calca-protein--human and Tuberculosis--Pulmonary

To systematically and quantitatively summarise the current evidence on the utility of the procalcitonin test (PCT) in discriminating pulmonary tuberculosis (TB) from other pulmonary infections.. We searched MEDLINE, EMBASE and the Cochrane database up to August 2013 for studies that reported the performance of PCT alone or compared with other biomarkers in diagnosing pulmonary TB. We summarised PCT using forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models.. We found nine qualifying studies covering 951 episodes of suspected TB along with 426 confirmed TB cases. The bivariate pooled sensitivity and specificity of PCT to distinguish TB from non-TB were respectively 42% (95%CI 30-56) and 87% (95%CI 63-96). The bivariate pooled sensitivity and specificity for PCT in distinguishing TB from bacterial pneumonia were respectively 78% (95%CI 67-86) and 85% (95%CI 78-90). Low heterogeneity was noted in studies comparing TB with bacterial pneumonia patients.. The results suggest consistently acceptable sensitivity and specificity of the PCT test in distinguishing TB from bacterial pneumonia. However, given the imperfect sensitivity and specificity of the test, medical decisions should be based on both the PCT test results as well as on clinical findings.

Topics: Area Under Curve; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Humans; Odds Ratio; Predictive Value of Tests; Protein Precursors; Respiratory Tract Infections; ROC Curve; Tuberculosis, Pulmonary

The diagnostic significance of procalcitonin concentrations in lower respiratory tract infections and tuberculosis is not known. A prospective analysis was, therefore, performed in patients with acute exacerbation of chronic bronchitis (AECB), community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and tuberculosis and their procalcitonin levels compared with those of patients with noninfectious lung diseases (controls). In addition, standard inflammatory parameter data were collected. A prospective clinical study was performed with four different groups of patients and a control group that consisted of patients with noninfectious lung diseases. A total of 129 patients were included: 25 with HAP, 26 CAP, 26 AECB, 27 tuberculosis, and 25 controls. C-reactive protein level, blood cell counts and procalcitonin concentration were evaluated on the first day after onset of clinical and inflammatory symptoms prior to treatment. The median procalcitonin concentrations in HAP, CAP, AECB and tuberculosis were not elevated in relation to the cut-off level of 0.5 ng x mL(-1). In the HAP group, in four of five patients who subsequently died, procalcitonin concentrations of >0.5 ng x mL(-1) were found. In acute lower respiratory infections, such as HAP, CAP and AECB, significantly elevated levels were found in comparison to the control group, but below the usual cut-off level. No differences were observed between tuberculosis and the control group. Relative to the current cut-off level of 0.5 ng x mL(-1), procalcitonin concentration is not a useful parameter for diagnosis of lower respiratory tract infections. However, compared to the control group, there were significantly elevated levels in patients with hospital-acquired pneumonia, community-acquired pneumonia and acute exacerbation of chronic bronchitis below the current cut-off level, which should be further investigated.

Topics: Acute Disease; Aged; Blood Cell Count; Bronchitis, Chronic; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Cross Infection; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pneumonia; Prospective Studies; Protein Precursors; Reproducibility of Results; Sensitivity and Specificity; Tuberculosis, Pulmonary

Comparisons of procalcitonin (PCT), C-reactive protein (CRP), and soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) would expand our knowledge of which biomarker is the best predictor for outcomes of patients with pulmonary tuberculosis (PTB).. We prospectively enrolled 243 PTB patients, in whom PCT, CRP, and sTREM-1 measurement were performed to evaluate their prognostic value for 6-month mortality.. Serum PCT, CRP, and sTREM-1 levels on diagnosis of PTB were significantly higher in nonsurvivors (2.22 ± 6.22 vs. 0.13 ± 0.31 ng/mL, P = 0.043; 42.1 ± 59.4 vs. 12.5 ± 29.1 mg/L, P = 0.004; 332 ± 362 vs. 128 ± 98 pg/mL, P = 0.001, respectively) as compared with 6-month survivors. In multivariate Cox regression analysis, PCT ≧ 0.5 ng/mL (hazard ratio 4.13, 95% CI, 1.99-8.58) and sTREM-1 ≧ 129 pg/mL (hazard ratio 3.39, 95% CI, 1.52-7.58) remained independent mortality predictors. Serum PCT and sTREM-1 levels above the cutoffs were also associated with the presence of disseminated tuberculosis.. Among PTB patients, higher PCT, CRP, and sTREM-1 levels are observed in nonsurvivors than in 6-month survivors. Serum levels of PCT and sTREM-1 over the cutoffs are independently associated with a poor outcome. In addition, higher PCT and sTREM-1 levels would raise the clinical suspicion of disseminated tuberculosis.

