Department of Emergency Medicine and Intensive Care, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands.
Clin Microbiol Infect. 2009 Nov;15(11):1020-5. doi: 10.1111/j.1469-0691.2009.02773.x. Epub 2009 Apr 24.
Little is known about procalcitonin (PCT) levels in patients with community-acquired pneumonia (CAP) caused by Legionella pneumophila. The aim of the present study was to investigate this infection marker in patients admitted with L. pneumophila pneumonia in relation to conventional inflammatory parameters, severity of pneumonia upon admission and clinical outcome. Eighteen patients admitted with CAP caused by L. pneumophila serogroup 1 were retrospectively examined. PCT measurements were carried out during the first week of admission in addition to measurements of C-reactive protein (CRP), white blood cell (WBC) count and registration of severity of pneumonia upon admission (CURB-65 score). The mean PCT level upon admission in patients with L. pneumophila pneumonia was 13.5 ng/mL (range 0.3-55.7 ng/mL). Mean CRP level was 397 mg/L (range 167-595 mg/L) and mean WBC count 11.7 x 10(9)/L (range 4.5-20.4 x 10(9)/L). Initial high PCT levels were indicative of more severe disease as reflected by prolonged intensive care unit (ICU) stay and/or in-hospital death. Patients admitted to the ICU showed significantly higher PCT levels compared with the remaining patients [26.7 ng/mL (range 4.6-55.7 ng/mL) vs. 6.9 ng/mL (range 0.3-29.3 ng/mL); p 0.019]. There was a significant correlation between Acute Physiology and Chronic Health Evaluation-II scores upon ICU admission and initial PCT levels upon hospital admission (r = 0.86; p 0.027). Persistently increased PCT levels during treatment were indicative of unfavourable clinical outcome. Conventional inflammatory parameters (CRP and WBC) and the CURB-65 score lacked this discriminatory capacity in our study population. PCT may therefore be a valuable tool in the initial clinical assessment and follow-up of patients with L. pneumophila pneumonia.
关于嗜肺军团菌引起的社区获得性肺炎（CAP）患者降钙素原（PCT）水平知之甚少。本研究的目的是调查这种感染标志物在军团菌肺炎入院患者中的情况，与常规炎症参数、入院时肺炎严重程度和临床结局相关。回顾性检查了 18 例由血清群 1 嗜肺军团菌引起的 CAP 患者。除 C 反应蛋白（CRP）、白细胞（WBC）计数和入院时肺炎严重程度（CURB-65 评分）登记外，还在入院的第一周内进行 PCT 测量。嗜肺军团菌肺炎患者入院时的平均 PCT 水平为 13.5ng/mL（范围 0.3-55.7ng/mL）。平均 CRP 水平为 397mg/L（范围 167-595mg/L），平均 WBC 计数为 11.7x10(9)/L（范围 4.5-20.4x10(9)/L）。初始高 PCT 水平表明疾病更严重，表现为 ICU 住院时间延长和/或院内死亡。入住 ICU 的患者 PCT 水平明显高于其余患者[26.7ng/mL（范围 4.6-55.7ng/mL）与 6.9ng/mL（范围 0.3-29.3ng/mL）；p=0.019]。入住 ICU 时急性生理学和慢性健康评估 II 评分与入院时初始 PCT 水平之间存在显著相关性（r=0.86；p=0.027）。治疗过程中 PCT 水平持续升高提示临床结局不佳。在本研究人群中，常规炎症参数（CRP 和 WBC）和 CURB-65 评分缺乏这种区分能力。因此，PCT 可能是评估和随访嗜肺军团菌肺炎患者的有用工具。
