Clinical Utility of Procalcitonin for Differentiating between Cryptogenic Organizing Pneumonia and Community-Acquired Pneumonia
Author(s)
Satoshi Takeda1,
Nobuhiko Nagata1*,
Hiroyuki Miyazaki1,
Takanori Akagi1,
Taishi Harada1,
Masaru Kodama1,
Shinichiro Ushijima1,
Takashi Aoyama1,
Kentaro Wakamatsu2,
Masaki Fujita3,
Kentaro Watanabe3
Affiliation(s)
1 Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan. 2 Department of Respiratory Medicine, National Hospital Organization Omuta Hospital, Omuta, Japan. 3 Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
1 Department of Respiratory Medicine, Fukuoka University Chikushi Hospital, Chikushino, Japan. 2 Department of Respiratory Medicine, National Hospital Organization Omuta Hospital, Omuta, Japan. 3 Department of Respiratory Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
ABSTRACT
Background: Differentiating cryptogenic organizing pneumonia (COP) from community-acquired pneumonia (CAP) can be difficult in some cases. Objective: To clarify the clinical utility of procalcitonin (PCT) levels for differentiating between COP and CAP. Methods: Blood PCT levels, leukocyte count, C-reactive protein concentration, number of segments involved on computed tomography (CT) images, and pneumonia severity assessment scale were retrospectively investigated from clinical charts and chest CT images of COP and CAP patients who were admitted to our hospital from 2012 to 2014. The clinical characteristics of COP patients were compared to those of CAP patients for whom causative organisms were not detected. Results: There were 16 COP and 94 CAP patients for whom causative organisms were not detected. Blood PCT levels of all COP patients were less than 0.16 ng/dL, and significantly lower than those of CAP patients (p = 0.0004), while the number of involved segments was significantly higher than that of CAP patients (p = 0.0001). Blood PCT levels and the number of involved segments remained independently significant for differentiating between COP and CAP by multivariate analysis. Receiver operating characteristics curve analysis revealed that 7 was the best cut-off number for involved segments to differentiate between COP and CAP patients with low PCT levels (sensitivity 85.7%, specificity 94.7%). Conclusion: A combination of PCT levels and number of involved segments on CT images is useful for differentiation between COP and CAP.
KEYWORDS
Cryptogenic Organizing Pneumonia, Procalcitonin, Community-Acquired Pneumonia, Computed Tomography
Cryptogenic Organizing Pneumonia, Procalcitonin, Community-Acquired Pneumonia, Computed Tomography
Cite this paper
Takeda, S. , Nagata, N. , Miyazaki, H. , Akagi, T. , Harada, T. , Kodama, M. , Ushijima, S. , Aoyama, T. , Wakamatsu, K. , Fujita, M. and Watanabe, K. (2015) Clinical Utility of Procalcitonin for Differentiating between Cryptogenic Organizing Pneumonia and Community-Acquired Pneumonia. International Journal of Clinical Medicine, 6, 372-376. doi: 10.4236/ijcm.2015.66048.
Takeda, S. , Nagata, N. , Miyazaki, H. , Akagi, T. , Harada, T. , Kodama, M. , Ushijima, S. , Aoyama, T. , Wakamatsu, K. , Fujita, M. and Watanabe, K. (2015) Clinical Utility of Procalcitonin for Differentiating between Cryptogenic Organizing Pneumonia and Community-Acquired Pneumonia. International Journal of Clinical Medicine, 6, 372-376. doi: 10.4236/ijcm.2015.66048.
References
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http://dx.doi.org/10.1183/09031936.06.00013505 [2] Cottin, V. and Cordier, J.F. (2012) Cryptogenic Organizing Pneumonia. Seminars in Respiratory and Critical Care Medicine, 33, 462-475.
http://dx.doi.org/10.1055/s-0032-1325157 [3] Goros, C.A., Drosou, E., Bassaris, H.P. and Skoutelis, A. (2000) Proversus Anti-Inflammatory Cytokine Profile in Patients with Severe Sepsis: A Marker for Prognosis and Future Therapeutic Options. Journal of Infectious Diseases, 181, 176-180.
http://dx.doi.org/10.1086/315214 [4] Christ-Crain, M. and Mueller, B. (2005) Procalcitonin in Bacterial Infections—Hype, Hope, More or Less? Swiss Medical Weekly, 135, 451-460. [5] Christ-Crain, M. and Mueller, B. (2007) Biomarkers in Respiratory Tract Infections: Diagnostic Guides to Antibiotic Prescription, Prognostic Markers and Mediators. European Respiratory Journal, 30, 556-573.
