Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Procalcitonin in 2009 H1N1 Influenza Pneumonia: Role in Differentiating from Bacterial Pneumonia

2009 H1N1 인플루엔자 폐렴에서 Procalcitonin의 유용성: 세균성 폐렴과의 감별 역할

  • Ahn, Shin (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won-Young (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yoon, Ji-Young (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Sohn, Chang-Hwan (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Seo, Dong-Woo (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Sung-Han (Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hong, Sang-Bum (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Chae-Man (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Koh, Youn-Suck (Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Won (Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 안신 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김원영 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 윤지영 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 손창환 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 서동우 (울산대학교 의과대학 서울아산병원 응급의학교실) ;
  • 김성한 (울산대학교 의과대학 서울아산병원 감염내과학교실) ;
  • 홍상범 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 임채만 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 고윤석 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 김원 (울산대학교 의과대학 서울아산병원 응급의학교실)
  • Received : 2010.02.24
  • Accepted : 2010.03.22
  • Published : 2010.04.30
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Abstract

Background: Procalcitonin is a well known marker in infection that plays a role in distinguishing between bacterial and viral infections in screening. The aim of the present study was to evaluate the role of procalcitonin in differentiating between 2009 H1N1 influenza pneumonia and community acquired pneumonia of bacterial origin, or mixed bacterial origin and 2009 H1N1 influenza infection. Methods: A retrospective observational study was performed over the 6-month winter period during the 2009 H1N1 influenza pandemic. Ninety-six patient-subjects were enrolled, all of whom had been diagnosed with community acquired pneumonia in emergency department during the study period. On admission, laboratory studies were performed, which included 2009 H1N1 influenza real-time polymerase chain reaction of nasal secretions and procalcitonin on serum; the laboratory values were compared between the study groups. Receiver operating characteristic curve analyses were performed on the resulting data. Results: Compared to those with bacterial or mixed infections (n=62) and bacterial pneumonia with confirmed organisms (n=30), patients with 2009 H1N1 pneumonia (n=34) were significantly more likely to have low procalcitonin levels (p=0.008, 0.001). Using cutoff of value >0.3 ng/mL, the sensitivity and specificity of procalcitonin for detection of patients with confirmed bacterial pneumonia were 76.2% and 60.6%, respectively. A significant difference in procalcitonin was found between 2009 H1N1 pneumonia and pneumonia caused by mixed influenza viral and bacterial infections (0.15 [0.05~0.84] vs. 10.3 [0.05~22.87] ng/mL, p=0.045). Conclusion: Serum procalcitonin measurement may assist in the discrimination between pneumonia of bacterial and of 2009 H1N1 influenza origin. High values of procalcitonin suggest that bacterial infection or mixed infection of bacteria and 2009 H1N1 influenza is more likely.

Keywords

References

  1. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361:680-9. https://doi.org/10.1056/NEJMoa0904252
  2. World Health Organization [Internet]. Global alert and response: pandemic (H1N1) 2009: update 87; c2010 [cited 2010 Feb 18]. Available from: http://www.who.int/csr/don/2010_02_12/en/index.html.
  3. Thompson WW, Shay DK, Weintraub E, Brammer L, Bridges CB, Cox NJ, et al. Influenza-associated hospitalizations in the United States. JAMA 2004;292:1333-40. https://doi.org/10.1001/jama.292.11.1333
  4. Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA 2003;289:179-86. https://doi.org/10.1001/jama.289.2.179
  5. Brundage JF, Shanks GD. Deaths from bacterial pneumonia during 1918-19 influenza pandemic. Emerg Infect Dis 2008;14:1193-9. https://doi.org/10.3201/eid1408.071313
  6. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341:515-8. https://doi.org/10.1016/0140-6736(93)90277-N
  7. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, et al. Effect of procalcitonin- guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 2004;363:600-7. https://doi.org/10.1016/S0140-6736(04)15591-8
  8. Stolz D, Christ-Crain M, Bingisser R, Leuppi J, Miedinger D, Muller C, et al. Antibiotic treatment of exacerbations of COPD: a randomized, controlled trial comparing procalcitonin-guidance with standard therapy. Chest 2007;131:9-19. https://doi.org/10.1378/chest.06-1500
  9. Ingram PR, Inglis T, Moxon D, Speers D. Procalcitonin and C-reactive protein in severe 2009 H1N1 influenza infection. Intensive Care Med 2010;36:528-32. https://doi.org/10.1007/s00134-009-1746-3
  10. Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J Respir Crit Care Med 2001;164:396-402. https://doi.org/10.1164/ajrccm.164.3.2009052
  11. Christ-Crain M, Muller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007;30:556-73. https://doi.org/10.1183/09031936.00166106
  12. Christ-Crain M, Stolz D, Bingisser R, Muller C, Miedinger D, Huber PR, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006;174:84-93. https://doi.org/10.1164/rccm.200512-1922OC
  13. Gerard Y, Hober D, Assicot M, Alfandari S, Ajana F, Bourez JM, et al. Procalcitonin as a marker of bacterial sepsis in patients infected with HIV-1. J Infect 1997;35:41-6. https://doi.org/10.1016/S0163-4453(97)90953-1
  14. Giamarellos-Bourboulis EJ, Grecka P, Poulakou G, Anargyrou K, Katsilambros N, Giamarellou H. Assessment of procalcitonin as a diagnostic marker of underlying infection in patients with febrile neutropenia. Clin Infect Dis 2001;32:1718-25. https://doi.org/10.1086/320744
  15. Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000;28:68-73. https://doi.org/10.1007/s150100050049
  16. Moulin F, Raymond J, Lorrot M, Marc E, Coste J, Iniguez JL, et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001;84:332-6. https://doi.org/10.1136/adc.84.4.332
  17. Chirouze C, Schuhmacher H, Rabaud C, Gil H, Khayat N, Estavoyer JM, et al. Low serum procalcitonin level accurately predicts the absence of bacteremia in adult patients with acute fever. Clin Infect Dis 2002;35:156-61. https://doi.org/10.1086/341023
  18. Chua AP, Lee KH. Procalcitonin in severe acute respiratory syndrome (SARS). J Infect 2004;48:303-6. https://doi.org/10.1016/j.jinf.2004.01.015
  19. Brunkhorst FM, Heinz U, Forycki ZF. Kinetics of procalcitonin in iatrogenic sepsis. Intensive Care Med 1998;24:888-9. https://doi.org/10.1007/s001340050683
  20. Nijsten MW, Olinga P, The TH, de Vries EG, Koops HS, Groothuis GM, et al. Procalcitonin behaves as a fast responding acute phase protein in vivo and in vitro. Crit Care Med 2000;28:458-61. https://doi.org/10.1097/00003246-200002000-00028
  21. Toikka P, Irjala K, Juven T, Virkki R, Mertsola J, Leinonen M, et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000;19:598-602. https://doi.org/10.1097/00006454-200007000-00003
  22. Wright PF, Kirkland KB, Modlin JF. When to consider the use of antibiotics in the treatment of 2009 H1N1 influenza-associated pneumonia. N Engl J Med 2009;361:e112. https://doi.org/10.1056/NEJMopv0910749
  23. Boussekey N, Leroy O, Alfandari S, Devos P, Georges H, Guery B. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med 2006;32:469-72. https://doi.org/10.1007/s00134-005-0047-8

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