Dijagnostički i prognostički značaj serumskog amiloida A, prokalcitonina i D-dimera kod bolesnika sa vanbolnički stečenom pneumonijom

Abstract

Severity assessment is a crucial component in the management of patients with community-acquired pneumonia (CAP). Recommended Pneumonia Severity Index (PSI) is an accurate predicting model, but not so easily applicable in clinical practice. The aim of the study was to determine whether some biomarkers of inflammation and coagulation, correlate with severity of CAP and can predict mortality risk better than standard biomarkers and recommended PSI. The study included 129 patients with CAP, an overall median age of 64.83 ± 13.32 y (77 males and 52 females). There were 55 (43.63%) patients with severe CAP. We were found a good linear correlation between severity of CAP and procalcitonin (r = 0.427; p < 0.001) and between D dimer (r = 0.5106; p < 0.0001). Serum amiloid A, WBC and CRP have poor linear correlation. In diagnosis of severe CAP best diagnostic value have procalcitonin (AUC = 0.813) and D-dimer (AUC = 0.789). Thirteen patients were died (10.7%), and 16 patients have complications (12.4%). In predicting of mortality risk PSI for cut of > PSI III showed sensitivity of 0.92, specificity 0.62 and AUC 0.868. Serum amiloid A, WBC and CRP were not in correlation with the risk of mortality. In non surviving patients D-dimer (2498.38 ng/mL) and procalcitonin (3.14 ng/mL) were significantly higher than in surviving patients. In predicting mortality risk, D-dimer (cut of >1538 ng/mL) showed sensitivity 0.84, specificity 0.86 and AUC 0.859. Procalcitonin, for cut of value > 0.93 ng/mL, in predicting of mortality risk showed sensitivity of 1.0, specifity of 0.64 and AUC 0.844. There was no statistical difference between AUC of PSI and D-dimer (p = 0.9005), and PSI and procalcitonin (p = 0.6135) in predicting mortality risk. This study pointed out that: serum amilod A correlates poor with severity of disease; and that high D-dimer and procalcitonin level correlate with severity of disease (better than CRP and WBC) and mortality risk (similar as recommended PSI). D-dimer and procalcitonin could be useful biomarkers for predicting severity of disease and clinical outcome in patients with CAP.