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Original Articles
Usefulness of Semi-quantitative Procalcitonin Assay in Critically Ill Patients with Bacterial Pneumonia
Seung Hwa Lee, M.D.1, Cheol-Hong Kim, M.D.1, Ji Youn Kim, M.D.1, Seon Wook Park, M.D.1, Young Wook Kim, M.D.1, In Gyu Hyun, M.D.1, Heungjeong Woo, M.D.1, and Hyun Soo Kim, M.D.2
Departments of Internal Medicine1 and Laboratory Medicine2, Hallym University College of Medicine, Seoul, Korea
Vol.41 Num.6 (p342~348)
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.
Keywords : Intensive care unit, Pneumonia, Procalcitonin