The association of serum procalcitonin and high-sensitivity C-reactive protein with pneumonia in elderly multimorbid patients with respiratory symptoms: retrospective cohort study

BMC Geriatrics

Research Article

Marcello Maggio¹  Nicoletta Cerundolo²  Antonio Nouvenne²  Tiziana Meschi²  Fulvio Lauretani²  Andrea Ticinesi²  Giuseppina Folesani³  Ilaria Morelli⁴  Beatrice Prati⁴  Loredana Guida⁴  Giuseppe Lippi⁵  Rosalia Aloe⁵ 

[1] Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy;Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy;Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy;INAIL-CERT Research Center at University of Parma, Parma, Italy;Internal Medicine and Critical Subacute Care Unit, Geriatric-Rehabilitation Department, Parma University Hospital, Parma, Italy;Laboratory of Clinical Chemistry and Hematology, Parma University Hospital, Parma, Italy;

关键词: Procalcitonin;    High-sensitivity C-reactive protein;    Pneumonia;    Multimorbid elderly;   

DOI  :  10.1186/s12877-016-0192-7

 received in 2015-05-08, accepted in 2016-01-06,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundSerum procalcitonin and high-sensitivity C-reactive protein (hs-CRP) elevations have been associated with pneumonia in adults. Our aim was to establish their diagnostic usefulness in a cohort of hospitalized multimorbid patients ≥65 years old admitted to hospital with acute respiratory symptoms.MethodsWith a retrospective cohort study design, all multimorbid patients ≥65 years-old with acute respiratory symptoms admitted to an internal medicine hospital ward in Italy from January to August 2013 were evaluated. Pneumonia diagnosis, comorbidities expressed through Cumulative Illness Rating Scale (CIRS), setting of living, length of stay, serum hs-CRP and procalcitonin at admission were collected for each patient. Data were analyzed with Mann-Whitney’s U test and multivariate Cox logistic regression analysis. A Receiver Operating Characteristic (ROC) curve was used to verify each biomarker’s association with pneumonia diagnosis.ResultsFour hundred fifty five patients (227 M) were included in the study, of whom 239 with pneumonia (138 M, mean age 80 ± 13) and 216 without pneumonia (89 M, mean age 80 ± 14). After adjustment for age and sex, median levels of hs-CRP were significantly higher in patients with pneumonia (116 mg/L, IQR 46.5–179.0, vs 22.5 mg/dl, IQR 6.9–84.4, p < 0.0001), while procalcitonin median levels were not (0.22 ng/ml IQR 0.12–0.87, vs 0.15 ng/ml, IQR 0.10–0.35, p = 0.08). The ROC analysis showed that, unlike procalcitonin, hs-CRP values were predictive of pneumonia (AUC 0.76, 95 % CI 0.72–0.79, p < 0.0001, cut-off value 61 mg/L), even after adjustment for possible confounders including nursing home residence and dementia. Serum hs-CRP levels >61 mg/L were independently associated with a 3.59-fold increased risk of pneumonia (OR 3.59, 95 % CI 2.35–5.48, p < 0.0001).ConclusionIn elderly multimorbid patients who require hospital admission for respiratory symptoms, serum hs-CRP testing seems to be more useful than procalcitonin for guiding the diagnostic process when clinical suspicion of pneumonia is present. Procalcitonin testing might hence be not recommended in this setting.

【 授权许可】

CC BY   
© Nouvenne et al. 2016