz, Philipp
author_facet Kutz, Alexander
Briel, Matthias
Christ-Crain, Mirjam
Stolz, Daiana
Bouadma, Lila
Wolff, Michel
Kristoffersen, Kristina B
Wei, Long
Burkhardt, Olaf
Welte, Tobias
Schroeder, Stefan
Nobre, Vandack
Tamm, Michael
Bhatnagar, Neera
Bucher, Heiner C
Luyt, Charles-Edouard
Chastre, Jean
Tubach, Florence
Mueller, Beat
Schuetz, Philipp
author_sort Kutz, Alexander
collection PubMed
description INTRODUCTION: Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population. METHODS: We analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results’ consistency. RESULTS: Overall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found. CONCLUSIONS: Admission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting.
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spelling pubmed-43830632015-04-03 Prognostic value of procalcitonin in respiratory tract infections across clinical settings Kutz, Alexander Briel, Matthias Christ-Crain, Mirjam Stolz, Daiana Bouadma, Lila Wolff, Michel Kristoffersen, Kristina B Wei, Long Burkhardt, Olaf Welte, Tobias Schroeder, Stefan Nobre, Vandack Tamm, Michael Bhatnagar, Neera Bucher, Heiner C Luyt, Charles-Edouard Chastre, Jean Tubach, Florence Mueller, Beat Schuetz, Philipp Crit Care Research INTRODUCTION: Whether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population. METHODS: We analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results’ consistency. RESULTS: Overall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found. CONCLUSIONS: Admission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting. BioMed Central 2015-03-06 2015 /pmc/articles/PMC4383063/ /pubmed/25887979 http://dx.doi.org/10.1186/s13054-015-0792-1 Text en © Kutz et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Kutz, Alexander
Briel, Matthias
Christ-Crain, Mirjam
Stolz, Daiana
Bouadma, Lila
Wolff, Michel
Kristoffersen, Kristina B
Wei, Long
Burkhardt, Olaf
Welte, Tobias
Schroeder, Stefan
Nobre, Vandack
Tamm, Michael
Bhatnagar, Neera
Bucher, Heiner C
Luyt, Charles-Edouard
Chastre, Jean
Tubach, Florence
Mueller, Beat
Schuetz, Philipp
Prognostic value of procalcitonin in respiratory tract infections across clinical settings
title Prognostic value of procalcitonin in respiratory tract infections across clinical settings
title_full Prognostic value of procalcitonin in respiratory tract infections across clinical settings
title_fullStr Prognostic value of procalcitonin in respiratory tract infections across clinical settings
title_full_unstemmed Prognostic value of procalcitonin in respiratory tract infections across clinical settings
title_short Prognostic value of procalcitonin in respiratory tract infections across clinical settings
title_sort prognostic value of procalcitonin in respiratory tract infections across clinical settings
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4383063/
https://www.ncbi.nlm.nih.gov/pubmed/25887979
http://dx.doi.org/10.1186/s13054-015-0792-1
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