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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...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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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. |
format | Online Article Text |
id | pubmed-4383063 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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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