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Semin Respir Crit Care Med 2012; 33(03): 266-271
DOI: 10.1055/s-0032-1315638
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Biomarkers and Community-Acquired Pneumonia: Tailoring Management with Biological Data

Antoni Torres
1   Department of Pneumology, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)- University of Barcelona (UB), Barcelona, Spain.
,
Paula Ramirez
2   Unidad de cuidados Intensivos, Hospital Universitario i Politecnic La Fe, Valencia, Spain.
,
Beatriz Montull
2   Unidad de cuidados Intensivos, Hospital Universitario i Politecnic La Fe, Valencia, Spain.
,
Rosario Menéndez
2   Unidad de cuidados Intensivos, Hospital Universitario i Politecnic La Fe, Valencia, Spain.
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Publikationsdatum:
20. Juni 2012 (online)

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Abstract

Community-acquired pneumonia (CAP) is the leading cause of death from infectious diseases worldwide, with an incidence of 0.3 to 0.5% in the adult population. A new diagnostic and prognostic approach relies on evaluation of biomarkers as an expression of the host's inflammatory response against the microorganism. C-reactive protein (CRP), procalcitonin (PCT), and cytokines are the most frequently studied, whereas pro-adrenomedullin (pro-ADM), pro-vasopressin (pro-VNP), and others are currently obtaining promising results. Their usefulness for diagnosis is limited, although PCT has been successfully used to guide prescription of antibiotics in patients with suspected CAP. Nevertheless, the accuracy of PCT in distinguishing between bacterial or viral infection and safely withholding antibiotics in CAP is the subject of debate. Analysis of systemic biomarkers in addition to clinical scores [Pneumonia Severity Index (PSI) or CURB-65 (confusion, urea, respiratory, blood pressure, >65 years)/CRB-65 (confusion, respiratory, blood pressure)] has been shown to improve 30 day mortality prediction and absence of severe complications. Pro-ADM is probably the biomarker that correlates most strongly with mortality prediction. During treatment, ~15% of hospitalized CAP patients develop treatment failure, and almost 6% may manifest rapidly progressive pneumonia. Initially increased and persistent raised levels of biomarkers and cytokines have been shown to identify patients at risk of treatment failure, thereby aiding clinical management. Data from the literature appear to support the use of biomarkers in routine clinical practice to improve the decision making in CAP.

