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Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patients.

Abstract：

BACKGROUND:Blood biomarkers are increasingly used to diagnose, guide therapy in, and risk-stratify community-acquired pneumonia (CAP) patients in emergency departments (EDs). How pre-analytic factors affect these markers' initial levels in this population is unknown. METHODS:In this secondary analysis of consecutive ED patients with CAP from a large multicentre antibiotic stewardship trial, we used adjusted multivariate regression models to determine the magnitude and statistical significance of differences in mean baseline concentrations of five biomarkers (procalcitonin [PCT], C-reactive protein [CRP], white blood cells count [WBC], proadrenomedullin [ProADM], copeptin) associated with six pre-analytic factors (antibiotic or corticosteroid pretreatment, age, gender, chronic renal failure or chronic liver insufficiency). RESULTS:Of 925 CAP patients (median age 73 years, 58.8% male), 25.5% had antibiotic pretreatment, 2.4%, corticosteroid pretreatment, 22.3%, chronic renal failure, 2.4% chronic liver insufficiency. Differences associated with pre-analytic factors averaged 6.1% ± 4.6%; the three largest statistically significant changes (95% confidence interval) were: PCT, +14.2% (+2.1% to +26.4%, p = 0.02) with liver insufficiency; ProADM, +13.2% (+10.2% to +16.1%, p < 0.01) with age above median; CRP, -12.8% (-25.4% to -0.2%, p = 0.05) with steroid pretreatment. In post hoc sensitivity analyses, reclassification statistics showed that these factors did not result in significant changes of biomarker levels across clinically used cut-off ranges. CONCLUSIONS:Despite statistically significant associations of some pre-analytic factors and biomarker levels, a clinically relevant influence seems unlikely. Our observations reinforce the concept of using biomarkers in algorithms with widely-separated cut-offs and overruling criteria considering the entire clinical picture. TRIAL REGISTRATION:Identifier ISRCTN95122877.

journal_name

BMC Anesthesiol

journal_title

BMC anesthesiology

authors

Kutz A,Grolimund E,Christ-Crain M,Thomann R,Falconnier C,Hoess C,Henzen C,Zimmerli W,Mueller B,Schuetz P,ProHOSP Study Group.

doi

10.1186/1471-2253-14-102

subject

Has Abstract

pub_date

2014-11-15 00:00:00

pages

102

issn

1471-2253

pii

316

journal_volume

pub_type

杂志文章,多中心研究,随机对照试验

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Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patients.