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Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes

Depts of ¹ Internal Medicine II, ³ Medical Microbiology and Hygiene and the, ⁵ CAPNETZ study centre, Ulm University Hospital, Ulm, ² Thoraxzentrum Ruhrgebiet, Dept of Respiratory Medicine and Infectious Diseases, Bochum, ⁴ Research Department, B.R.A.H.M.S. AG, Hennigsdorf, ⁶ Dept of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité–Universitatsmedzin Berlin, Berlin and ⁷ Dept of Pneumology, Hannover Medical School, University Clinic, Hannover, Germany.

CORRESPONDENCE: T. Welte, Dept of Pneumology, Hannover Medical School, University Clinic, Carl Neuberg Str. 1, D-30625 Hannover, Germany. Fax: 49 5115323353. E-mail: welte.tobias{at}mh-hannover.de

Keywords: Community-acquired pneumonia, CRB-65 (confusion, respiratory rate 30breaths·min^–1, low blood pressure (systolic value <90mmHg or diastolic value 60 mmHg) and age 65 yrs) score, C-reactive protein, mortality, procalcitonin, prognosis

Received: May 6, 2007
Accepted October 15, 2007

The aim of the present study was to investigate the prognostic value, in patients with community-acquired pneumonia (CAP), of procalcitonin (PCT) compared with the established inflammatory markers C-reactive protein (CRP) and leukocyte (WBC) count alone or in combination with the CRB-65 (confusion, respiratory rate 30 breaths·min^–1, low blood pressure (systolic value <90 mmHg or diastolic value 60 mmHg) and age 65 yrs) score.

In total, 1,671 patients with proven CAP were enrolled in the study. PCT, CRP, WBC and CRB-65 score were all determined on admission and patients were followed-up for 28 days for survival.

In contrast to CRP and WBC, PCT levels markedly increased with the severity of CAP, as measured by the CRB-65 score. In 70 patients who died during follow-up, PCT levels on admission were significantly higher compared with levels in survivors. In receiver operating characteristic analysis for survival, the area under the curve (95% confidence interval) for PCT and CRB-65 was comparable (0.80 (0.75–0.84) versus 0.79 (0.74–0.84)), but each significantly higher compared with CRP (0.62 (0.54–0.68)) and WBC (0.61 (0.54–0.68)). PCT identified low-risk patients across CRB classes 0–4.

In conclusion, procalcitonin levels on admission predict the severity and outcome of community-acquired pneumonia with a similar prognostic accuracy as the CRB-65 score and a higher prognostic accuracy compared with C-reactive protein and leukocyte count. Procalcitonin levels can provide independent identification of patients at low risk of death within CRB-65 (confusion, respiratory rate 30 breaths·min^–1, low blood pressure (systolic value <90 mmHg or diastolic value 60 mmHg) and age 65 yrs) risk classes.