Prediction value of procalcitonin combining CURB-65 for 90-day mortality in community-acquired pneumonia

ABSTRACT

Background: Due to its high mortality rate, immediate and reliable severity assessment and accurate prediction of prognosis at hospital admission is critical for the management of community-acquired pneumonia (CAP) patients.

Methods: Consecutive patients with primary diagnosis of CAP and hospitalized at our hospital from January 2013 to December 2015 were screened for this retrospective study. Demographic information, clinical and laboratory examination, severity model scoring, and 90-day outcomes were studied. Area under the curve (AUC) of receiver operating characteristic curve (ROC) was analyzed to compare the predictive value of different prognostic scoring methods.

Results: 2099 CAP patients with a median age of 60 (IQR 44.0–73.0) years-old were included in this study. Median length of stay was 10 days (IQR 8.0–13.0). The all-cause 90-day mortality was found in 2.19% (46/2099) of all patients. PCT was identified as an independent predictor for the prognosis of CAP patients. CURB-65 in combination with PCT outperformed other predictive methods in 90-day mortality with the optimal AUC of 0.900 and Youden’s Index of 0.706.

Conclusions: PCT is a good marker for the assessment of severity and 90-day mortality of CAP patients. The combination of PCT and CURB-65 was more accurate than other prognostic models in predicting 90-day mortality.

KEYWORDS:

• Pneumonia
• prognosis
• long-term mortality
• Youden’s Index
• procalcitonin
• outcome

Article highlights

• PCT is a good marker for the assessment of severity and 90-day mortality of CAP patients. Elevated serum PCT levels were strongly correlated with poor outcomes of CAP.

• The combination of PCT and CURB-65 was more accurate than other prognostic models in predicting 90-day mortality of CAP patients.

• Optimal AUC of CURB-65 in combination with PCT was 0.9000 with Youden’s Index of 0.706.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The study was supported by the Fund of Harbin Science and Technology Bureau (NO.2016RAXYJ092). The funder did not make a substantial contribution to the article.