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Open Access Research

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

Stefan Krüger1*, Santiago Ewig2, Jana Papassotiriou3, Jan Kunde3, Reinhard Marre4, Heike von Baum4, Norbert Suttor56, Tobias Welte7 and the CAPNETZ study group

Author Affiliations

1 Medical Clinic I, University Clinic RWTH Aachen, Germany

2 Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Ev. Krankenhaus Herne und Augusta Kranken-Anstalt Bochum, Germany

3 Research Department, Brahms AG, Hennigsdorf, Germany

4 Department of Medical Microbiology and Hygiene, University Hospital Ulm, Germany

5 Department of Internal Medicine, Charite- University Medicine, Berlin, Germany

6 Infectious Diseases and Pulmonary Medicine, Charite- University Medicine, Berlin, Germany

7 Department of Pneumology, Hannover Medical School, University Clinic Hannover, Germany

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Respiratory Research 2009, 10:65  doi:10.1186/1465-9921-10-65

Published: 12 July 2009

Abstract

Background

Aim of this study was to evaluate the correlation of inflammatory markers procalcitonin (PCT), C-reactive protein (CRP) and leukocyte count (WBC) with microbiological etiology of CAP.

Methods

We enrolled 1337 patients (62 ± 18 y, 45% f) with proven CAP. Extensive microbiological workup was performed. In all patients PCT, CRP, WBC and CRB-65 score were determined. Patients were classified according to microbial diagnosis and CRB-65 score.

Results

In patients with typical bacterial CAP, levels of PCT, CRP and WBC were significantly higher compared to CAP of atypical or viral etiology. There were no significant differences in PCT, CRP and WBC in patients with atypical or viral etiology of CAP. In contrast to CRP and WBC, PCT markedly increased with severity of CAP as measured by CRB-65 score (p < 0.0001). In ROC analysis for discrimination of patients with CRB-65 scores > 1, AUC for PCT was 0.69 (95% CI 0.66 to 0.71), which was higher compared to CRP and WBC (p < 0.0001). CRB-65, PCT, CRP and WBC were higher (p < 0.0001) in hospitalised patients in comparison to outpatients.

Conclusion

PCT, CRP and WBC are highest in typical bacterial etiology in CAP but do not allow individual prediction of etiology. In contrast to CRP and WBC, PCT is useful in severity assessment of CAP.