Topics: Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Male; Membrane Glycoproteins; Middle Aged; Prognosis; Prospective Studies; Protein Precursors; Receptors, Immunologic; Serum; Survival Analysis; Triggering Receptor Expressed on Myeloid Cells-1; Tuberculosis, Pulmonary; Young Adult

To explore the diagnostic value of serum procalcitonin (PCT), interleukin-10 (IL-10), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in community acquired pneumonia (CAP) and tuberculosis (PTB).. 113 CAP cases patients and 78 PTB cases were enrolled from May 2011 to March 2012. Routine blood test, serum PCT, CRP, IL-10 and ESR of patients within 24 hours were analyzed retrospectively.. The serum concentrations of PCT, IL-10, CRP and ESR in CAP patients with CAP were 0.35±0.017 mg/mL, 0.095±0.004 mg/L, 59.80±5.12 mg/L and 35.00±4.81 mm/1h, respectively, significantly higher than patients with PTB (p < 0.01); According to the result of ROC curve analysis in CAP and PTB, the PTC area under ROC curve is 0.715 (95% CI 0.647-0.782), the sensitivity and specific degree of serum PTC were significant better than CRP and IL10 (p < 0.05). In tuberculosis sputum culture, the serum concentrations of IL-10 and ESR in TB positive group were 0.045±0.013 mg/L and 62.50±8.69 mm/1h, significantly higher than that of TB negative group (p < 0.05); whereas, the concentrations of serum PCT and CRP in TB positive and negative groups had no significant difference (p > 0.05).. The levels of serum PCT, IL-10, CRP and ESR in CAP patients are higher than that in PTB patients. Therefore, the serum PCT, IL10, CRP and ESR level is benefit to distinguish between CAP and PTB. This could provide a comprehensible evidence for both diagnosis and prognosis.

Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; Biomarkers; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Chi-Square Distribution; Community-Acquired Infections; Diagnosis, Differential; Female; Humans; Interleukin-10; Male; Middle Aged; Mycobacterium tuberculosis; Pneumonia; Predictive Value of Tests; Protein Precursors; Retrospective Studies; ROC Curve; Sputum; Tuberculosis, Pulmonary; Up-Regulation

There are very few data on serum procalcitonin (PCT) levels in pulmonary tuberculosis (PTB) patients who are negative for HIV. We assessed serum PCT in consecutive patients diagnosed with pulmonary tuberculosis or community-acquired pneumonia (CAP) on admission to discriminate between PTB and CAP, and examined the value of prognostic factors in PTB. 102 PTB patients, 62 CAP patients, and 34 healthy volunteers were enrolled. Serum PCT in PTB patients was significantly lower than in CAP patients (mean ± sd 0.21 ± 0.49 versus 4.10 ± 8.68 ng·mL⁻¹; p < 0.0001). By receiver-operating characteristic curve analysis, serum PCT was an appropriate discrimination marker for PTB and CAP (area under the curve 0.866). PTB patients with ≥ 0.5 ng·mL⁻¹ (normal cut-off) had significantly shorter survival than those with < 0.5 ng·mL⁻¹ (p < 0.0001). Serum PCT is not habitually elevated in HIV-negative PTB patients and is a useful biomarker for discriminating between PTB and CAP; however, when serum PCT is outside the normal range, it is a poor prognostic marker.

Topics: Aged; Aged, 80 and over; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prognosis; Protein Precursors; ROC Curve; Severity of Illness Index; Tuberculosis, Pulmonary

To evaluate the level and prognostic value of procalcitonin (PCT) in a West African out-patient cohort with pulmonary tuberculosis (PTB).. Patients were clinically scored (TB score), grouped into severity classes (SCs) upon diagnosis and followed for 12 months. Patients were categorised by comparisons of severity class (SC I+II or SC III) and levels of PCT and C-reactive protein (CRP) at diagnosis. Fifty healthy volunteers from the study area were used as controls. The association with TB score was explored using Spearman's rank correlation test. Survival curves stratified after baseline levels of PCT and CRP were compared using the log-rank test.. We included 218 patients in the study. PCT and CRP levels were low, but were significantly higher in patients than in controls (P < 0.001), and were higher for SC III compared to SC I+II patients (P = 0.021 for PCT, P < 0.001 for CRP). Human immunodeficiency virus (HIV) status did not influence results. We found positive correlations between both PCT and CRP and TB score. There was a significantly increased risk of mortality with increasing baseline PCT (P = 0.01), whereas high CRP did not predict mortality rate (P = 0.887).. In West African PTB patients, PCT levels were low but increased significantly with increasing severity of disease, and can predict mortality risk.

