Pneumology Service, Hospital Galdakao-Usansolo, 48960, Galdakao, Bizkaia, Spain.
Eur J Clin Microbiol Infect Dis. 2012 Dec;31(12):3397-405. doi: 10.1007/s10096-012-1708-5. Epub 2012 Aug 5.
The aim of the present study is to evaluate the usefulness of two biomarkers-procalcitonin (PCT) and C-reactive protein (CRP)-in addition to the CURB-65 score for assessing the site of care and the etiology of non-severe community-acquired pneumonia (CAP). We conducted a prospective observational study from April 1, 2006, to June 30, 2007, in a single teaching hospital in northern Spain among patients with non-severe CAP. In addition to collecting data needed to determine the CURB-65 score, microbial cultures were taken and levels of PCT and CRP were measured. We compared the prognostic accuracy of these biomarkers with the CURB-65 score to predict hospitalization and microbial etiology using receiver operating characteristic (ROC) curves. A total of 344 patients with non-severe CAP were enrolled; 73 were admitted to the hospital and 271 were treated on an outpatient basis. An etiologic diagnostic was made for 44 %, with atypical pathogens predominating. Levels of PCT and CRP increased with increasing CURB-65 scores. Patients admitted to the hospital had higher PCT and CRP levels than outpatients (p < 0.001). For predicting hospitalization, PCT had a better area under the ROC curve (AUC) (0.81) than the CURB-65 score alone (0.77). For PCT plus the CURB-65 score, the AUC increased significantly from 0.77 to 0.83. In patients with bacterial CAP, the biomarker levels were significantly higher than among patients with atypical or viral etiology (p < 0.001). PCT with a cut-off point of 0.15 ng/mL was the best predictor for bacterial etiology and for select patients eligible for outpatient care. In conclusion, levels of PCT and CRP positively correlate with increasing severity of CAP and may have a role in predicting both patients who can safely receive outpatient care and the microbial etiology in patients with low CURB-65 scores.
本研究旨在评估降钙素原（PCT）和 C 反应蛋白（CRP）这两种生物标志物除 CURB-65 评分外，对评估非重症社区获得性肺炎（CAP）患者的治疗场所和病因的有用性。我们于 2006 年 4 月 1 日至 2007 年 6 月 30 日在西班牙北部的一家教学医院进行了一项前瞻性观察性研究，纳入了非重症 CAP 患者。除收集用于确定 CURB-65 评分的数据外，还进行了微生物培养和 PCT、CRP 水平的检测。我们使用受试者工作特征（ROC）曲线比较了这些生物标志物与 CURB-65 评分对预测住院和微生物病因的预后准确性。共纳入 344 例非重症 CAP 患者，73 例住院，271 例门诊治疗。确定了 44%的病因诊断，以非典型病原体为主。随着 CURB-65 评分的增加，PCT 和 CRP 水平升高。住院患者的 PCT 和 CRP 水平高于门诊患者（p<0.001）。预测住院时，PCT 的 ROC 曲线下面积（AUC）（0.81）优于单独 CURB-65 评分（0.77）。对于 PCT 加 CURB-65 评分，AUC 从 0.77 显著增加至 0.83。在细菌性 CAP 患者中，生物标志物水平明显高于非典型或病毒性病因患者（p<0.001）。PCT 截断值为 0.15ng/mL 是预测细菌性病因和选择适合门诊治疗患者的最佳指标。总之，PCT 和 CRP 水平与 CAP 严重程度呈正相关，可能有助于预测既能安全接受门诊治疗又能预测 CURB-65 评分低的患者的微生物病因。
