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Nurdan Köktürk, Asiye Kanbay, Neslihan Bukan , Numan EkimGazi University School of Medicine The Diagnostic Value of Serum Procalcitonin In Differential Diagnosis of Pulmonary Embolism and Community Acquired Pneumonia
Introduction 1 • Fever occurs in 26% of pulmonary embolism (PE) patients • Presence of high fever may cause confusion in differential diagnosis of PE vs. pneumonia
Introduction 2 • Serum procalcitonin (PCT) level is a useful test to identify bacterial infections • PCT is a prohormone of the calcitonin that is produced by the C cells of the thyroid gland • It is secreted as part of systemic inflammatory response to infection • Serum values of PCT correlated with the type and severity of infection
Aim • To investigate the diagnostic value of PCT in differential diagnosis of PE and community acquired pneumonia (CAP) • The second goal is to demonstrate possible relation of PCT with other systemic markers in appropriately treated patients
Materials and Method Study group Group 1: PE with fever in first 72 hours (n=8) Group 2: PE without fever (n=16) Group 3: Community acquired pneumonia (n=22) • Patients were evaluated at the initial diagnosis and the 3rd day of the treatment of the hospitalization days. • Blood leukocyte count, CRP, ESR, PCT, IL6 and TNF α levels were measured at defined measurement points. • Group analysis was performed to see how those parameters were influenced by appropriate treatment.
113 patients were eligible 22 patients with CAP 89 patients with PE 65 patient excluded patients using antibacterial agent (n=17) lung cancer (n=3), urinary tract infection (n=19) wound infection (n=4), lower respiratory tract infection (n=13) extensive surgery (n=7) early major trauma (n=1) 8 PE patients with fever 16 patients without fever
Table 2: Initial and third day‘s laboratory measurements *:Shows statistically difference
The correlation of serum PCT level and leukocyte, sedimentation levels was not reach statistical significance. • The correlation reached statistical significance between serum PCT level and CRP, body temperature (r=0.455, p=0.001; r=0.653, p=0.000; respectively).
Discussion 1: • Patients with CAP had significantly higher PCT levels than PE patients with or without fever on admission. • PCT levels did not change with anticoagulant treatment in both PE groups, in CAP group antibiotic therapy caused the decreasing level of PCT.
PE patients did not show PCT positivity in PE group even febrile patients • Sedimentation rate, CRP and blood leukocyte counts are reached statistical difference by anticoagulant and antibacterial therapy in all groups. Discussion 2 Isabelle D, Marc A,Olivier A, et al. Procalcitonin Measurement for Differential Diagnosis Between Pulmonary Embolism and Pneumonia, Crit Care Med, 31 (2) 661, 2003.
Discussion 3 • PCT was identified as a better discriminating marker than CRP to characterize the level of inflammation according to the ACCP/SCCM Consensus Conference criteria. It is more specific to inflammation caused by infection than CRP. • CRP is affected from immunosuppressive treatment (ie; steroids) but PCT levels do not change under those medications. • Another superiority of PCT to CRP is, it is rapidly increases in infectious conditions
Discussion 4 • ProRESP study group: 200 patients • PCT guided antibiotic therapy: the percentage of patients in the PCT group, antibiotic therapy was reduced by almost 50%, as compared with standard group. Christ-Crain M, Jaccard-Stolz D, Bingisser R, et-al. Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster- randomised, single blinded intervention trial. Lancet 2004:363:600-6007.
Conclusion • These findings suggested that serum PCT levels might be more useful than blood leukocyte count, CRP, and ESR to differentiate especially PE with fever from CAP.