Clinical significance of procalcitonin in critically ill patients with pneumonia receiving bronchoalveolar lavage
Main Article Content
Keywords
Bronchoalveolar Lavage; bronchoscopy; pneumonia
Abstract
Background: As a useful tool in intensive care units (ICU), fiberoptic bronchoscopy (FOB) may cause a deterioration of infection. This study is to investigate the clinical significance of procalcitonin (PCT) in critically ill patients with severe pneumonia receiving bronchoalveolar lavage (BAL).
Methods: A retrospective case-control study was performed in a single respiratory ICU (RICU) with 6-bed. Critically ill patients with severe pneumonia admitted to RICU were consecutively reviewed from March 2017 to October 2019. Chi-square test, Wilcoxon test, Mann Whitney U-test, Kaplan–Meier survival analysis or Cox’s proportional hazards regression model was used as appropriate.
Results: A total of 72 eligible patients were included in the final analysis, 51 of which received BAL performed by FOB. Serum levels of PCT in group received BAL is markedly increased at 24 hours after FOB (p<0.001). Forty-eight hours later, BAL group with decreased serum levels of PCT had less SOFA score and decreased mortality compared with those with increased serum levels of PCT. Furthermore, Kaplan-Meier analysis indicated that patients with decreased serum levels of PCT had improved survival rate during hospital (Breslow test, p=0.041). However, increased PCT after BAL was not an independent risk factor for in-hospital mortality (hazard ratio: 1.689, 95% CI[ 0.626 ,4.563], p=0.301).
Conclusions: BAL performed by FOB increased serum levels of PCT. However, PCT levels decreased at 48 hours after BAL predicted a good prognosis of patients with severe pneumonia.
References
2. Du Rand IA, Blaikley J, Booton R et al: British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax , 2013;68 Suppl 1:i1-i44.
3. Ma KC, Chung A, Aronson KI et al: Bronchoscopic intubation is an effective airway strategy in critically ill patients. J Crit Care, 2017;38:92-96.
4. Peng YY, Soong WJ, Lee YS, Tsao PC, Yang CF, Jeng MJ: Flexible bronchoscopy as a valuable diagnostic and therapeutic tool in pediatric intensive care patients: a report on 5 years of experience. Pediatr Pulmonol, 2011;46:1031-1037.
5. Prebil SE, Andrews J, Cribbs SK, Martin GS, Esper A: Safety of research bronchoscopy in critically ill patients. J Crit Care, 2014;29:961-964.
6. Saka H, Watanabe A, Shimokata K et al. [Prophylactic use of antibiotics for fever following fiberoptic bronchoscopy and bronchography]. Kokyu To Junkan, 1992;40:1105-1108.
7. Picard E, Schwartz S, Goldberg S, Glick T, Villa Y, Kerem E: A prospective study of fever and bacteremia after flexible fiberoptic bronchoscopy in children. Chest, 2000;117: 573-577.
8. Yigla M, Oren I, Bentur L et al: Incidence of bacteraemia following fibreoptic bronchoscopy. Eur Respir J, 1999;14:789-791.
9. Sharif-Kashani B, Shahabi P, Behzadnia N et al: Incidence of fever and bacteriemia following flexible fiberoptic bronchoscopy: a prospective study. Acta Med Iran, 2010;48:385-388.
10. Liu D, Su LX, Guan W, Xiao K, Xie LX: Prognostic value of procalcitonin in pneumonia: A systematic review and meta-analysis. Respirology, 2016;21:280-288.
11. Quah J, Jiang B, Tan PC, Siau C, Tan TY: Impact of microbial Aetiology on mortality in severe community-acquired pneumonia. BMC Infect Dis, 2018;18:451.
12. Kamat IS, Ramachandran V, Eswaran H, Guffey D, Musher DM: Procalcitonin to distinguish viral from bacterial pneumonia: A systematic review and meta-analysis. Clin Infect Dis, 2020;70:538-542.
13. Huang DT, Yealy DM, Filbin MR et al: Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med ,2018;379:236-249.
14. Cao B, Huang Y, She DY et al: Diagnosis and treatment of community-acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association. Clin Respir J, 2018;12:1320-1360.
15. Ergan B, Nava S: The use of bronchoscopy in critically ill patients: considerations and complications. Expert Rev Respir Med, 2018;12:651-663.
