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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Greaves, Ronda / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter


IMPACT FACTOR 2018: 3.638

CiteScore 2018: 2.44

SCImago Journal Rank (SJR) 2018: 1.191
Source Normalized Impact per Paper (SNIP) 2018: 1.205

Online
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1437-4331
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Volume 57, Issue 10

Issues

Utility of procalcitonin for differentiating cryptogenic organising pneumonia from community-acquired pneumonia

Akihiro Ito
  • Corresponding author
  • Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Miwa, Kurashiki 710-8602, Japan, Phone: +81 86 422 0210, Fax: +81 86 421 3424
  • Email
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/ Tadashi Ishida
  • Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
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/ Hiromasa Tachibana
  • Department of Respiratory Medicine, National Hospital Organization, Minami Kyoto Hospital, Joyo, Japan
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/ Machiko Arita
  • Department of Respiratory Medicine, Ohara Healthcare Foundation, Kurashiki Central Hospital, Kurashiki, Japan
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  • De Gruyter OnlineGoogle Scholar
/ Akio Yamazaki / Yasuyoshi Washio
  • Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
  • Other articles by this author:
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Published Online: 2019-05-23 | DOI: https://doi.org/10.1515/cclm-2019-0175

Abstract

Background

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).

Methods

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.

Results

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).

Conclusions

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.

Keywords: C-reactive protein; community-acquired pneumonia; cryptogenic organising pneumonia; inflammatory biomarker; procalcitonin

References

  • 1.

    Cordier JF. Cryptogenic organising pneumonia. Eur Respir J 2006;28:422–46.PubMedCrossrefGoogle Scholar

  • 2.

    Cottin V, Cordier JF. Cryptogenic organizing pneumonia. Semin Respir Crit Care Med 2012;33:462–75.Web of SciencePubMedCrossrefGoogle Scholar

  • 3.

    Cordier JF. Organising pneumonia. Thorax 2000;55:318–28.CrossrefWeb of SciencePubMedGoogle 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.CrossrefWeb of ScienceGoogle 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.PubMedWeb of ScienceCrossrefGoogle 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.PubMedCrossrefGoogle 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.Web of SciencePubMedGoogle 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.Web of SciencePubMedCrossrefGoogle 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.Web of SciencePubMedGoogle 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.Web of ScienceCrossrefPubMedGoogle 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.Web of ScienceCrossrefGoogle 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.PubMedCrossrefGoogle 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.PubMedWeb of ScienceCrossrefGoogle 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.PubMedCrossrefGoogle 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.PubMedCrossrefGoogle 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.Web of SciencePubMedCrossrefGoogle 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.PubMedWeb of ScienceCrossrefGoogle 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.CrossrefGoogle 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.CrossrefPubMedWeb of ScienceGoogle 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.CrossrefPubMedGoogle Scholar

About the article

Received: 2019-02-13

Accepted: 2019-04-23

Published Online: 2019-05-23

Published in Print: 2019-09-25


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.


Citation Information: Clinical Chemistry and Laboratory Medicine (CCLM), Volume 57, Issue 10, Pages 1632–1637, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/cclm-2019-0175.

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