• Alexander Kutz, Matthias Briel, Mirjam Christ-Crain, Daiana Stolz, Lila Bouadma, Michel Wolff, Kristina B Kristoffersen, Long Wei, Olaf Burkhardt, Tobias Welte, Stefan Schroeder, Vandack Nobre, Michael Tamm, Neera Bhatnagar, Heiner C Bucher, Charles-Edouard Luyt, Jean Chastre, Florence Tubach, Beat Mueller, and Philipp Schuetz.
• University Department of Medicine, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland. kutz.alexander@gmail.com.
• Crit Care. 2015 Jan 1;19:74.

IntroductionWhether the inflammatory biomarker procalcitonin provides prognostic information across clinical settings and different acute respiratory tract infections (ARIs) is poorly understood. In the present study, we investigated the prognostic value of admission procalcitonin levels to predict adverse clinical outcome in a large ARI population.MethodsWe analysed data from 14 trials and 4,211 ARI patients to study associations of admission procalcitonin levels and setting specific treatment failure and mortality alone at 30 days. We used multivariable hierarchical logistic regression and conducted sensitivity analyses stratified by clinical settings and ARI diagnoses to assess the results' consistency.ResultsOverall, 864 patients (20.5%) experienced treatment failure and 252 (6.0%) died. The ability of procalcitonin to differentiate patients with from those without treatment failure was highest in the emergency department setting (treatment failure area under the curve (AUC): 0.64 (95% confidence interval (CI): 0.61, 0.67), adjusted odds ratio (OR): 1.85 (95% CI: 1.61, 2.12), P <0.001; and mortality AUC: 0.67 (95% CI: 0.63, 0.71), adjusted OR: 1.82 (95% CI: 1.45, 2.29), P <0.001). In lower respiratory tract infections, procalcitonin was a good predictor of identifying patients at risk for mortality (AUC: 0.71 (95% CI: 0.68, 0.74), adjusted OR: 2.13 (95% CI: 1.82, 2.49), P <0.001). In primary care and intensive care unit patients, no significant association of initial procalcitonin levels and outcome was found.ConclusionsAdmission procalcitonin levels are associated with setting specific treatment failure and provide the most prognostic information regarding ARI in the emergency department setting.

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