Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis
Identifieur interne : 003604 ( Main/Exploration ); précédent : 003603; suivant : 003605Procalcitonin for diagnosis of bacterial pneumonia in critically ill patients during 2009 H1N1 influenza pandemic: a prospective cohort study, systematic review and individual patient data meta-analysis
Auteurs : Roman Pfister [Allemagne] ; Matthias Kochanek [Allemagne] ; Timo Leygeber [Allemagne] ; Christian Brun-Buisson [France] ; Elise Cuquemelle [France] ; Mariana Benevides Paiva Machado [Brésil] ; Enrique Piacentini [Espagne] ; Naomi E. Hammond [Australie] ; Paul R. Ingram [Australie] ; Guido Michels [Allemagne]Source :
- Critical Care [ 1364-8535 ] ; 2014.
Abstract
Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza.
Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search.
PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1;
In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment.
Url:
DOI: 10.1186/cc13760
PubMed: 24612487
PubMed Central: 4056761
Affiliations:
- Allemagne, Australie, Brésil, Espagne, France
- District de Cologne, Minas Gerais, Nouvelle-Galles du Sud, Rhénanie-du-Nord-Westphalie, Île-de-France
- Belo Horizonte, Cologne, Créteil, Sydney
- Université fédérale du Minas Gerais
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Le document en format XML
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<author><name sortKey="Pfister, Roman" sort="Pfister, Roman" uniqKey="Pfister R" first="Roman" last="Pfister">Roman Pfister</name>
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<author><name sortKey="Machado, Mariana Benevides Paiva" sort="Machado, Mariana Benevides Paiva" uniqKey="Machado M" first="Mariana Benevides Paiva" last="Machado">Mariana Benevides Paiva Machado</name>
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<author><name sortKey="Piacentini, Enrique" sort="Piacentini, Enrique" uniqKey="Piacentini E" first="Enrique" last="Piacentini">Enrique Piacentini</name>
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<country xml:lang="fr">Espagne</country>
<wicri:regionArea>Department of Critical Care Medicine, Hospital Universitari Mutua Terrassa, Terrassa</wicri:regionArea>
<wicri:noRegion>Terrassa</wicri:noRegion>
</affiliation>
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<author><name sortKey="Hammond, Naomi E" sort="Hammond, Naomi E" uniqKey="Hammond N" first="Naomi E" last="Hammond">Naomi E. Hammond</name>
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</placeName>
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<placeName><settlement type="city">Sydney</settlement>
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</placeName>
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<author><name sortKey="Ingram, Paul R" sort="Ingram, Paul R" uniqKey="Ingram P" first="Paul R" last="Ingram">Paul R. Ingram</name>
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<country xml:lang="fr">Australie</country>
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<author><name sortKey="Michels, Guido" sort="Michels, Guido" uniqKey="Michels G" first="Guido" last="Michels">Guido Michels</name>
<affiliation wicri:level="3"><nlm:aff id="I1">Department of Internal Medicine III, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany</nlm:aff>
<country xml:lang="fr">Allemagne</country>
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<region type="district" nuts="2">District de Cologne</region>
<settlement type="city">Cologne</settlement>
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</affiliation>
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<front><div type="abstract" xml:lang="en"><sec><title>Introduction</title>
<p>Procalcitonin (PCT) is helpful for diagnosing bacterial infections. The diagnostic utility of PCT has not been examined thoroughly in critically ill patients with suspected H1N1 influenza.</p>
</sec>
<sec><title>Methods</title>
<p>Clinical characteristics and PCT were prospectively assessed in 46 patients with pneumonia admitted to medical ICUs during the 2009 and 2010 influenza seasons. An individual patient data meta-analysis was performed by combining our data with data from five other studies on the diagnostic utility of PCT in ICU patients with suspected 2009 pandemic influenza A(H1N1) virus infection identified by performing a systematic literature search.</p>
</sec>
<sec><title>Results</title>