Keywords

cytokine - diagnosis - treatment
 

  • References

  • 1 Armstrong GL, Conn LA, Pinner RW. Trends in infectious disease mortality in the United States during the 20th century. JAMA 1999; 281 (1) 61-66
    CrossrefPubMedSuche in Google Scholar
  • 2 Kaplan V, Angus DC, Griffin MF, Clermont G, Scott Watson R, Linde-Zwirble WT. Hospitalized community-acquired pneumonia in the elderly: age- and sex-related patterns of care and outcome in the United States. Am J Respir Crit Care Med 2002; 165 (6) 766-772
    CrossrefPubMedSuche in Google Scholar
  • 3 Deng JC, Standiford TJ. The systemic response to lung infection. Clin Chest Med 2005; 26 (1) 1-9
    CrossrefPubMedSuche in Google Scholar
  • 4 Müller B, Süess E, Schuetz P , et al. Circulating levels of pro-atrial natriuretic peptide in lower respiratory tract infections. J Intern Med 2006; 260 (6) 568-576
    CrossrefPubMedSuche in Google Scholar
  • 5 Masiá M, Papassotiriou J, Morgenthaler NG, Hernández I, Shum C, Gutiérrez F. Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia. Clin Chem 2007; 53 (12) 2193-2201
    CrossrefPubMedSuche in Google Scholar
  • 6 Müller B, Morgenthaler N, Stolz D , et al. Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections. Eur J Clin Invest 2007; 37 (2) 145-152
    CrossrefPubMedSuche in Google Scholar
  • 7 Masiá M, Papassotiriou J, Morgenthaler NG, Hernández I, Shum C, Gutiérrez F. Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia. Clin Chem 2007; 53 (12) 2193-2201
    CrossrefPubMedSuche in Google Scholar
  • 8 Bijlsma JJ, Burghout P, Kloosterman TG , et al. Development of genomic array footprinting for identification of conditionally essential genes in Streptococcus pneumoniae. Appl Environ Microbiol 2007; 73 (5) 1514-1524
    CrossrefPubMedSuche in Google Scholar
  • 9 Luna CM. C-reactive protein in pneumonia: let me try again. Chest 2004; 125 (4) 1192-1195
    CrossrefPubMedSuche in Google Scholar
  • 10 Gibot S, Cravoisy A, Levy B , et al. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 2004; 350 (5) 451-458
    CrossrefPubMedSuche in Google Scholar
  • 11 Almirall J, Bolíbar I, Toran P , et al; Community-Acquired Pneumonia Maresme Study Group. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125 (4) 1335-1342
    CrossrefPubMedSuche in Google Scholar
  • 12 Flanders SA, Stein J, Shochat G , et al. Performance of a bedside C-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough. Am J Med 2004; 116 (8) 529-535
    CrossrefPubMedSuche in Google Scholar
  • 13 Müller B, Harbarth S, Stolz D , et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007; 7: 10
    CrossrefPubMedSuche in Google Scholar
  • 14 Polzin A, Pletz M, Erbes R , et al. Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 2003; 21 (6) 939-943
    CrossrefPubMedSuche in Google Scholar
  • 15 Van dM V, Neven AK, Van den Broek PJ , et al. Diagnostic value of C-reactive protein in infections of the lower respiratory tract: systematic review. BMJ 2005; 331: 26
    CrossrefPubMedSuche in Google Scholar
  • 16 Korppi M, Kröger L. C-reactive protein in viral and bacterial respiratory infection in children. Scand J Infect Dis 1993; 25 (2) 207-213
    CrossrefPubMedSuche in Google Scholar
  • 17 Heiskanen-Kosma T, Korppi M. Serum C-reactive protein cannot differentiate bacterial and viral aetiology of community-acquired pneumonia in children in primary healthcare settings. Scand J Infect Dis 2000; 32 (4) 399-402
    CrossrefPubMedSuche in Google Scholar
  • 18 Virkki R, Juven T, Rikalainen H, Svedström E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax 2002; 57 (5) 438-441
    CrossrefPubMedSuche in Google Scholar
  • 19 Prat C, Domínguez J, Rodrigo C , et al. Procalcitonin, C-reactive protein and leukocyte count in children with lower respiratory tract infection. Pediatr Infect Dis J 2003; 22 (11) 963-968
    PubMedSuche in Google Scholar
  • 20 Moulin F, Raymond J, Lorrot M , et al. Procalcitonin in children admitted to hospital with community acquired pneumonia. Arch Dis Child 2001; 84 (4) 332-336
    CrossrefPubMedSuche in Google Scholar
  • 21 Toikka P, Irjala K, Juvén T , et al. Serum procalcitonin, C-reactive protein and interleukin-6 for distinguishing bacterial and viral pneumonia in children. Pediatr Infect Dis J 2000; 19 (7) 598-602
    CrossrefPubMedSuche in Google Scholar
  • 22 García Vázquez E, Martínez JA, Mensa J , et al. C-reactive protein levels in community-acquired pneumonia. Eur Respir J 2003; 21 (4) 702-705
    CrossrefPubMedSuche in Google Scholar
  • 23 Masiá M, Gutiérrez F, Shum C , et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 2005; 128 (4) 2223-2229
