This study aimed to investigate the usefulness of inflammatory biomarkers such as white blood cell (WBC) count, C-reactive protein (CRP) and procalcitonin (PCT) for differentiating cryptogenic organising pneumonia (COP) from community-acquired pneumonia (CAP).
COP patients hospitalised in Kurashiki Central Hospital between January 2010 and December 2017 whose WBC counts and CRP and PCT levels were measured were investigated retrospectively, and their results were compared with those of hospitalised CAP patients who were prospectively enrolled between October 2010 and November 2017. Definite COP was defined by specific histopathological findings, and possible COP was defined as a consolidation shadow on chest computed tomography and lymphocyte dominance in bronchoalveolar lavage fluid in the absence of specific histopathological findings or lung specimens. The discriminatory abilities of WBC counts, CRP and PCT were evaluated by receiver operating characteristic (ROC) curve analysis.
There were 56 patients in the entire COP group, 35 (61.4%) with definite COP, and 914 CAP patients. All three biomarkers were significantly lower in COP than in CAP. The AUC value of PCT in all COP patients was 0.79, significantly higher than of both CRP (AUC 0.59, p < 0.001) and WBC (AUC 0.69, p = 0.048). In definite COP patients, the AUC value of PCT was 0.79, which was also significantly higher than of both WBC (AUC 0.64, p = 0.006) and CRP (AUC 0.64, p = 0.001).
PCT is a more useful biomarker for differentiating COP from CAP than WBC count or CRP. However, PCT should be used as an adjunct to clinical presentation and radiological findings.
The authors would like to thank all of their colleagues who treated the COP and CAP patients.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organisation(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
1. Cordier JF. Cryptogenic organising pneumonia. Eur Respir J 2006;28:422–46.10.1183/09031936.06.00013505Search in Google Scholar
2. Cottin V, Cordier JF. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med 2012;33:462–75.10.1055/s-0032-1325157Search in Google Scholar
3. Cordier JF. Organising pneumonia. Thorax 2000;55:318–28.10.1136/thorax.55.4.318Search in Google Scholar
4. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007;44(Suppl 2):S27–72.10.1086/511159Search in Google Scholar
5. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax 2012;67:71–9.10.1136/thx.2009.129502Search in Google Scholar
6. Assicot M, Gendrel D, Carsin H, Raymond J, Guilbaud J, Bohuon C. High serum procalcitonin concentrations in patients with sepsis and infection. Lancet 1993;341:515–8.10.1016/0140-6736(93)90277-NSearch in Google Scholar
7. Odermatt J, Friedli N, Kutz A, Briel M, Bucher HC, Christ-Crain M, et al. Effects of procalcitonin testing on antibiotic use and clinical outcomes in patients with upper respiratory tract infections. An individual patient data meta-analysis. Clin Chem Lab Med 2017;56:170–7.10.1515/cclm-2017-0252Search in Google Scholar
8. Hey J, Thompson-Leduc P, Kirson NY, Zimmer L, Wilkins D, RiceB, et al. Procalcitonin guidance in patients with lower respiratory tract infections: a systematic review and meta-analysis. Clin Chem Lab Med 2018;56:1200–9.10.1515/cclm-2018-0126Search in Google Scholar
9. Sager R, Wirz Y, Amin D, Amin A, Hausfater P, Huber A, et al. Are admission procalcitonin levels universal mortality predictors across different medical emergency patient populations? Results from the multi-national, prospective, observational TRIAGE study. Clin Chem Lab Med 2017;55:1873–80.10.1515/cclm-2017-0144Search in Google Scholar
10. Müller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007;7:10.10.1186/1471-2334-7-10Search in Google Scholar
11. Kolditz M, Halank M, Schulte-Hubbert B, Höffken G. Procalcitonin improves the differentiation between infectious and cryptogenic/secondary organizing pneumonia. J Infection 2012;64:122–4.10.1164/ajrccm-conference.2012.185.1_MeetingAbstracts.A5253Search in Google Scholar
12. Palmucci S, Roccasalva F, Puglisi S, Torrisi SE, Vindigni V, Mauro LA, et al. Clinical and radiological features of idiopathic interstitial pneumonias (IIPs): a pictorial review. Insights Imaging 2014;5:347–64.10.1007/s13244-014-0335-3Search in Google Scholar
13. Schuetz P, Albrich W, Mueller B. Procalcitonin for diagnosis of infection and guide to antibiotic decisions: past, present and future. BMC Med 2011;9:107.10.1186/1741-7015-9-107Search in Google Scholar
14. Vestbo J, Hurd SS, Agustí AG, Jones PW, Vogelmeier C, AnzuetoA, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2013;187:347–65.10.1164/rccm.201204-0596PPSearch in Google Scholar
15. Mehrian P, Shahnazi M, Dahaj AA, Bizhanzadeh S, Karimi MA. The spectrum of presentations of cryptogenic organizing pneumonia in high resolution computed tomography. Pol J Radiol 2014;79:456–60.10.12659/PJR.891011Search in Google Scholar
16. Mehrian P, Doroudinia A, Rashti A, Aloosh O, Dorudinia A. High-resolution computed tomography findings in chronic eosinophilic vs. cryptogenic organising pneumonia. Int J Tuberc Lung Dis 2017;21:1181–6.10.5588/ijtld.16.0723Search in Google Scholar
17. Schuetz P, Beishuizen A, Broyles M, Ferrer R, Gavazzi G, Gluck EH, et al. Procalcitonin (PCT)-guided antibiotic stewardship: an international experts consensus on optimized clinical use. Clin Chem Lab Med 2019;57:1308–18.10.1515/cclm-2018-1181Search in Google Scholar
18. Takeda S, Nagata N, Miyazaki H, Akagi T, Harada T, Kodama M, et al. Clinical utility of procalcitonin for differentiating between cryptogenic organizing pneumonia and community-acquired pneumonia. Int J Clin Med 2015;6:372–6.10.4236/ijcm.2015.66048Search in Google Scholar
19. Ito A, Ishida T, Tachibana H, Ito Y, Takaiwa T. Serial procalcitonin levels for predicting prognosis in community-acquired pneumonia. Respirology 2016;21:1459–64.10.1111/resp.12846Search in Google Scholar
20. Self WH, Balk RA, Grijalva CG, Williams DJ, Zhu Y, Anderson EJ, et al. Procalcitonin as a marker of etiology in adults hospitalized with community-acquired pneumonia. Clin Infect Dis 2017;65:183–90.10.1093/cid/cix317Search in Google Scholar
©2019 Walter de Gruyter GmbH, Berlin/Boston