Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia

• Published in: Intensive care medicine Vol. 36; no. 5; pp. 799 - 809
• Main Authors: Claessens, Yann-Erick, Mathevon, Thierry, Kierzek, Gérald, Grabar, Sophie, Jegou, David, Batard, Eric, Loyer, Clarisse, Davido, Alain, Hausfater, Pierre, Robert, Hélène, Lavagna-Perez, Leila, Bernot, Bruno, Plaisance, Patrick, Leroy, Christophe, Renaud, Bertrand
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.05.2010; Springer; Springer Nature B.V
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Atrial Natriuretic Factor - blood; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - analysis; Calcitonin - blood; Calcitonin Gene-Related Peptide; Clinical death. Palliative care. Organ gift and preservation; Community-Acquired Infections - blood; Community-Acquired Infections - diagnostic imaging; Critical Care Medicine; Emergency Medicine; Emergency Service, Hospital; Female; Humans; Intensive; Intensive care medicine; Male; Medical care; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Original; Pain Medicine; Patient Admission; Pediatrics; Peptides; Pneumology/Respiratory System; Pneumonia - blood; Pneumonia - diagnostic imaging; Prognosis; Prospective Studies; Protein Precursors - blood; Quality management; Radiography; Sensitivity and Specificity; Severity of Illness Index; France; Emergency department; Low risk; Admission; Community acquired pneumonia; Lung disease; Pneumonia; Intensive care; Respiratory disease; Procalcitonin; Atrial natriuretic peptide; Natriuretic hormone; Community acquired infection; Risk factor; C reactive protein; Resuscitation
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-010-1818-4

Background The use at bedside of C-reactive protein (CRP), procalcitonin (PCT) or mid-regional pro-atrial natriuretic peptide (ANP) has been advocated to help management of patients with community-acquired pneumonia (CAP) in emergency medicine. Objective To assess the effectiveness of CRP, PCT, and ANP measures in assisting emergency physicians deciding hospital admission for CAP with low risk of complication. Design Multicenter, prospective, observational study with blind evaluation. Setting Emergency departments of 12 French hospitals. Patients Five hundred forty-nine consecutive, immunocompetent adult patients with mild CAP. Measurements Centralized and blind measure of baseline CRP, PCT, and ANP; sensitivity, specificity, and positive and negative likelihood ratios for determining hospital admission. Gold standard for admission was defined by experts’ advice combined with admission requirement or death at 28 days. Optimal threshold values were determined by receiver operating characteristic (ROC) curves, and area under curve (AUC) of the three biomarkers was compared. Results According to gold standard, 310 (56%) patients required admission and 239 (44%) needed to be discharged. PCT and ANP levels increased with Pneumonia Severity Index risk categories. ANP (AUC 0.76 [95% CI 0.72–0.80]) more accurately predicted admission requirement than did PCT (AUC 0.65 [95% CI 0.61–0.70]) or CRP (AUC 0.59 [95% CI 0.54–0.64]) (both p values <0.01). We determined that 135 pmol/L was a threshold for ANP level to discriminate admission requirement (positive likelihood ratio 7.45 [95% CI 4.22–8.16]). Conclusions In a selected population of CAP with low risk of complication, a single ANP measurement was more accurate than CRP and PCT to predict appropriate admission. These results should be confirmed by additional studies.