중환자실에 입원한 세균성 폐렴환자에서 반정량적 procalcitonin 검사의 유용성 = Usefulness of Semi-quantitative Procalcitonin Assay in Critically Ill Patients with Bacterial Pneumonia

다국어 초록 (Multilingual Abstract)

Background:In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia.
Materials and Methods:Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (≥104 CFU/mL) was performed in all cases on the 5th day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit.
Results:A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was ＜0.5 ng/mL in half of the cases (14/28) and ≥0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of ＜0.5 ng/mL, patients with serum procalcitonin level of ≥0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P＜0.05), and showed increased tendency for death (P=0.052). Positive bacterial BAL cultures were noted in 17 cases (60.7%). Of these, 7 cases (41.2%) showed serum procalcitonin level ≥0.5 ng/mL.
Conclusions:High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.

다국어 초록 (Multilingual Abstract)

Background:In pulmonary infection, serum procalcitonin levels increase rapidly, probably in response to sepsis-related cytokine release from neuroendocrine cells of bronchial epithelium and inflammatory cells. We applied procalcitonin assay in critically ill patients with bacterial pneumonia.
Materials and Methods:Patients admitted to the intensive care unit (ICU) and show diffuse infiltrations in their chest X-ray were included. Quantitative bronchoalveolar lavage (BAL) culture (≥104 CFU/mL) was performed in all cases on the 5th day of ICU admission. We excluded patients with structural lung disease, non-infectious lung infiltrations, and atypical infections such as Mycobacterium tuberculosis, Pneumocystis jiroveci, and viruses. Serum procalcitonin levels were measured semi-quantitatively by using PCT-Q kit.
Results:A total of 28 adult patients (M:F=23:5) were included: 11 (39.3%) medically-ill patients, 7 (25%) surgically-ill patients, and 10 (35.7%) burn patients. Serum procalcitonin level was ＜0.5 ng/mL in half of the cases (14/28) and ≥0.5 ng/mL in the remaining half of the cases. Compared to those with serum procalcitonin level of ＜0.5 ng/mL, patients with serum procalcitonin level of ≥0.5 ng/mL had more frequent mechanical ventilation, higher CRP/APACHE II scores/number of organ failure (P＜0.05), and showed increased tendency for death (P=0.052). Positive bacterial BAL cultures were noted in 17 cases (60.7%). Of these, 7 cases (41.2%) showed serum procalcitonin level ≥0.5 ng/mL.
Conclusions:High serum procalcitonin level seems to be closely associated with the severity and poor prognosis in critically ill patients with bacterial pneumonia. However, pneumonia could not be excluded with low level of procalcitonin among ICU patients.

참고문헌 (Reference)

1 Luyt CE, "Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia" 34 : 1434-1440, 2008

2 Galley HF, "The immuno-inflammatory cascade" 77 : 11-16, 1996

3 Le Moullec JM, "The complete sequence of human preprocalcitonin" 167 : 93-97, 1984

4 최희정, "The Clinical Value of Procalcitonin inDiagnosis of Patients with Fever" 대한감염학회 37 (37): 1-8, 2005

5 Christ-Crain M, "Tamm M, Mller B. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial" 174 : 84-93, 2006

6 Charles PE, "Serum procalcitonin for the early recognition of nosocomial infection in the critically ill patients: a preliminary report" 9 : 49-, 2009

7 Ramirez P, "Sequential measurements of procalcitonin levels in diagnosing ventilator-associated pneumonia" 31 : 356-362, 2008

8 Oberhoffer M, "Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis" 27 : 1814-1818, 1999

9 Boucher BA, "Searching for simple outcome markers in sepsis: an effort in futility?" 27 : 1390-1391, 1999

10 Luna CM, "Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome" 31 : 676-682, 2003

11 Carlet J, "Rapid diagnostic methods in the detection of sepsis" 13 : 483-494, 1999

12 Karzai W, "Procalcitonin-a new indicator of the systemic response to severe infections" 25 : 329-334, 1997

13 Holm A, "Procalcitonin versus C- reactive protein for predicting pneumonia in adults with lower respiratory tract infection in primary care" 57 : 555-560, 2007

14 Ugarte H, "Procalcitonin used as a marker of infection in the intensive care unit" 27 : 498-504, 1999

15 Luyt CE, "Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia" 171 : 48-53, 2005

16 Jensen JU, "Procalcitonin increase in early identification of critically ill patients at high risk of mortality" 34 : 2596-2602, 2006

17 Becker KL, "Procalcitonin and the calcitonin gene family of peptides in inflammation, infection, and sepsis: a journey from calcitonin back to its precursors" 89 : 1512-1525, 2004

18 Christ-Crain M, "Procalcitonin and pneumonia: Is it a useful marker?" 9 : 233-240, 2007

19 Moscovitz H, "Plasma cytokine determinations in emergency department patients as a predictor of bacteremia and infectious disease severity" 22 : 1102-1107, 1994

20 Clinical Laboratory Standards Institute, "Performance standards for antimicrobial susceptibility testing; eighteenth informational supplement" Clinical and Laboratory Standards Institute 2008

21 Amour J, "Influence of renal dysfunction on the accuracy of procalcitonin for the diagnosis of postoperative infection after vascular surgery" 36 : 1147-1154, 2008

22 Assicot M, "High serum procalcitonin concentrations in patients with sepsis and infection" 341 : 515-518, 1993

23 American Thoracic Society, "Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia" 171 : 388-416, 2005

24 Niederman MS, "Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention" 163 : 1730-1754, 2001

25 Harbarth S, "Geneva Sepsis Network. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis" 164 : 396-402, 2001

26 Chastre J, "Evaluation of bronchoscopic techniques for the diagnosis of nosocomial pneumonia" 152 : 231-240, 1995

27 Christ-Crain M, "Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster- randomised, single-blinded intervention trial" 363 : 600-607, 2004

28 Clec'h C, "Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock" 34 : 102-107, 2006

29 Mndi Y, "Diagnostic relevance of procalcitonin, IL-6, and sICAM-1 in the prediction of infected necrosis in acute pancreatitis" 28 : 41-49, 2000

30 Boussekey N, "Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit" 33 : 257-263, 2005

31 Baughman RP, "Diagnosis of ventilator-associated pneumonia" 9 : 397-402, 2003

32 de Werra I, "Cytokines, nitrite/nitrate, soluble tumor necrosis factor receptors, and procalcitonin concentrations: comparisons in patients with septic shock, cardiogenic shock, and bacterial pneumonia" 25 : 607-613, 1997

33 Kim SI, "Clinical usefulness of procalcitonin in febrile patients; comparison with erythrocyte sedimentation rate and C-reactive protein" 32 : 129-134, 2000

34 Mller B, "Calcitonin precursors are reliable markers of sepsis in a medical intensive care unit" 28 : 977-983, 2000

35 Krüger S, "CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes" 31 : 349-355, 2008

36 Pvoa P, "C-reactive protein as an indicator of sepsis" 24 : 1052-1056, 1998

37 Christ-Crain M, "Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators" 30 : 556-573, 2007