The Role of Monitoring Procalcitonin in Comprehensive Evaluation during Diagnosis and Treatment of Community Acquired Pneumonia_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

MuHuaidian ^# ,  ZhouMin , HanZhaoyong , YangTao , ShenMeizhu , XiaoChunhai

Department of Respirtory Medicine, Jinshan Branch of The Sixth People's Hospital of Shanghai, Shanghai, 201599, China;

Corresponding author：

ZhouMin, Email: zhoumin-1209@163.com

Keywords：

Community acquired pneumonia; Procalcitonin; Antibiotics; Chest computed tomography

DOI：

10.7507/1671-6205.2015039

Video：

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Objective To investigate the role of dynamic monitoring procalcitonin (PCT) in the comprehensive evaluation during the diagnosis and treatment of community acquired pneumonia (CAP). Methods Four hundred and sixty-eight patients with CAP were randomly assigned to a PCT-guided group (the research group) and a standard guideline group (the control group). The clinical symptoms,CURB-65 grade,blood leucocyte count and classification,and C-reactive protein (CRP)were compared between two groups. The PCT-guided application time of antibiotics,the hospitalization time,chest CT examination rate,the cure or the improvement rate were also estimated and commpared. Results The hospitalization time [(9.6±1.7)days vs. (10.9±1.6)days],hospitalization cost [(6 957.11±1 009.46) yuan vs. (8 011.35±1 049.77) yuan],chest CT examination rate (56.96% vs. 89.40%),the application time of antibiotics [(16.5±2.3)days vs. (20.0±1.2)days],and the rate of required antibiotics upgrade (6.96% vs. 11.06%) in the research group were all significantly lower than the control group (P<0.05). There was no significant difference between two groups in the ratio of the adverse reaction of antibiotics (14.78% vs. 15.20%),the rate of transfer into ICU (2.61% vs. 3.69%) or the mortality (1.74% vs. 2.30%)(P>0.05). Conclusion On the basis of CAP guidelines,the dynamic monitoring of PCT may shorten the time of antibiotic use and the hospitalization,reduce the cost of hospitalization and the rate of chest CT scan in patients with CAP.

Citation： MuHuaidian, ZhouMin, HanZhaoyong, YangTao, ShenMeizhu, XiaoChunhai. The Role of Monitoring Procalcitonin in Comprehensive Evaluation during Diagnosis and Treatment of Community Acquired Pneumonia. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(2): 152-156. doi: 10.7507/1671-6205.2015039 Copy

1.	中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南.中华结核和呼吸杂志,2006,29:651-655.
2.	徐作军,丁可,黄慧,等.社区获得性肺炎诊断和治疗指南临床应用调查及490例病例分析.中华结核和呼吸杂志,2007,30:442-446.
3.	Fernández González F, Detrés J, Torrellas P, et al. Comparison of the appropriate use of antibiotics based on clinical guidelines between physicians in-training versus practicing physicians. Bol Asoc Med P R,2013,105:21-24.
4.	Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded intervention trial. Lancet,2004,363:600-607.
5.	Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections:the ProHOSP randomized controlled trial. JAMA,2009,302:1059-1066.
6.	Horie M, Ugajin M, Suzuki M, et al. Diagnostic and prognostic value of procalcitonin in community-acquired pneumonia. Am J Med Sci,2012,343:30-35.
7.	Kirtland SH, Winterbauer RH. Slowly resolving, chronic, and recurrent pneumonia. Clin Chest Med,1991,12:303.
8.	Remington LT, Sligl WI.Community-acquired pneumonia. Curr Opin Pulm Med,2014,20:215-224.
9.	Menéndez R, Martínez R, Reyes S, et al.Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax,2009,64:587-591.
10.	Valencia M, Badia JR, Cavalcanti M, et al. Pneumonia severity index class V patient with community-acquired pneumonia:characteristics, outcomes and value of severity scores. Chest,2007,132:515-522.
11.	Buising KL, Thursky KA, Black JF, et al. A prospective comparison of severity scores for identifying patients with severe community-acquired pneumonia:reconsidering what is meant by severe pneumonia. Thorax,2006,61:419-424.
12.	Lim WS. Severity assessment in community-acquired pneumonia:moving on. Thorax,2007,62:287-288.
13.	Hohenthal U, Hurme S, Helenius H, et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect,2009,15:1026-1032.
14.	Manma P, Nedelnikova K, Gurlich R, et al. Physiology and genetics of procalcitonin. Physiol Res,2000,49(Suppl):S57-S61.
15.	Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections:an individual patient data meta-analysis. Clin Infect Dis,2012,55:651-662.
16.	Dusemund F,Bucher B, Meyer S, et al. Influence of procalcitonin on decision to start antibiotic treatment in patients with a lower respiratory tract infection:insight from the observational multicentric ProREAL surveillance. Eur J Clin Microbiol Infect Dis,2013,32:51-60.
17.	Kristoffersen KB, Søgaard OS, Wejse C, et al. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial. Clin Microbiol Infect,2009,15:481-487.
18.	Muller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis,2007,7:10-12.