16. Yan W, Qin L, Liu Q, Zhang Y: [Analysis on utility and efficacy of fiberoptic bronchoscopy in intensive care unit]. Zhonghua Yi Xue Za Zhi, 2015;95:2372-2374.
17. Lee HW, Min J, Park J et al: Clinical impact of early bronchoscopy in mechanically ventilated patients with aspiration pneumonia. Respirology, 2015;20:1115-1122.
18. Yazicioglu Mocin O, Karakurt Z, Aksoy F et al: Bronchoscopy as an indicator of tracheobronchial fungal infection in non-neutropenic intensive-care unit patients. Clin Microbiol Infect, 2013;19:E136-141.
19. Wang C, Ye S, Wang X, Zhao Y, Ma Q, Wang L: Clinical Efficacy and Safety of Mechanical Ventilation Combined with Fiberoptic Bronchoalveolar Lavage in Patients with Severe Pulmonary Infection. Med Sci Monit, 2019; 25:5401-5407.
20. Chalumeau-Lemoine L, Stoclin A, Billard V, Laplanche A, Raynard B, Blot F: Flexible fiberoptic bronchoscopy and remifentanil target-controlled infusion in ICU: a preliminary study. Intensive Care Med, 2013;39:53-58.
21. Lucena CM, Martinez-Olondris P, Badia JR et al: [Fiberoptic bronchoscopy in a respiratory intensive care unit]. Med Intensiva, 2012;36:389-395.
22. Mohanka MR, Mehta AC, Budev MM, Machuzak MS, Gildea TR: Impact of bedside bronchoscopy in critically ill lung transplant recipients. J Bronchology Interv Pulmonol, 2014;21:199-207.
23. A KV, Khosravi M: BAL for pneumonia prevention in tracheostomy patients: A clinical trial study. Pak J Med Sci, 2013;29:148-151.
24. Prkno A, Wacker C, Brunkhorst FM, Schlattmann P: Procalcitonin-guided therapy in intensive care unit patients with severe sepsis and septic shock--a systematic review and meta-analysis. Crit Care, 2013;17:R291.
25. Bloos F, Marshall JC, Dellinger RP et al: Multinational, observational study of procalcitonin in ICU patients with pneumonia requiring mechanical ventilation: a multicenter observational study. Crit Care, 2011;15:R88.
26. Schnabel RM, van der Velden K, Osinski A, Rohde G, Roekaerts PM, Bergmans DC: Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients. BMC Pulm Med, 2015;15:107.
27. Halwani M, Solaymani-Dodaran M, Grundmann H, Coupland C, Slack R: Cross-transmission of nosocomial pathogens in an adult intensive care unit: incidence and risk factors. J Hosp Infect, 2006;63:39-46.
28. Hackner K, Riegler W, Handzhiev S et al: Fever after bronchoscopy: serum procalcitonin enables early diagnosis of post-interventional bacterial infection. BMC Pulm Med, 2017;17:156.
29. Phua J, Dean NC, Guo Q, Kuan WS, Lim HF, Lim TK: Severe community-acquired pneumonia: timely management measures in the first 24 hours. Crit Care, 2016;20:237.
30. Valade S, Biard L, Lemiale V et al: Severe atypical pneumonia in critically ill patients: a retrospective multicenter study. Ann Intensive Care, 2018;8(1):81.
31. Garnacho-Montero J, Barrero-Garcia I, Gomez-Prieto MG, Martin-Loeches I: Severe community-acquired pneumonia: current management and future therapeutic alternatives. Expert Rev Anti Infect Ther, 2018:1-11.
32. Naqvi IH, Mahmood K, Ziaullaha S, Kashif SM, Sharif A: Better prognostic marker in ICU - APACHE II, SOFA or SAP II! Pak J Med Sci, 2016;32:1146-1151.
33. Shehabi Y, Sterba M, Garrett PM et al: Procalcitonin algorithm in critically ill adults with undifferentiated infection or suspected sepsis. A randomized controlled trial. Am J Respir Crit Care Med, 2014;190:1102-1110.
34. Li B, Zhao X, Li S: Serum Procalcitonin Level and Mortality Risk in Critically ill Patients with Ventilator-Associated Pneumonia. Cell Physiol Biochem, 2015;37:1967-1972.
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
