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KMID : 0383820090670030205
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Tuberculosis and Respiratory Diseases
2009 Volume.67 No. 3 p.205 ~ p.211
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Semi-quantitative Procalcitonin Assay in Critically ill Patients with Respiratory infections
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Kim Ji-Youn
Kim Cheol-Hong
Park Sung-Hoon
Lee Chang-Youl
Hwang Yong-Il
Choi Jeong-Hee
Shin Tae-Rim
Park Yong-Bum
Jang Seung-Hun
Lee Jae-Young
Park Sang-Myeon
Kim Dong-Gyu
Lee Myung-Goo
Hyun In-Gyu
Chung Ki-Suck
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Abstract
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Background: Serum procalcitonin level has been considered prognostic during sepsis and septic shock. We investigated the significance of procalcitonin in critically ill patients with respiratory infections.
Methods: The patients who had radiographically diagnosed diffuse lung infiltrations were enrolled on a prospective basis. Bronchoalveolar lavage (BAL) fluid for the purpose of quantitative cultures (≥104 cfu/mL) was obtained from all patients. Serum procalcitonin levels determined by PCT-Q kit were measured on BAL day and classified as follows; ＜0.5 ng/mL, 0.5∼2.0 ng/mL, 2.0∼10.0 ng/mL and ＞10.0 ng/mL. We analyzed the patient’s characteristics according to outcome; favorable or unfavorable, defined as death.
Results: Patients from the following categories were included: medical 17 (47.2%), surgical 9 (25%), and burned 10 (27.8%). APACHE II scores on admission to intensive care unit were 11.5±6.89 and 11 (30.6%) had unfavorable outcomes. A procalcitonin level ≥0.5 ng/mL was in 17 (47.2%) of all. On univariate analysis, the frequencies of burn injury, mechanical ventilation, multiple organ failure, and a procalcitonin level ≥0.5 ng/mL were more often increased in patients with unfavorable outcomes than in those with favorable outcomes (p＜.05). Also, a higher procalcitonin range and ventilator-associated pneumonia (VAP) were more closely associated with an unfavorable outcome (p＜.05). However in multivariate analysis, a strong predictor of unfavorable outcome was burn injury (p＜.05). A procalcitonin level ≥0.5 ng/mL was more sensitive in predicting VAP than unfavorable outcome.
Conclusion: A higher procalcitonin level seems to be associated with VAP, but further study is required to know that procalcitonin would be a prognostic marker in critically ill patients with respiratory infections.
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KEYWORD
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Bronchoaveolar lavage, Procalcitonin, Respiratory infections, Ventilator-associated pneumonia
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