http://dx.doi.org/10.1183/09031936.00166106 [6] Linscheid, P., Seboek, D., Zulewski, H., Keller, U. and Muller, B. (2005) Autocrine/Paracrine Role of Inflammation-Mediated Calcitonin Gene-Related Peptide and Adrenomedullin Expression in Human Adipose Tissue. Endocrinology, 146, 2699-2708.
http://dx.doi.org/10.1210/en.2004-1424 [7] Schuetz, P., Christ-Crain, M. and Mueller, B. (2009) Procalcitonin and Other Biomarkers to Improve Assessment and Antibiotic Stewardship in Infection—Hope for Hype? Swiss Medical Weekly, 139, 318-326. [8] Limper, M., de Kruif, M.D., Duits, A.J., Brandjes, D.P.M. and van Gorp, E.C.M. (2010) The Diagnostic Role of Procalcitonin and Other Biomarkers in Discriminating Infectious from Non-Infectious Fever. Journal of Infection, 60, 409-416.
http://dx.doi.org/10.1016/j.jinf.2010.03.016 [9] Kolditz, M., Halank, M., Schulte-Hubbert, B. and Hoffken, G. (2012) Procalcitonin Improves the Differentiation between Infectious and Cryptogenic/Secondary Organizing Pneumonia. Journal of Infection, 64, 122-124.
http://dx.doi.org/10.1016/j.jinf.2011.10.012 [10] Yanagihara, K., Kohno, S. and Matsushima, T. (2001) Japanese Guidelines for the Management of Community-Acquired Pneumonia. International Journal of Antimicrobial Agents, 18, S45-S48.
http://dx.doi.org/10.1016/S0924-8579(01)00402-2
[1] Cordier, J.-F. (2006) Cryptogenic Organizing Pneumonia. European Respiratory Journal, 28, 422-446.
http://dx.doi.org/10.1183/09031936.06.00013505 [2] Cottin, V. and Cordier, J.F. (2012) Cryptogenic Organizing Pneumonia. Seminars in Respiratory and Critical Care Medicine, 33, 462-475.
http://dx.doi.org/10.1055/s-0032-1325157 [3] Goros, C.A., Drosou, E., Bassaris, H.P. and Skoutelis, A. (2000) Proversus Anti-Inflammatory Cytokine Profile in Patients with Severe Sepsis: A Marker for Prognosis and Future Therapeutic Options. Journal of Infectious Diseases, 181, 176-180.
http://dx.doi.org/10.1086/315214 [4] Christ-Crain, M. and Mueller, B. (2005) Procalcitonin in Bacterial Infections—Hype, Hope, More or Less? Swiss Medical Weekly, 135, 451-460. [5] Christ-Crain, M. and Mueller, B. (2007) Biomarkers in Respiratory Tract Infections: Diagnostic Guides to Antibiotic Prescription, Prognostic Markers and Mediators. European Respiratory Journal, 30, 556-573.
http://dx.doi.org/10.1183/09031936.00166106 [6] Linscheid, P., Seboek, D., Zulewski, H., Keller, U. and Muller, B. (2005) Autocrine/Paracrine Role of Inflammation-Mediated Calcitonin Gene-Related Peptide and Adrenomedullin Expression in Human Adipose Tissue. Endocrinology, 146, 2699-2708.
http://dx.doi.org/10.1210/en.2004-1424 [7] Schuetz, P., Christ-Crain, M. and Mueller, B. (2009) Procalcitonin and Other Biomarkers to Improve Assessment and Antibiotic Stewardship in Infection—Hope for Hype? Swiss Medical Weekly, 139, 318-326. [8] Limper, M., de Kruif, M.D., Duits, A.J., Brandjes, D.P.M. and van Gorp, E.C.M. (2010) The Diagnostic Role of Procalcitonin and Other Biomarkers in Discriminating Infectious from Non-Infectious Fever. Journal of Infection, 60, 409-416.
http://dx.doi.org/10.1016/j.jinf.2010.03.016 [9] Kolditz, M., Halank, M., Schulte-Hubbert, B. and Hoffken, G. (2012) Procalcitonin Improves the Differentiation between Infectious and Cryptogenic/Secondary Organizing Pneumonia. Journal of Infection, 64, 122-124.
http://dx.doi.org/10.1016/j.jinf.2011.10.012 [10] Yanagihara, K., Kohno, S. and Matsushima, T. (2001) Japanese Guidelines for the Management of Community-Acquired Pneumonia. International Journal of Antimicrobial Agents, 18, S45-S48.
http://dx.doi.org/10.1016/S0924-8579(01)00402-2