<p>PCT levels, measured within 24 hours of ICU admission, were significantly elevated in patients with bacterial pneumonia (isolated or coinfection with H1N1; <italic>n</italic>
= 77) (median = 6.2 μg/L, interquartile range (IQR) = 0.9 to 20) than in patients with isolated H1N1 influenza pneumonia (<italic>n</italic>
= 84; median = 0.56 μg/L, IQR = 0.18 to 3.33). The area under the curve of the receiver operating characteristic curve of PCT was 0.72 (95% confidence interval (CI) = 0.64 to 0.80; <italic>P</italic>
< 0.0001) for diagnosis of bacterial pneumonia, but increased to 0.76 (95% CI = 0.68 to 0.85; <italic>P</italic>
< 0.0001) when patients with hospital-acquired pneumonia and immune-compromising disorders were excluded. PCT at a cut-off of 0.5 μg/L had a sensitivity (95% CI) and a negative predictive value of 80.5% (69.9 to 88.7) and 73.2% (59.7 to 84.2) for diagnosis of bacterial pneumonia, respectively, which increased to 85.5% (73.3 to 93.5) and 82.2% (68.0 to 92.0) in patients without hospital acquired pneumonia or immune-compromising disorder.</p>
</sec>
<sec><title>Conclusions</title>
<p>In critically ill patients with pneumonia during the influenza season, PCT is a reasonably accurate marker for detection of bacterial pneumonia, particularly in patients with community-acquired disease and without immune-compromising disorders, but it might not be sufficient as a stand-alone marker for withholding antibiotic treatment.</p>
</sec>
</div>
</front>
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</analytic>
</biblStruct>
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<author><name sortKey="Tidefelt, U" uniqKey="Tidefelt U">U Tidefelt</name>
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</analytic>
</biblStruct>
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</listBibl>
</div1>
</back>
</TEI>
<affiliations><list><country><li>Allemagne</li>
<li>Australie</li>
<li>Brésil</li>
<li>Espagne</li>
<li>France</li>
</country>
<region><li>District de Cologne</li>
<li>Minas Gerais</li>
<li>Nouvelle-Galles du Sud</li>
<li>Rhénanie-du-Nord-Westphalie</li>
<li>Île-de-France</li>
</region>
<settlement><li>Belo Horizonte</li>
<li>Cologne</li>
<li>Créteil</li>
<li>Sydney</li>
</settlement>
<orgName><li>Université fédérale du Minas Gerais</li>
</orgName>
</list>
<tree><country name="Allemagne"><region name="Rhénanie-du-Nord-Westphalie"><name sortKey="Pfister, Roman" sort="Pfister, Roman" uniqKey="Pfister R" first="Roman" last="Pfister">Roman Pfister</name>
</region>
<name sortKey="Kochanek, Matthias" sort="Kochanek, Matthias" uniqKey="Kochanek M" first="Matthias" last="Kochanek">Matthias Kochanek</name>
<name sortKey="Leygeber, Timo" sort="Leygeber, Timo" uniqKey="Leygeber T" first="Timo" last="Leygeber">Timo Leygeber</name>
<name sortKey="Michels, Guido" sort="Michels, Guido" uniqKey="Michels G" first="Guido" last="Michels">Guido Michels</name>
</country>
<country name="France"><region name="Île-de-France"><name sortKey="Brun Buisson, Christian" sort="Brun Buisson, Christian" uniqKey="Brun Buisson C" first="Christian" last="Brun-Buisson">Christian Brun-Buisson</name>
</region>
<name sortKey="Cuquemelle, Elise" sort="Cuquemelle, Elise" uniqKey="Cuquemelle E" first="Elise" last="Cuquemelle">Elise Cuquemelle</name>
</country>
<country name="Brésil"><region name="Minas Gerais"><name sortKey="Machado, Mariana Benevides Paiva" sort="Machado, Mariana Benevides Paiva" uniqKey="Machado M" first="Mariana Benevides Paiva" last="Machado">Mariana Benevides Paiva Machado</name>
</region>
</country>
<country name="Espagne"><noRegion><name sortKey="Piacentini, Enrique" sort="Piacentini, Enrique" uniqKey="Piacentini E" first="Enrique" last="Piacentini">Enrique Piacentini</name>
</noRegion>
</country>
<country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Hammond, Naomi E" sort="Hammond, Naomi E" uniqKey="Hammond N" first="Naomi E" last="Hammond">Naomi E. Hammond</name>
</region>
<name sortKey="Hammond, Naomi E" sort="Hammond, Naomi E" uniqKey="Hammond N" first="Naomi E" last="Hammond">Naomi E. Hammond</name>
<name sortKey="Ingram, Paul R" sort="Ingram, Paul R" uniqKey="Ingram P" first="Paul R" last="Ingram">Paul R. Ingram</name>
<name sortKey="Ingram, Paul R" sort="Ingram, Paul R" uniqKey="Ingram P" first="Paul R" last="Ingram">Paul R. Ingram</name>
</country>
</tree>
</affiliations>
</record>
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