Correlation and Assessment of Cost-Effectivity of Simultaneous PCT and CRP Measurements for Patients with Community-Acquired Pneumonia and COPD Inflamation

Yıl 2019, Cilt: 21 Sayı: 2, 239 - 248, 31.08.2019

Nermin Dindar Badem Seydi Ali Peker Sedat Kaygusuz

https://doi.org/10.24938/kutfd.590431

Cited By: 1

Öz

Objective: Bacterial infections are important
causes of morbidity and mortality. Serum procalcitonin and C-reactive protein
are significant indicators during the diagnosis, treatment and follow-up of
systemic inflammations and bacterial infections. In this study, correlation
between levels of procalcitonin, which has recently become commonly used in
infection cases, and C-reactive protein, the conventional indicator, were
investigated for patients whose final diagnoses were found as pneumonia and/or
COPD inflammation. Additionally, the study aimed to determine which among the two
indicators was cost-effective for the diagnosis and management of lower
respiratory infections.

Material and Methods: Procalcitonin and C-reactive protein
results of 4712 samples, which were gathered from 1948 patients and measured
simultaneously were assessed. Among the samples, 499 (10.6%) were from COPD
inflammation patients (Group I), 1480 (31.4%) were from pneumonia patients
(Group II), and the remaining 2733 (58%) were from COPD inflammation and
pneumonia patients (Group III).

Results: A strong positive correlation was
detected between C-reactive protein and procalcitonin levels (rho=0.512,
p<0.001). As for the assessments within the established groups I, II and
III, again a strong positive correlation was seen (rho=0.539, p<0.001;
rho=0.509, p<0.001; rho=0.511, p<0.001, respectively).

Conclusion: Procalcitonine was found to be
positively correlated to C-reactive protein and it was suggested that
procalcitonine could be used instead of the costly C reactive protein during
long-term infection care.

Anahtar Kelimeler

Community-acquired pneumonia, COPD inflammation, procalcitonin, C-reactive protein

EŞ ZAMANLI PCT VE CRP İSTENEN TOPLUM KÖKENLİ PNÖMONİ VE KOAH ALEVLENMESİ OLAN HASTALARDA BU PARAMETRELERİN KORELASYONU VE MALİYET ETKİLİLİK AÇISINDAN DEĞERLENDİRİLMESİ

Öz

Amaç: Bakteriyel enfeksiyonlar önemli
morbidite ve mortalite nedenidir. Serum prokalsitonin ve C-reaktif protein
sistemik inflamasyon ve bakteriyel enfeksiyonların tanı, tedavi ve takibinde
önemli belirteçlerdir. Bu çalışmada nihai tanıları pnömoni ve/veya KOAH
alevlenmesi olan hastalarda son zamanlarda enfeksiyon takibinde sıklıkla kullanılmaya
başlanan prokalsitonin ile klasik belirteç olarak kullanılan C-reaktif protein
düzeyleri arasındaki korelasyon araştırıldı. Ayrıca alt solunum yolu
enfeksiyonu tanısı ya da yönetimi için C-reaktif proteinin mi, prokalsitoninin
mi maliyet etkililik açısından yararlı olduğunu saptamayı amaçladık.

Gereç ve Yöntemler:
Toplam 1948 hastadan elde
edilmiş 4712 örnekten eş zamanlı çalışılan prokalsitonin ve C-reaktif protein
sonuçları değerlendirildi. Örneklerden 499’u (%10.6) KOAH alevlenmesi (Grup I),
1480’i (%31.4) pnömoni (Grup II) ve 2733 (%58)’i KOAH alevlenmesi ve pnömoni
(Grup III) tanısı almış hastaların örneklerinden oluşuyordu.

Bulgular: C-reaktif protein ve prokalsitonin
düzeyleri arasında pozitif güçlü korelasyon saptandı (rho=0.512, p<0.001).
Yine prokalsitonin ve C-reaktif protein arasındaki grup içi değerlendirmede
Grup I, Grup II ve Grup III’de pozitif güçlü korelasyon tespit edildi
(sırasıyla rho=0.539, p<0.001; rho=0.509, p<0.001; rho=0.511,
p<0.001).

Sonuç: Prokalsitoninin
C-reaktif protein ile korelasyon gösterdiği, enfeksiyonun ileri dönem takibinde
yüksek maliyetli prokalsitonin yerine C-reaktif protein ölçümünün
kullanılmasının uygun olacağı kanaatine varılmıştır.

