Wesley H. Self, MD, MPH; Carlos G. Grijalva, MD, MPH; Derek J. Williams, MD, MPH; Alison Woodworth, PhD; Robert A. Balk, MD; Sherene Fakhran, MD; Yuwei Zhu, MD; D. Mark Courtney, MD; James Chappell, MD, PhD; Evan J. Anderson, MD; Chao Qi, PhD; Grant W. Waterer, MD, PhD; Christopher Trabue, MD; Anna M. Bramley, MPH; Seema Jain, MD; Kathryn M. Edwards, MD; Richard G. Wunderink, MD  CHEST Oct 2016; 150(4): 819-828

Background: Predicting the need for intensive care among adults with community-acquired pneumonia (CAP) remains challenging.

Methods: Using a multicenter prospective cohort study of adults hospitalized with CAP, we evaluated the association of serum procalcitonin (PCT) concentration at hospital presentation with the need for invasive respiratory or vasopressor support (IRVS), or both, within 72 h. Logistic regression was used to model this association, with results reported as the estimated risk of IRVS for a given PCT concentration. We also assessed whether the addition of PCT changed the performance of established pneumonia severity scores, including the pneumonia severity index and the American Thoracic Society minor criteria, for prediction of IRVS.

Results: Of 1,770 enrolled patients, 115 required IRVS (6.5%). Using the logistic regression model, PCT concentration had a strong association with IRVS risk. Undetectable PCT (< 0.05 ng/mL) was associated with a 4% (95% CI, 3.1%-5.1%) risk of IRVS. For concentrations < 10 ng/mL, PCT had an approximate linear association with IRVS risk: for each 1 ng/mL increase in PCT, there was a 1% to 2% absolute increase in the risk of IRVS. With a PCT concentration of 10 ng/mL, the risk of IRVS was 22.4% (95% CI, 16.3%-30.1%) and remained relatively constant for all concentrations > 10 ng/mL. When added to each pneumonia severity score, PCT contributed significant additional risk information for the prediction of IRVS.

Conclusions: Serum PCT concentration was strongly associated with the risk of requiring IRVS among adults hospitalized with CAP and is potentially useful for guiding decisions about ICU admission.

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