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Can serum procalcitonin levels help interpret indeterminate chest radiographs in patients hospitalized with acute respiratory illness?
Author(s) -
Walsh Edward E.,
Swinburne Andrew J.,
Becker Kenneth L.,
Nylen Eric S.,
Snider Richard H.,
Baran Andrea,
Peterson Derick R.,
Falsey Ann R.
Publication year - 2013
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.1002/jhm.1984
Subject(s) - medicine , procalcitonin , pneumonia , pulmonologist , bronchitis , radiography , medical diagnosis , asthma , community acquired pneumonia , chest radiograph , pulmonology , receiver operating characteristic , intensive care medicine , radiology , sepsis
BACKGROUND Clinical diagnosis of pneumonia is difficult and chest radiographs often indeterminate, leading to incorrect diagnoses and antibiotic overuse. OBJECTIVE To determine if serum procalcitonin (ProCT) could assist in managing patients with respiratory illness and indeterminate radiographs. DESIGN Subjects were prospectively enrolled during 2 consecutive winters. SETTING A 520‐bed hospital in Rochester, NY. PATIENTS Five hundred twenty‐eight adults admitted with acute respiratory illness were enrolled. MEASUREMENTS Serum ProCT, admission diagnoses, and chest radiographic findings were used to derive receiver operating characteristics curves to assess predictive accuracy of ProCT for the presence of infiltrates. RESULTS Subjects with pneumonia had higher ProCT (median 0.27 ng/ml) than those with exacerbations of chronic obstructive pulmonary disease (0.08 ng/ml), acute bronchitis (0.09 ng/ml), or asthma (0.06 ng/ml). ProCT had moderate accuracy for the presence of infiltrates (area under curve [AUC] 0.72), when indeterminate radiographs were independently classified as infiltrates by a pulmonologist evaluating patients. CONCLUSIONS ProCT may be useful in diagnosing pneumonia when chest radiographs are indeterminate. Journal of Hospital Medicine 2013;8:61–67. © 2012 Society of Hospital Medicine