Topics: Adult; Biomarkers; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Chi-Square Distribution; Dietary Supplements; Female; Guinea-Bissau; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Outpatients; Protein Precursors; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Survival Rate; Time Factors; Treatment Outcome; Tuberculosis, Pulmonary; Up-Regulation; Vitamin D

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Comorbidity; Humans; Pneumonia; Prognosis; Protein Precursors; Pulmonary Medicine; Tuberculosis, Pulmonary

Procalcitonin (PCT) is a marker of the inflammatory response to infection. In the present study the serum PCT of 46 pulmonary tuberculosis patients, 46 non-tuberculosis pulmonary disease and 46 healthy subjects were analyzed using semiquantitative PCT-Q kit. All healthy individuals (100%) were negative regarding PCT. Using cut-off value of 0.5 ng/ml, The sensitivity, specificity positive predictive value and negative predictive value for serum PCT in distinguishing tuberculous from nontuberculous pulmonary disease were 36.9%, 63.1%, 50% and 50%, respectively. According to our results the serum PCT is not a reliable marker for diagnosis of pulmonary tuberculosis due to low sensitivity and specificity.

Topics: Adult; Aged; Aged, 80 and over; Calcitonin; Calcitonin Gene-Related Peptide; Case-Control Studies; Female; Humans; Lung Diseases; Male; Middle Aged; Protein Precursors; Sensitivity and Specificity; Tuberculosis, Pulmonary; Young Adult

We investigated the utility of serum C-reactive protein (CRP) and procalcitonin (PCT) for differentiating pulmonary tuberculosis (TB) from bacterial community-acquired pneumonia (CAP) in South Korea, a country with an intermediate TB burden.. We conducted a prospective study, enrolling 87 participants with suspected CAP in a community-based referral hospital. A clinical assessment was performed before treatment, and serum CRP and PCT were measured. The test results were compared to the final diagnoses.. Of the 87 patients, 57 had bacterial CAP and 30 had pulmonary TB. The median CRP concentration was 14.58 mg/dL (range, 0.30 to 36.61) in patients with bacterial CAP and 5.27 mg/dL (range, 0.24 to 13.22) in those with pulmonary TB (p<0.001). The median PCT level was 0.514 ng/mL (range, 0.01 to 27.75) with bacterial CAP and 0.029 ng/mL (range, 0.01 to 0.87) with pulmonary TB (p<0.001). No difference was detected in the discriminative values of CRP and PCT (p=0.733).. The concentrations of CRP and PCT differed significantly in patients with pulmonary TB and bacterial CAP. The high sensitivity and negative predictive value for differentiating pulmonary TB from bacterial CAP suggest a supplementary role of CRP and PCT in the diagnostic exclusion of pulmonary TB from bacterial CAP in areas with an intermediate prevalence of pulmonary TB.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pneumonia, Bacterial; Prospective Studies; Protein Precursors; Severity of Illness Index; Tuberculosis, Pulmonary

Clinical outcome of pneumonia depends on a multifaceted treatment approach. Not only diagnostic methods but also early indicators of the degree of inflammatory response can aid in therapeutic decisions. The objective was to evaluate the usefulness of procalcitonin and neopterin in distinguishing among aetiologies as well as severity in patients with pneumonia.. A total of one hundred sixteen patients with clinical, radiographic and microbiological diagnosis of pneumonia were grouped by aetiology, pneumonia severity index, and by the presence of unilobar or multilobar radiographic pulmonary infiltrates. Procalcitonin and neopterin were measured by immunoassays.. Patients with pneumococcal pneumonia presented elevated procalcitonin and neopterin levels, being higher in bacteraemic than in non-bacteraemic pneumonia. Patients with Legionella pneumonia presented elevated neopterin levels and slightly elevated procalcitonin levels. Patients with tuberculosis and Pneumocystis jirovecii pneumonia presented elevated neopterin and low or not detectable procalcitonin. Procalcitonin and neopterin levels were increased in high-risk classes of pneumonia severity index. Both parameters yielded significant correlation to the radiographic extent and also to young age.. Procalcitonin and neopterin levels vary depending on age, aetiology and severity of pneumonia. Together with clinical and microbiological data, combined measurement can help to identify patients who might benefit from additional therapies.

