Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino-city, 818-8502, Japan.
Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka-city, 814-0180, Japan.
BMC Geriatr. 2019 Jan 7;19(1):3. doi: 10.1186/s12877-018-1008-8.
Procalcitonin (PCT) is a useful marker for pneumonia. However, its clinical usefulness in elderly patients has not been studied extensively. This study aimed to assess the relationship between PCT and prognosis and pneumonia severity in elderly patients with pneumonia acquired outside the hospital.
Data considered relevant to pneumonia severity and prognosis were retrospectively obtained from clinical charts of all patients with pneumonia who were admitted to our hospital from 2010 to 2017. The primary outcome was 30-day mortality in elderly patients (aged ≥75 years), and the relationship between PCT levels and pneumonia severity, as determined by the pneumonia severity index (PSI) was also examined.
Data were collected from 667 patients, of which 436 were elderly patients. Multivariate and receiver operating characteristic curve analysis revealed that albumin, body mass index, and PSI class rather than PCT are important factors related to 30-day mortality in elderly patients. PCT was also not an independent prognostic factor in younger patients. PCT levels significantly differed by pneumonia severity (mild, moderate, and severe) in both younger (p < 0.001) and elderly (p < 0.0001) patients, with levels increasing as severity increased. In contrast, C-reactive protein (CRP) levels and white blood cell counts did not significantly differ by pneumonia severity in younger and elderly patients. A subgroup analysis focused on Streptococcus pneumoniae pneumonia revealed that PCT levels differed by severity in elderly patients (p = 0.03), with levels increasing as severity increased.
PCT was not an independent predictor of 30-day mortality in both of elderly and younger patients. PCT levels, but not CRP levels, significantly increased with increasing pneumonia severity in younger and elderly patients, although the degree of increase tended to be lower in elderly patients compared to younger patients for the same severity. PCT levels also significantly increased with increasing pneumonia severity in elderly patients with Streptococcus pneumoniae pneumonia.
降钙素原 (PCT) 是肺炎的有用标志物。然而，其在老年患者中的临床应用尚未得到广泛研究。本研究旨在评估 PCT 与预后及社区获得性肺炎老年患者肺炎严重程度的关系。
从 2010 年至 2017 年我院收治的所有社区获得性肺炎患者的临床病历中回顾性收集与肺炎严重程度和预后相关的数据。主要终点为老年患者（年龄≥75 岁）的 30 天死亡率，同时还研究了 PCT 水平与肺炎严重程度（肺炎严重指数 [PSI]）的关系。
共纳入 667 例患者的数据，其中 436 例为老年患者。多变量和受试者工作特征曲线分析显示，白蛋白、体重指数和 PSI 分级而非 PCT 是老年患者 30 天死亡率的重要相关因素。在年轻患者中，PCT 也不是独立的预后因素。PCT 水平在年轻（p<0.001）和老年（p<0.0001）患者中均显著因肺炎严重程度（轻度、中度和重度）而异，随着严重程度的增加而升高。相比之下，年轻和老年患者的 C 反应蛋白（CRP）水平和白细胞计数与肺炎严重程度无显著差异。一项针对肺炎链球菌肺炎的亚组分析显示，老年患者的 PCT 水平因严重程度而异（p=0.03），随着严重程度的增加而升高。
PCT 不是老年和年轻患者 30 天死亡率的独立预测因素。在年轻和老年患者中，PCT 水平而非 CRP 水平随着肺炎严重程度的增加而显著升高，尽管对于同一严重程度，老年患者的升高程度往往低于年轻患者。在肺炎链球菌肺炎的老年患者中，PCT 水平也随肺炎严重程度的增加而显著升高。