1. 中华医学会呼吸病学分会.社区获得性肺炎诊断和治疗指南.中华结核和呼吸杂志,2006,29:651-655.
2. 徐作军,丁可,黄慧,等.社区获得性肺炎诊断和治疗指南临床应用调查及490例病例分析.中华结核和呼吸杂志,2007,30:442-446.
3. Fernández González F, Detrés J, Torrellas P, et al. Comparison of the appropriate use of antibiotics based on clinical guidelines between physicians in-training versus practicing physicians. Bol Asoc Med P R,2013,105:21-24.
4. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections:cluster-randomised, single-blinded intervention trial. Lancet,2004,363:600-607.
5. Schuetz P, Christ-Crain M, Thomann R, et al. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections:the ProHOSP randomized controlled trial. JAMA,2009,302:1059-1066.
6. Horie M, Ugajin M, Suzuki M, et al. Diagnostic and prognostic value of procalcitonin in community-acquired pneumonia. Am J Med Sci,2012,343:30-35.
7. Kirtland SH, Winterbauer RH. Slowly resolving, chronic, and recurrent pneumonia. Clin Chest Med,1991,12:303.
8. Remington LT, Sligl WI.Community-acquired pneumonia. Curr Opin Pulm Med,2014,20:215-224.
9. Menéndez R, Martínez R, Reyes S, et al.Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax,2009,64:587-591.
10. Valencia M, Badia JR, Cavalcanti M, et al. Pneumonia severity index class V patient with community-acquired pneumonia:characteristics, outcomes and value of severity scores. Chest,2007,132:515-522.
11. Buising KL, Thursky KA, Black JF, et al. A prospective comparison of severity scores for identifying patients with severe community-acquired pneumonia:reconsidering what is meant by severe pneumonia. Thorax,2006,61:419-424.
12. Lim WS. Severity assessment in community-acquired pneumonia:moving on. Thorax,2007,62:287-288.
13. Hohenthal U, Hurme S, Helenius H, et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect,2009,15:1026-1032.
14. Manma P, Nedelnikova K, Gurlich R, et al. Physiology and genetics of procalcitonin. Physiol Res,2000,49(Suppl):S57-S61.
15. Schuetz P, Briel M, Christ-Crain M, et al. Procalcitonin to guide initiation and duration of antibiotic treatment in acute respiratory infections:an individual patient data meta-analysis. Clin Infect Dis,2012,55:651-662.
16. Dusemund F,Bucher B, Meyer S, et al. Influence of procalcitonin on decision to start antibiotic treatment in patients with a lower respiratory tract infection:insight from the observational multicentric ProREAL surveillance. Eur J Clin Microbiol Infect Dis,2013,32:51-60.
17. Kristoffersen KB, Søgaard OS, Wejse C, et al. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial. Clin Microbiol Infect,2009,15:481-487.
18. Muller B, Harbarth S, Stolz D, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis,2007,7:10-12.

Chinese Journal of Respiratory and Critical Care Medicine

The Role of Monitoring Procalcitonin in Comprehensive Evaluation during Diagnosis and Treatment of Community Acquired Pneumonia

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