    CrossrefPubMedSuche in Google Scholar
  • 24 Masiá M, Gutiérrez F, Padilla S , et al. Clinical characterisation of pneumonia caused by atypical pathogens combining classic and novel predictors. Clin Microbiol Infect 2007; 13 (2) 153-161
    PubMedSuche in Google Scholar
  • 25 Prat C, Domínguez J, Andreo F , et al. Procalcitonin and neopterin correlation with aetiology and severity of pneumonia. J Infect 2006; 52 (3) 169-177
    CrossrefPubMedSuche in Google Scholar
  • 26 Boussekey N, Leroy O, Georges H, Devos P, d'Escrivan T, Guery B. Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit. Infection 2005; 33 (4) 257-263
    CrossrefPubMedSuche in Google Scholar
  • 27 Hedlund J, Hansson LO. Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 2000; 28 (2) 68-73
    CrossrefPubMedSuche in Google Scholar
  • 28 Krüger S, Ewig S, Papassotiriou J , et al; CAPNETZ Study Group. Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ. Respir Res 2009; 10: 65
    CrossrefPubMedSuche in Google Scholar
  • 29 Nyamande K, Lalloo UG, John M. TB presenting as community-acquired pneumonia in a setting of high TB incidence and high HIV prevalence. Int J Tuberc Lung Dis 2007; 11 (12) 1308-1313
    PubMedSuche in Google Scholar
  • 30 Christ-Crain M, Stolz D, Bingisser R , et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006; 174 (1) 84-93
    CrossrefPubMedSuche in Google Scholar
  • 31 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 (9409) 600-607
    CrossrefPubMedSuche in Google Scholar
  • 32 Schuetz PH, Christ-Crain M, Thomann R , et al; ProHOSP Study Group. Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 2009; 302 (10) 1059-1066
    CrossrefPubMedSuche in Google Scholar
  • 33 Brunkhorst FM, Al-Nawas B, Krummenauer F, Forycki ZF, Shah PM. Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia. Clin Microbiol Infect 2002; 8 (2) 93-100
    CrossrefPubMedSuche in Google Scholar
  • 34 Müller F, Christ-Crain M, Bregenzer T , et al; ProHOSP Study Group. Procalcitonin levels predict bacteremia in patients with community-acquired pneumonia: a prospective cohort trial. Chest 2010; 138 (1) 121-129
    CrossrefPubMedSuche in Google Scholar
  • 35 Menéndez R, Martínez R, Reyes S , et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009; 64 (7) 587-591
    CrossrefPubMedSuche in Google Scholar
  • 36 Krüger S, Ewig S, Marre R , et al; CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31 (2) 349-355
    CrossrefPubMedSuche in Google Scholar
  • 37 Menéndez R, Martinez R, Reyes S , et al. Stability in community-acquired pneumonia: one step forward with markers?. Thorax 2009; 64 (11) 987-992
    CrossrefPubMedSuche in Google Scholar
  • 38 Menéndez R, Torres A, Rodríguez de Castro F , et al; Neumofail Group. Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis 2004; 39 (12) 1783-1790
    CrossrefPubMedSuche in Google Scholar
  • 39 Menéndez R, Cavalcanti M, Reyes S , et al. Markers of treatment failure in hospitalised community acquired pneumonia. Thorax 2008; 63 (5) 447-452
    CrossrefPubMedSuche in Google Scholar
  • 40 Ramírez P, Ferrer M, Martí V , et al. Inflammatory biomarkers and prediction for intensive care unit admission in severe community-acquired pneumonia. Crit Care Med 2011; 39 (10) 2211-2217
    CrossrefPubMedSuche in Google Scholar
  • 41 Krüger S, Ewig S, Giersdorf S, Hartmann O, Suttorp N, Welte T ; German Competence Network for the Study of Community Acquired Pneumonia (CAPNETZ) Study Group. Cardiovascular and inflammatory biomarkers to predict short- and long-term survival in community-acquired pneumonia: Results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med 2010; 182 (11) 1426-1434
    CrossrefPubMedSuche in Google Scholar
  • 42 Guertler C, Wirz B, Christ-Crain M, Zimmerli W, Mueller B, Schuetz P. Inflammatory responses predict long-term mortality risk in community-acquired pneumonia. Eur Respir J 2011; 37 (6) 1439-1446
    CrossrefPubMedSuche in Google Scholar
  • 43 Christ-Crain M, Morgenthaler NG, Struck J, Harbarth S, Bergmann A, Müller B. Mid-regional pro-adrenomedullin as a prognostic marker in sepsis: an observational study. Crit Care 2005; 9 (6) R816-R824
    CrossrefPubMedSuche in Google Scholar
  • 44 Christ-Crain M, Morgenthaler NG, Stolz D , et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care 2006; 10 (3) R96
    CrossrefPubMedSuche in Google Scholar
  • 45 Albrich WC, Dusemund F, Rüegger K , et al. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis 2011; 11: 112
    CrossrefPubMedSuche in Google Scholar