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Is it cost-effective to use procalcitonin to predict outcome in community-acquired pneumonia in the ED?

428 Correspondence

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  • Is it cost-effective to use procalcitonin to predict outcome in community-acquired pneumonia in the ED?

    To the Editor,

    We read with great interest the article by Park et al [1] in the September 2012 issue of the American Journal of Emergency Medicine. In their study of patients with community-acquired pneumonia at the emergency depart- ment, procalcitonin was a good predictor for mortality and disease severity. Although initial PCT level had the similar area under the curve of 3 prediction rules, including pneumonia severity index, CURB65 (confusion, urea

    >7mmol/L, respiration rate>=30 breaths/min, low blood pressure [systolic value 90 mm Hg or diastolic value <=60 mm Hg and age >=65 years), and Infectious Disease Society of

    America/American Thoracic Society guidelines for predicting outcome, the measurement of PCT is not cheap. Therefore, we wonder whether the additional cost of PCT measurement in patients with community-acquired pneumonia only for prediction outcome is worth.

    However, the recent meta-analysis about the use of PCT to guide initiation and duration of antibiotic treatment in patients with acute Respiratory infections showed that antibiotic consumption was significantly reduced, but this intervention was not associated with higher mortality rates or treatment failure [2]. Although this kind of application of PCT was not evaluated in this study, it should be more cost- effective in common clinical practice.

    Shih-Yang Su Department of Emergency Medicine Tainan Municipal Hospital

    Tainan, Taiwan

    Chien-Ming Chao Chih-Cheng Lai

    Department of Intensive Care Medicine

    Chi Mei Medical Center Liouying, Tainan, Taiwan

    E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2012.10.008

    References

    1. Park JH, Wee JH, Choi SP, Oh SH. The value of procalcitonin level in community-acquired pneumonia in the ED. Am J Emerg Med 2012;30: 1248-54.
    2. Schuetz P, Muller B, Christ-Crain M, Stolz D, Tamm M, Bouadma L, et al. Procalcitonin to initiate or discontinue antibiotics in acute respiratory tract infections. Cochrane Database Syst Rev 2012;9:CD007498.

      “Is it cost-effective to use procalcitonin to predict outcome in community-acquired pneumonia in the ED?” Response to the authors

      To the Editor,

      These readers ask whether using procalcitonin at the emergency department (ED) is cost-effective to predict outcome in community-acquired pneumonia . The study of Park et al [1] demonstrated that procalcitonin level was more valuable than conventional biomarkers for predict- ing the mortality and severity of CAP upon ED admission and suggested that it might be valuable as an adjunct to CAP prediction for prognosis and Severity assessment.

      Because it is difficult to rapidly apply prediction rules (eg, pneumonia severity index , CURB65 (confusion, urea N7 mmol/L, respiration rate >=30 breaths per minute, low blood pressure [systolic value b90 mm Hg or diastolic value

      <=60 mm Hg], and age >=65 years) score, or the Infectious Disease Society of America and the American Thoracic Society (IDSA/ATS) guidelines in the chaotic ED situation, many emergency physicians seek to identify biomarkers that can readily and reliably predict the mortality and severity of CAP. Although conventional biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate , and white blood cell (WBC) have been used to monitor infectious patients’ clinical state, they do not respond accurately to these patients’ severity and outcome.

      A recent meta-analysis [2] reported that the procalcitonin level is valuable to guide initiation and discontinuation of antibiotic treatment in patients with Acute respiratory infections and also indicated that further studies should be

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