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      Ratio of procalcitonin/Simpson’s dominance index predicted the short-term prognosis of patients with severe bacterial pneumonia

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          Abstract

          Objective

          The aim of this study was to explore the predictive value of the ratio of procalcitonin (PCT) in serum to Simpson’s dominance index (SDI) in bronchoalveolar lavage fluid (BALF), in short-term prognosis of patients with severe bacterial pneumonia (SBP).

          Methods

          This is a retrospective review of case materials of 110 patients with SBP who selected BALF metagenomic next-generation sequencing technique in the intensive care unit (ICU) of the Affiliated Hospital of Yangzhou University from January 2019 and July 2022. Based on the acute physiology and chronic health status score II, within 24 h after admission to the ICU, patients were divided into a non-critical group ( n = 40) and a critical group ( n = 70). Taking death caused by bacterial pneumonia as the endpoint event, the 28-day prognosis was recorded, and the patients were divided into a survival group ( n = 76) and a death group ( n = 34). The SDI, PCT, C-reactive protein (CRP), PCT/SDI, and CRP/SDI were compared and analyzed.

          Results

          Compared with the non-critical group, the critical group had a higher PCT level, a greater PCT/SDI ratio, a longer ventilator-assisted ventilation time (VAVT), and more deaths in 28 days. Compared with the survivors, the death group had a higher PCT level, a lower SDI level, and a greater PCT/SDI ratio. The SDI level was significantly negatively correlated with the VAVT ( r = −0.675, p < 0.05), while the PCT level, ratio of PCT/SDI, and ratio of CRP/SDI were remarkably positively correlated with VAVT ( r = 0.669, 0.749, and 0.718, respectively, p < 0.05). The receiver operating characteristic (ROC) curves analysis showed that the area under ROC curves of PCT/SDI predicting patient death within 28 days was 0.851, followed by PCT + SDI, PCT, SDI, and CRP/SDI (0.845, 0.811, 0.778, and 0.720, respectively). The sensitivity and specificity of PCT/SDI for predicting death were 94.1% and 65.8%, respectively, at the optimal value (11.56). Cox regression analysis displayed that PCT/SDI (HR = 1.562; 95% CI: 1.271 to 1.920; p = 0.039) and PCT (HR = 1.148; 95% CI: 1.105 to 1.314; p = 0.015) were independent predictors of death in patients.

          Conclusion

          The ratio of PCT/SDI was a more valuable marker in predicting the 28-day prognosis in patients with SBP.

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          Most cited references20

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          Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

          Joshua Metlay, Grant Waterer, Ann C Long … (2019)
          Background: This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia. Methods: A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations. Results: The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions. Conclusions: The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.
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            Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

            Andre Kalil, Mark L Metersky, Michael Klompas … (2016)
            It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel's recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews.
            Article 0 comments Cited 728 times – based on 0 reviews     Review now
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              Numerical index of the discriminatory ability of typing systems: an application of Simpson's index of diversity.

              P Hunter, M Gaston (1988)
              An index of discrimination for typing methods is described, based on the probability of two unrelated strains being characterized as the same type. This index may be used to compare typing methods and select the most discriminatory system.
              Article 0 comments Cited 208 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Cell Infect Microbiol
                Journal ID (iso-abbrev): Front Cell Infect Microbiol
                Journal ID (publisher-id): Front. Cell. Infect. Microbiol.
                Title: Frontiers in Cellular and Infection Microbiology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 2235-2988
                Publication date (Electronic): 03 July 2023
                Publication date Collection: 2023
                Volume: 13
                Electronic Location Identifier: 1175747
                Affiliations
                [1] 1 Department of Infection Control, Affiliated Hospital of Yangzhou University , Yangzhou, China
                [2] 2 Department of Critical Care Unit, Affiliated Hospital of Yangzhou University , Yangzhou, China
                [3] 3 Department of Neurology, Affiliated Hospital of Yangzhou University , Yangzhou, China
                Author notes

                Edited by: Jianmin Chai, Foshan University, China

                Reviewed by: Karthik Subramanian, Rajiv Gandhi Centre for Biotechnology, India; Rachele Invernizzi, Broad Institute, United States

                *Correspondence: Hongling Hou, hlhou@ 123456yzu.edu.cn ; Qing Shan, qingshan@ 123456yzu.edu.cn
                Article
                DOI: 10.3389/fcimb.2023.1175747
                PMC ID: 10350521
                SO-VID: 23d93d4b-a2af-4989-bffe-464df4c892f6
                Copyright © Copyright © 2023 Sun, Liu, Zheng, Shan and Hou
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 28 February 2023
                Date accepted : 12 June 2023
                Page count
                Figures: 3, Tables: 3, Equations: 1, References: 20, Pages: 9, Words: 3932
                Funding
                This work was supported by grants from the Hengrui Pharmacy Service Special Research Grant Project of Jiangsu Province Pharmaceutical Association, China (H202129) and the Pharmaceutical Research Project Sponsored by Tianqing Hospital of Jiangsu Province Pharmaceutical Association, China (Q202050).
                Categories
                Subject: Cellular and Infection Microbiology
                Subject: Original Research
                Custom metadata
                section-in-acceptance Microbiome in Health and Disease

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: bacterial pneumonia,bronchoalveolar lavage fluid,procalcitonin,simpson’s dominance index,predictive
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: bacterial pneumonia, bronchoalveolar lavage fluid, procalcitonin, simpson’s dominance index, predictive

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