Anahtar Kelimeler

KOAH alevlenmesi, Toplum kökenli pnömoni, prokalsitonin, C-reaktif protein

Kaynakça

• 1. Simon L, Gauvin F, Amre DK, Saint-Louis P, Lacroix J. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004;39(2):206-17.
• 2. Çolak A, Yılmaz C, Toprak B, Aktoğu S. Procalcitonin and CRP as biomarkers in discrimination of community-acquired pneumonia and exacerbation of COPD. J Med Biochem. 2017;36(2):122-26. Doi:10.1515/jomb-2017-0011.
• 3. Taşçı C, Deniz Ö, Tozkoparan E, Özkan M, Balkan A, Bilgiç H ve ark. Toplum kökenli pnömonilerde serum prokalsitonin değerleri ile diğer akut faz reaktanları ve hastalığın radyolojik yaygınlığı arasındaki ilişki. Toraks Dergisi. 2007;8(3):156-62.
• 4. Taşbakan MS, Gündüz C, Sayıner A, Çilli A, Çelenk Karaboğa B, Şakar Çoşkun A et al. Serum procalcitonin and C-reactive protein kinetics as indicators of treatment outcome in hospitalized patients with community-acquired pneumonia. Turk J Med Sci. 2016;46(5):1422-7. Doi:10.3906/sag-1507-20.
• 5. Müller F, Christ-Crain, Bregenzer T, Krause M, Zimmerli W, Mueller B et al. Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia. Chest. 2010;138(1):121-9. Doi:10.1378/chest.09-2920.
• 6. Özlü T, Bülbül Y, Alataş F, Arseven O, Şakar Coşkun A, Çilli A ve ark. Türk Toraks Derneği erişkinlerde toplumda gelişen pnömoni tanı ve tedavi uzlaşı raporu. Türk Toraks Dergisi. 2009;10(Supp 9):1-16.
• 7. Lacoma A, Prat C, Andreo F, Lores L, Ruiz-Manzano J, Ausina V et al. Value of procalcitonin, C-reactive protein, and neopterin in exacerbations of chronic obstructive pulmonary disease. International Journal of COPD. 2011;6:157-69. Doi:10.2147/COPD.S16070.
• 8. Sapey E, Stockley RA. COPD exacerbations 2: aetiology. Thorax. 2006;61(3):250-8.
• 9. Akcay I, Okoh AK, Yalav O, Eray IC, Rencuzogullari A, Dalci K et al. The prognostic value of pro-calcitonin, CRP and thyroid hormones in secondary peritonitis: a single-center prospective study. Ulus Travma Acil Cerrahi Derg. 2014;5(20):343-52.
• 10. Christ-Crain M, Opal SM. Clinical review: The role of biomarkers in the diagnosis and management of community-acquired pneumonia. Critical Care. 2010;203(14):1-11.
• 11. Harrison M, Collins CD. Is procalcitonin-guided antimicrobial use cost-effective in adult patients with suspected bacterial ınfection and sepsis? Infect Control Hosp Epidemiol. 2015;36(3):265-72.
• 12. Gyawali B, Ramakrishna K, Dhamoon AS. Sepsis: The evolution in definition, pathophysiology, and management. SAGE Open Medicine. 2019;7:2050312119835043. Doi:10.1177/2050312119835043.
• 13. Price CP, Trull AK, Berry D, Gorman EG. Development and validation of a particle-enhanced turbidimetric immunoassay for C-reactive protein. J Immunol Methods. 1987;99(2):205-11.
• 14. Meisner M. Procalcitonin (PCT)-A new innovative infection parameter. Biochemical and clinical aspects. In: Meisner M, ed. Procalcitonin (PCT)-A New, Innovative Infection Parameter. Biochemical and Clinical Aspects. 3rd ed. New York. Thieme Publishers, 2000:63-8.
• 15. Yoon YK, Kim MJ, Yang KS, Ham SY. The role of serum procalcitonin in the differential diagnosis of pneumonia from pulmonary edema among the patients with pulmonary infiltrates on chest radiography. Medicine. 2018;97(47):1-7. Doi:10.1097/MD.0000000000013348.
• 16. Lippi G, Meschi T, Cervellin G. Inflammatory biomarkers for the diagnosis, monitoring and follow-up of community-acquired pneumonia: Clinical Evidence and Perspectives. Eur J Intern Med. 2011;22(5):460-5.
• 17. Micaelidis CI, Zimmerman RK, Nowalk MP, Fine MJ, Smith KJ. Cost-effectiveness of procalcitonin-guided antibiotic therapy for outpatient management of acute respiratory tract ınfections in adults. J Gen Intern Med. 2013;29(4):579-86. Doi:10.1007/s11606-013-2679-7.
• 18. Bouadma L, Luyt CE, Tubach F, Cracco C, Alvarez A, Schwebel C et al. Use of procalcitonin to reduce patients’ exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet. 2010;375(9713):463-74. Doi:10.1016/S0140-6736(09)61879-1.
• 19. Schuetz P, Christ-Crain M, Wolbers M, Schild U, Thomann R, Falconnier C et al. Procalcitonin guided antibiotic therapy and hospitalization in patients with lower respiratory tract infections: a prospective, multicenter, randomized controlled trial. BMC Health Serv Res. 2007;7:102.
• 20. Drozdov D, Dusemund F, Müller B, Werner, Albrich C. Efficacy and safety of procalcitonin-guided antibiotic therapy in lower respiratory tract ınfections. Antibiotics. 2013,2(1):1-10. Doi:10.3390/antibiotics2010001.
• 21. Poyrazoğlu MH, Per H, Öztürk M, Bingöl N, Üzüm K. Çocukluk çağı pnömonilerinde serum prokalsitonin düzeyleri. Çocuk Sağlığı ve Hastalıkları Dergisi. 2002;46(3):169-76.
• 22. Does Y, Limper M, Schuit SCE, Poley MJ, Rosmalen J, Ramakers C et al. Higher diagnostic accuracy and costeffectiveness using procalcitonin in the treatment of emergency medicine patients with fever (The HiTEMP study): a multicenter randomized study. BMC Emergency Medicine. 2016;16(17):1-7. Doi:10.1186/s12873-016-0081-6.
• 23. Bafadhel M, Clark TW, Reid C, Medina M, Batham S, Barer MR. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. CHEST. 2011;139(6):1410-8. Doi:10.1378/chest.10-1747.