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• W2334043636 abstract "<h3>BACKGROUND:</h3> Early identification of treatment failure for nosocomial pneumonia remains a major challenge. The goal of this study was to test whether procalcitonin kinetics can be used to assess the clinical efficacy in older critically ill patients with nosocomial pneumonia. <h3>METHODS:</h3> A prospective observational study was conducted with 60 subjects (≥ 65 y old) admitted to the ICU with severe nosocomial pneumonia. Serum procalcitonin was measured on days 0, 3, and 7 and at the end of treatment. The procalcitonin time course was analyzed according to the therapeutic efficacy. <h3>RESULTS:</h3> Procalcitonin levels were elevated in all subjects (<i>n</i> = 60) on day 0, and the median level (range) was 2.5 (0.85–42.7) μg/L. There were no differences in procalcitonin between the improved subjects (<i>n</i> = 41) and those without improvement (<i>n</i> = 19) on day 0 (<i>P</i> > .05). However, lower procalcitonin levels on days 3 and 7 and at the end of treatment (all <i>P</i> < .05) and greater rates of procalcitonin decline between days 0 and 3 (ΔPCT_d3%; 29.5 ± 10.8% vs 15.1 ± 5.9%, <i>P</i> = .009) were observed in the improved subjects compared with those with no improvement. ΔPCT_d3% was the best single predictor of efficacy (area under the curve of 0.79, <i>P</i> < .001) and had a sensitivity of 75.7% and a specificity of 72.0% with a threshold of 26.2%. By comparison, traditional parameters and absolute procalcitonin failed to predict treatment response (<i>P</i> > .05). Indeed, the combination of ΔPCT_d3% > 26.2% and a modified Clinical Pulmonary Infection Score of < 6 points improved the predictive value (area under the curve of 0.89, sensitivity of 81.3%, specificity of 86.5%). <h3>CONCLUSIONS:</h3> Procalcitonin levels were not influenced by aging, and procalcitonin kinetics might help to identify treatment failure. ΔPCT_d3% in combination with the Clinical Pulmonary Infection Score has been shown to be a marker of clinical efficacy at an earlier stage." @default.
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• W2334043636 date "2013-12-10" @default.
• W2334043636 modified "2023-10-18" @default.
• W2334043636 title "Procalcitonin Kinetics and Nosocomial Pneumonia in Older Patients" @default.
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• W2334043636 doi "https://doi.org/10.4187/respcare.02364" @default.
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