Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia

Wesley H. Self, Robert A. Balk, Carlos G. Grijalva, Derek J. Williams, Yuwei Zhu, Evan J. Anderson, Grant W. Waterer, D. Mark Courtney, Anna M. Bramley, Christopher Trabue, Sherene Fakhran, Anne J. Blaschke, Seema Jain, Kathryn M. Edwards, Richard G. Wunderink

    Research output: Contribution to journalArticle

    26 Citations (Scopus)

    Abstract

    Background. Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. Methods. We evaluated the association between serum procalcitonin concentration at hospital admission with pathogens detected in a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia. Systematic pathogen testing included cultures, serology, urine antigen tests, and molecular detection. Accuracy of procalcitonin to discriminate between viral and bacterial pathogens was calculated. Results. Among 1735 patients, pathogens were identified in 645 (37%), including 169 (10%) with typical bacteria, 67 (4%) with atypical bacteria, and 409 (24%) with viruses only. Median procalcitonin concentration was lower with viral pathogens (0.09 ng/mL; interquartile range [IQR], <0.05-0.54 ng/mL) than atypical bacteria (0.20 ng/mL; IQR, <0.05-0.87 ng/mL; P =.05), and typical bacteria (2.5 ng/mL; IQR, 0.29-12.2 ng/mL; P <.01). Procalcitonin discriminated bacterial pathogens, including typical and atypical bacteria, from viral pathogens with an area under the receiver operating characteristic (ROC) curve of 0.73 (95% confidence interval [CI],.69-.77). A procalcitonin threshold of 0.1 ng/mL resulted in 80.9% (95% CI, 75.3%-85.7%) sensitivity and 51.6% (95% CI, 46.6%-56.5%) specificity for identification of any bacterial pathogen. Procalcitonin discriminated between typical bacteria and the combined group of viruses and atypical bacteria with an area under the ROC curve of 0.79 (95% CI,.75-.82). Conclusions. No procalcitonin threshold perfectly discriminated between viral and bacterial pathogens, but higher procalcitonin strongly correlated with increased probability of bacterial pathogens, particularly typical bacteria.

    Original languageEnglish (US)
    Pages (from-to)183-190
    Number of pages8
    JournalClinical Infectious Diseases
    Volume65
    Issue number2
    DOIs
    StatePublished - Jul 15 2017

    Fingerprint

    Calcitonin
    Pneumonia
    Bacteria
    Confidence Intervals
    ROC Curve
    Viral Pneumonia
    Viruses
    Bacterial Pneumonia
    Serology
    Respiratory Tract Infections
    Dissection
    Urine
    Prospective Studies
    Guidelines
    Anti-Bacterial Agents
    Antigens

    All Science Journal Classification (ASJC) codes

    • Microbiology (medical)
    • Infectious Diseases

    Cite this

    Self, W. H., Balk, R. A., Grijalva, C. G., Williams, D. J., Zhu, Y., Anderson, E. J., ... Wunderink, R. G. (2017). Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia. Clinical Infectious Diseases, 65(2), 183-190. https://doi.org/10.1093/cid/cix317

    Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia. / Self, Wesley H.; Balk, Robert A.; Grijalva, Carlos G.; Williams, Derek J.; Zhu, Yuwei; Anderson, Evan J.; Waterer, Grant W.; Courtney, D. Mark; Bramley, Anna M.; Trabue, Christopher; Fakhran, Sherene; Blaschke, Anne J.; Jain, Seema; Edwards, Kathryn M.; Wunderink, Richard G.

    In: Clinical Infectious Diseases, Vol. 65, No. 2, 15.07.2017, p. 183-190.

    Research output: Contribution to journalArticle

    Self, WH, Balk, RA, Grijalva, CG, Williams, DJ, Zhu, Y, Anderson, EJ, Waterer, GW, Courtney, DM, Bramley, AM, Trabue, C, Fakhran, S, Blaschke, AJ, Jain, S, Edwards, KM & Wunderink, RG 2017, 'Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia', Clinical Infectious Diseases, vol. 65, no. 2, pp. 183-190. https://doi.org/10.1093/cid/cix317
    Self, Wesley H. ; Balk, Robert A. ; Grijalva, Carlos G. ; Williams, Derek J. ; Zhu, Yuwei ; Anderson, Evan J. ; Waterer, Grant W. ; Courtney, D. Mark ; Bramley, Anna M. ; Trabue, Christopher ; Fakhran, Sherene ; Blaschke, Anne J. ; Jain, Seema ; Edwards, Kathryn M. ; Wunderink, Richard G. / Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia. In: Clinical Infectious Diseases. 2017 ; Vol. 65, No. 2. pp. 183-190.
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    title = "Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia",
    abstract = "Background. Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. Methods. We evaluated the association between serum procalcitonin concentration at hospital admission with pathogens detected in a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia. Systematic pathogen testing included cultures, serology, urine antigen tests, and molecular detection. Accuracy of procalcitonin to discriminate between viral and bacterial pathogens was calculated. Results. Among 1735 patients, pathogens were identified in 645 (37{\%}), including 169 (10{\%}) with typical bacteria, 67 (4{\%}) with atypical bacteria, and 409 (24{\%}) with viruses only. Median procalcitonin concentration was lower with viral pathogens (0.09 ng/mL; interquartile range [IQR], <0.05-0.54 ng/mL) than atypical bacteria (0.20 ng/mL; IQR, <0.05-0.87 ng/mL; P =.05), and typical bacteria (2.5 ng/mL; IQR, 0.29-12.2 ng/mL; P <.01). Procalcitonin discriminated bacterial pathogens, including typical and atypical bacteria, from viral pathogens with an area under the receiver operating characteristic (ROC) curve of 0.73 (95{\%} confidence interval [CI],.69-.77). A procalcitonin threshold of 0.1 ng/mL resulted in 80.9{\%} (95{\%} CI, 75.3{\%}-85.7{\%}) sensitivity and 51.6{\%} (95{\%} CI, 46.6{\%}-56.5{\%}) specificity for identification of any bacterial pathogen. Procalcitonin discriminated between typical bacteria and the combined group of viruses and atypical bacteria with an area under the ROC curve of 0.79 (95{\%} CI,.75-.82). Conclusions. No procalcitonin threshold perfectly discriminated between viral and bacterial pathogens, but higher procalcitonin strongly correlated with increased probability of bacterial pathogens, particularly typical bacteria.",
    author = "Self, {Wesley H.} and Balk, {Robert A.} and Grijalva, {Carlos G.} and Williams, {Derek J.} and Yuwei Zhu and Anderson, {Evan J.} and Waterer, {Grant W.} and Courtney, {D. Mark} and Bramley, {Anna M.} and Christopher Trabue and Sherene Fakhran and Blaschke, {Anne J.} and Seema Jain and Edwards, {Kathryn M.} and Wunderink, {Richard G.}",
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    T1 - Procalcitonin as a Marker of Etiology in Adults Hospitalized with Community-Acquired Pneumonia