Topics: Adult; Aged; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Female; Humans; Legionnaires' Disease; Male; Middle Aged; Neopterin; Pneumonia, Bacterial; Pneumonia, Pneumocystis; Protein Precursors; Risk Factors; Tuberculosis, Pulmonary

The aim of our prospective study was to evaluate the predictive value of serum procalcitonin (PCT) level in comparison with C-reactive protein level and erythrocyte sedimentation rate for the diagnosis of pulmonary tuberculosis (PTB) on admission and 6 months after the administration of anti-tuberculous chemotherapy (ATCT). Seventy-five adult male patients with active PTB who were mycobacteriologically diagnosed (smear and culture positivity) were examined in this study. As a control group, 75 healthy adult males were enrolled. The measured serum PCT levels were within the normal range both in healthy individuals and in patients 6 months after ATCT. Serum PCT levels had been slightly high on admission in patients with PTB in comparison with controls (P = 0.01) and patients who had ATCT (P = 0.001), and this difference was statistically significant, but the PCT levels of most cases with PTB (58.7%) were below the usual cut-off level (0.5 ng/mL). We conclude from this study that the serum PCT level was not a reliable indicator in the diagnosis of active PTB because of its low sensitivity (41.3%), and in most cases it was not capable of overcoming the cut-off level even if statistically meaningful results were obtained. The PCT test for the presumptive diagnosis of PTB cannot be substituted for microbiological, epidemiological, clinical and radiological data.

Topics: Adult; Aged; Aged, 80 and over; Blood Sedimentation; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Humans; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Protein Precursors; Sensitivity and Specificity; Tuberculosis, Pulmonary

Pulmonary tuberculosis (PTB) and pneumococcal community-acquired pneumonia (PCAP) are common causes of lower respiratory tract infections in HIV-seropositive patients and may have similar clinical and radiological features. This study aimed to assess the value of serum procalcitonin (PCT) and C-reactive protein (CRP) levels in HIV-seropositive patients with pneumonia, and to investigate their potential role in differentiating pneumococcal from mycobacterial infections. HIV-seropositive patients admitted with pneumonia were evaluated prospectively, 34 with PTB and 33 with PCAP. All 33 patients in the PCAP group and 20 of 34 patients in the PTB group had elevated PCT levels (>0.1 ng x mL(-1)). All patients in both groups had elevated CRP levels (>10 mg x L(-1)). The PTB group had significantly lower CD4 T-lymphocyte counts, lower CRP levels, lower white cell counts, and lower PCT levels than the PCAP group. Receiver operating characteristic analysis showed that optimal discrimination between PTB and PCAP could be performed at a cut-off point of 3 ng x mL(-1) for PCT (sensitivity 81.8%; specificity 82.35%) and 246 mg x L(-1) for CRP (sensitivity 78.8%; specificity 82.3%). In conclusion, HIV-seropositive patients with pneumococcal community-acquired pneumonia had significantly higher procalcitonin and C-reactive protein levels than those with pulmonary tuberculosis. A procalcitonin level >3 ng x mL(-1) and a C-reactive protein level >246 mg x L(-1) were both highly predictive of pneumococcal infection.

Topics: Adult; C-Reactive Protein; Calcitonin; Calcitonin Gene-Related Peptide; Community-Acquired Infections; Diagnosis, Differential; Female; HIV Seropositivity; Humans; Male; Pneumonia, Pneumococcal; Prospective Studies; Protein Precursors; Tuberculosis, Pulmonary

The aim of our study was to evaluate the prognostic value of serum procalcitonine (PCT) assay in adult respiratory infections. Forty-nine patients admitted with pleurisy, community-acquired pneumonia, tuberculosis, infection were included in this prospective study. PCT was assayed on admission and discharge. Biological and clinical parameters of gravity were also evaluated. Twenty patients had elevated PCT of more than 0.50 ng/ml. In 29 patients, PCT was undetectable. The serum PCT level was normal in the patients with tuberculosis, infection, pneumocytosis. PCT did not correlate with the biological and clinical markers of the disease severity but the evolution of PCT correlated with the evolution of C-reactive-protein (r = 0.58, p < 0.05). PCT seems to be an early marker of the evolution of respiratory infections, but it does not help to establish prognosis. Further studies are necessary to assess the potential value of PCT in more severe respiratory infections requiring assisted ventilation.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Analysis of Variance; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Female; Glycoproteins; Humans; Linear Models; Male; Middle Aged; Pleurisy; Pneumonia; Pneumonia, Pneumocystis; Prognosis; Prospective Studies; Protein Precursors; Respiratory Tract Infections; Tuberculosis, Pulmonary