Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scanReport as inadecuate




Diagnostic accuracy of C-reactive protein and procalcitonin in suspected community-acquired pneumonia adults visiting emergency department and having a systematic thoracic CT scan - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 19:366

First Online: 16 October 2015Received: 05 July 2015Accepted: 27 September 2015

Abstract

IntroductionCommunity-acquired pneumonia CAP requires prompt treatment, but its diagnosis is complex. Improvement of bacterial CAP diagnosis by biomarkers has been evaluated using chest X-ray infiltrate as the CAP gold standard, producing conflicting results. We analyzed the diagnostic accuracy of biomarkers in suspected CAP adults visiting emergency departments for whom CAP diagnosis was established by an adjudication committee which founded its judgment on a systematic multidetector thoracic CT scan.

MethodsIn an ancillary study of a multi-center prospective study evaluating the impact of systematic thoracic CT scan on CAP diagnosis, sensitivity and specificity of C-reactive protein CRP and procalcitonin PCT were evaluated. Systematic nasopharyngeal multiplex respiratory virus PCR was performed at inclusion. An adjudication committee classified CAP diagnostic probability on a 4-level Likert scale, based on all available data.

ResultsTwo hundred patients with suspected CAP were analyzed. The adjudication committee classified 98 patients 49.0 % as definite CAP, 8 4.0 % as probable, 23 11.5 % as possible and excluded in 71 35.5 %, including 29 patients with pulmonary infiltrates on chest X-ray. Among patients with radiological pulmonary infiltrate, 23 % were finally classified as excluded. Viruses were identified by PCR in 29 % of patients classified as definite. Area under the curve was 0.787 95 % confidence interval 95 % CI, 0.717 to 0.857 for CRP and 0.655 95 % CI, 0.570 to 0.739 for PCT to detect definite CAP. CRP threshold at 50 mg-L resulted in a positive predictive value of 0.76 and a negative predictive value of 0.75. No PCT cut-off resulted in satisfactory positive or negative predictive values. CRP and PCT accuracy was not improved by exclusion of the 25 25.5 % definite viral CAP cases.

ConclusionsFor patients with suspected CAP visiting emergency departments, diagnostic accuracy of CRP and PCT are insufficient to confirm the CAP diagnosis established using a gold standard that includes thoracic CT scan. Diagnostic accuracy of these biomarkers is also insufficient to distinguish bacterial CAP from viral CAP.

Trial registrationClinicalTrials.gov registry NCT01574066 February 7, 2012

AbbreviationsCAPCommunity-acquired pneumonia

COPDChronic obstructive pulmonary disease

CRPC-reactive protein

IQRInterquartile range

LRTILower respiratory tract infections

NPVNegative predictive value

OROdds ratio

PCRPolymerase chain reaction

PCTProcalcitonin

PPVPositive predictive value

SDStandard deviation

SIRSSystemic inflammatory response syndrome

Xavier Duval and Yann-Erick Claessens contributed equally to this work.

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-015-1083-6 contains supplementary material, which is available to authorized users.

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Author: Josselin Le Bel - Pierre Hausfater - Camille Chenevier-Gobeaux - François-Xavier Blanc - Mikhael Benjoar - Cécile Ficko -

Source: https://link.springer.com/







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