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Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study

Frank Bloos1, John C Marshall2, Richard P Dellinger3, Jean-Louis Vincent4, Guillermo Gutierrez5, Emanuel Rivers6, Robert A Balk7, Pierre-Francois Laterre8, Derek C Angus9, Konrad Reinhart1* and Frank M Brunkhorst1

Author Affiliations

1 Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany

2 Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada

3 Division of Critical Care Medicine, Department of Medicine, Cooper University Hospital, One Cooper Plaza D393, Camden, NJ 08103, USA

4 Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, 1070 Brussels, Belgium

5 Division of Pulmonary and Critical Care Medicine, The George Washington University, 2150 Pennsylvania Ave., Washington, DC 20037, USA

6 Department of Critical Care Medicine, Henry Ford Hospital, 2799 West Grand Boulevard, Detroit, MI 48202, USA

7 Department of Pulmonary Critical Care, Medicine Rush Presbyterian St. Luke's Medical Center, 1753 West Congress Parkway, Chicago, IL 60612-3809, USA

8 Department of Intensive Care, Cliniques Universitaires St-Luc Ave., Hippocrate 10, 1200 Brussels, Belgium

9 Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA 15261, USA

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Critical Care 2011, 15:R88  doi:10.1186/cc10087

Published: 7 March 2011

Abstract

Introduction

The intent of this study was to determine whether serum procalcitonin (PCT) levels are associated with prognosis, measured as organ dysfunctions and 28-day mortality, in patients with severe pneumonia.

Methods

This was a multicenter, observational study of critically ill adult patients with pneumonia requiring mechanical ventilation conducted in 10 academic hospitals in Canada, the United States, and Central Europe. PCT was measured daily for 14 days using an immuno-luminometric assay.

Results

We included 175 patients, 57 with community acquired pneumonia (CAP), 61 with ventilator associated pneumonia (VAP) and 57 with hospital acquired pneumonia (HAP). Initial PCT levels were higher in CAP than VAP patients (median (interquartile range: IQR); 2.4 (0.95 to 15.8) vs. 0.7 (0.3 to 2.15), ng/ml, P < 0.001) but not significantly different to HAP (2.2 (0.4 to 8.0) ng/ml). The 28-day ICU mortality rate for all patients was 18.3% with a median ICU length of stay of 16 days (range 1 to 142 days). PCT levels were higher in non-survivors than in survivors. Initial and maximum PCT levels correlated with maximum Sequential Organ Failure Assessment (SOFA) score r2 = 0.50 (95% CI: 0.38 to 0.61) and r2 = 0.57 (0.46 to 0.66), respectively. Receiver operating curve (ROC) analysis on discrimination of 28-day mortality showed areas under the curve (AUC) of 0.74, 0.70, and 0.69 for maximum PCT, initial PCT, and Acute Physiology and Chronic Health Evaluation (APACHE) II score, respectively. The optimal cut-off to predict mortality for initial PCT was 1.1 ng/ml (odds ratio: OD 7.0 (95% CI 2.6 to 25.2)) and that for maximum PCT was 7.8 ng/ml (odds ratio 5.7 (95% CI 2.5 to 13.1)).

Conclusions

PCT is associated with the severity of illness in patients with severe pneumonia and appears to be a prognostic marker of morbidity and mortality comparable to the APACHE II score.