| Procalcitonin in 2009 H1N1 Influenza Pneumonia: Role in Differentiating from Bacterial Pneumonia. |
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Shin Ahn, Won Young Kim, Ji Young Yoon, Chang Hwan Sohn, Dong Woo Seo, Sung Han Kim, Sang Bum Hong, Chae Man Lim, Youn Suck Koh, Won Kim |
1Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. wonpia@yahoo.co.kr
2Department of Respiratory and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
3Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. |
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| Abstract |
BACKGROUND
Procalcitonin is a well known marker in infection that plays a role in distinguishing between bacterial and viral infections in screening. The aim of the present study was to evaluate the role of procalcitonin in differentiating between 2009 H1N1 influenza pneumonia and community acquired pneumonia of bacterial origin, or mixed bacterial origin and 2009 H1N1 influenza infection. METHODS: A retrospective observational study was performed over the 6-month winter period during the 2009 H1N1 influenza pandemic. Ninety-six patient-subjects were enrolled, all of whom had been diagnosed with community acquired pneumonia in emergency department during the study period. On admission, laboratory studies were performed, which included 2009 H1N1 influenza real-time polymerase chain reaction of nasal secretions and procalcitonin on serum; the laboratory values were compared between the study groups. Receiver operating characteristic curve analyses were performed on the resulting data. RESULTS: Compared to those with bacterial or mixed infections (n=62) and bacterial pneumonia with confirmed organisms (n=30), patients with 2009 H1N1 pneumonia (n=34) were significantly more likely to have low procalcitonin levels (p=0.008, 0.001). Using cutoff of value >0.3 ng/mL, the sensitivity and specificity of procalcitonin for detection of patients with confirmed bacterial pneumonia were 76.2% and 60.6%, respectively. A significant difference in procalcitonin was found between 2009 H1N1 pneumonia and pneumonia caused by mixed influenza viral and bacterial infections (0.15 [0.05~0.84] vs. 10.3 [0.05~22.87] ng/mL, p=0.045). CONCLUSION: Serum procalcitonin measurement may assist in the discrimination between pneumonia of bacterial and of 2009 H1N1 influenza origin. High values of procalcitonin suggest that bacterial infection or mixed infection of bacteria and 2009 H1N1 influenza is more likely. |
| Key Words:
Influenza A Virus, H1N1 Subtype, Procalcitonin, Pneumonia |
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