    AU - Self, Wesley H.

    AU - Balk, Robert A.

    AU - Grijalva, Carlos G.

    AU - Williams, Derek J.

    AU - Zhu, Yuwei

    AU - Anderson, Evan J.

    AU - Waterer, Grant W.

    AU - Courtney, D. Mark

    AU - Bramley, Anna M.

    AU - Trabue, Christopher

    AU - Fakhran, Sherene

    AU - Blaschke, Anne J.

    AU - Jain, Seema

    AU - Edwards, Kathryn M.

    AU - Wunderink, Richard G.

    PY - 2017/7/15

    Y1 - 2017/7/15

    N2 - Background. Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. Methods. We evaluated the association between serum procalcitonin concentration at hospital admission with pathogens detected in a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia. Systematic pathogen testing included cultures, serology, urine antigen tests, and molecular detection. Accuracy of procalcitonin to discriminate between viral and bacterial pathogens was calculated. Results. Among 1735 patients, pathogens were identified in 645 (37%), including 169 (10%) with typical bacteria, 67 (4%) with atypical bacteria, and 409 (24%) with viruses only. Median procalcitonin concentration was lower with viral pathogens (0.09 ng/mL; interquartile range [IQR], <0.05-0.54 ng/mL) than atypical bacteria (0.20 ng/mL; IQR, <0.05-0.87 ng/mL; P =.05), and typical bacteria (2.5 ng/mL; IQR, 0.29-12.2 ng/mL; P <.01). Procalcitonin discriminated bacterial pathogens, including typical and atypical bacteria, from viral pathogens with an area under the receiver operating characteristic (ROC) curve of 0.73 (95% confidence interval [CI],.69-.77). A procalcitonin threshold of 0.1 ng/mL resulted in 80.9% (95% CI, 75.3%-85.7%) sensitivity and 51.6% (95% CI, 46.6%-56.5%) specificity for identification of any bacterial pathogen. Procalcitonin discriminated between typical bacteria and the combined group of viruses and atypical bacteria with an area under the ROC curve of 0.79 (95% CI,.75-.82). Conclusions. No procalcitonin threshold perfectly discriminated between viral and bacterial pathogens, but higher procalcitonin strongly correlated with increased probability of bacterial pathogens, particularly typical bacteria.

    AB - Background. Recent trials suggest procalcitonin-based guidelines can reduce antibiotic use for respiratory infections. However, the accuracy of procalcitonin to discriminate between viral and bacterial pneumonia requires further dissection. Methods. We evaluated the association between serum procalcitonin concentration at hospital admission with pathogens detected in a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia. Systematic pathogen testing included cultures, serology, urine antigen tests, and molecular detection. Accuracy of procalcitonin to discriminate between viral and bacterial pathogens was calculated. Results. Among 1735 patients, pathogens were identified in 645 (37%), including 169 (10%) with typical bacteria, 67 (4%) with atypical bacteria, and 409 (24%) with viruses only. Median procalcitonin concentration was lower with viral pathogens (0.09 ng/mL; interquartile range [IQR], <0.05-0.54 ng/mL) than atypical bacteria (0.20 ng/mL; IQR, <0.05-0.87 ng/mL; P =.05), and typical bacteria (2.5 ng/mL; IQR, 0.29-12.2 ng/mL; P <.01). Procalcitonin discriminated bacterial pathogens, including typical and atypical bacteria, from viral pathogens with an area under the receiver operating characteristic (ROC) curve of 0.73 (95% confidence interval [CI],.69-.77). A procalcitonin threshold of 0.1 ng/mL resulted in 80.9% (95% CI, 75.3%-85.7%) sensitivity and 51.6% (95% CI, 46.6%-56.5%) specificity for identification of any bacterial pathogen. Procalcitonin discriminated between typical bacteria and the combined group of viruses and atypical bacteria with an area under the ROC curve of 0.79 (95% CI,.75-.82). Conclusions. No procalcitonin threshold perfectly discriminated between viral and bacterial pathogens, but higher procalcitonin strongly correlated with increased probability of bacterial pathogens, particularly typical bacteria.

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