Aging Clinical and Experimental Research

, Volume 30, Issue 2, pp 193–197 | Cite as

Combined use of the multidimensional prognostic index (MPI) and procalcitonin serum levels in predicting 1-month mortality risk in older patients hospitalized with community-acquired pneumonia (CAP): a prospective study

  • Alberto Pilotto
  • Simone Dini
  • Julia Daragjati
  • Manuela Miolo
  • Monica Maria Mion
  • Andrea Fontana
  • Mario Lo Storto
  • Martina Zaninotto
  • Alberto Cella
  • Paolo Carraro
  • Filomena Addante
  • Massimiliano Copetti
  • Mario Plebani
Short Communication

Abstract

Background

Several scores and biomarkers, i.e., procalcitonin (PCT), were proposed to stratify the mortality risk in community-acquired pneumonia (CAP).

Aim

Evaluating prognostic accuracy of PCT and Multidimensional Prognostic Index (MPI) for 1-month mortality risk in older patients with CAP.

Methods

At hospital admission and at discharge, patients were evaluated by a Comprehensive Geriatric Assessment to calculate MPI. Serum PCT was measured at admission and 1, 3, and 5 days after hospital admission.

Results

49 patients were enrolled. The overall 1-month mortality was 44.5 for 100-persons year. Mortality rates were higher with the increasing of MPI. In survived patients, MPI at discharge showed higher predictive accuracy than MPI at admission. Adding PCT levels to admission MPI prognostic accuracy for 1-month mortality significantly increased.

Conclusion

In older patients with CAP, MPI significantly predicted 1 month mortality. PCT levels significantly improved the accuracy of MPI at admission in predicting 1-month mortality.

Keywords

Community-acquired pneumonia Elderly Procalcitonin, Multidimensional prognostic index 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Jackson ML, Neuzil KM, Thompson WW et al (2004) The burden of community-acquired pneumonia in seniors: results of a population-based study. Clin Infect Dis 39:1642–1650CrossRefPubMedGoogle Scholar
  2. 2.
    Fung HB, Monteagudo-Chu MO (2010) Community-acquired pneumonia in the elderly. Am J Geriatr Pharmacother 8:47–62CrossRefPubMedGoogle Scholar
  3. 3.
    Carey EC, Covinsky KE, Lui LY et al (2008) Prediction of mortality in community-living frail elderly people with long-term care needs. J Am Geriatr Soc 56:68–75CrossRefPubMedGoogle Scholar
  4. 4.
    Pilotto A, Ferrucci L, Franceschi M et al (2008) Development and validation of a multidimensional prognostic index for one-year mortality from comprehensive geriatric assessment in hospitalized older patients. Rejuvenation Res 11:151–161CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Yourman LC, Lee SJ, Schonberg MA, Widera EW, Smith AK (2012) Prognostic indices for older adults: a systematic review. JAMA 307:182–192CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Pilotto A, Addante F, Ferrucci L et al (2009) The Multidimensional Prognostic Index predicts short- and long-term mortality in hospitalized geriatric patients with pneumonia. J Gerontol A Biol Sci Med 64A:880–887CrossRefGoogle Scholar
  7. 7.
    Ito A, Ishida T, Tachibana H et al (2016) Serial procalcitonin levels for predicting prognosis in community-acquired pneumonia. Respirology 21:1459–1464CrossRefPubMedGoogle Scholar
  8. 8.
    Lapin SV, Maslianskiĭ AL, Lazareva NM et al (2013) The value of quantitative analysis of procalcitonine in diagnostics of septic complications in patients with autoimmune rheumatic diseases. Klin Lab Diagn 1:28–33Google Scholar
  9. 9.
    Fine MJ, Auble TE, Yealy DM et al (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250CrossRefPubMedGoogle Scholar
  10. 10.
    Lee SH, Chan RC, Wu JY et al (2013) Diagnostic value of procalcitonin for bacterial infection in elderly patients- a systematic review and meta-analysis. Int J Clin Pract 67:1350–1357CrossRefPubMedGoogle Scholar
  11. 11.
    Schuetz P, Christ-Crain M, Thomann R et al (2009) Effect of procalcitonin-based guidelines vs standard guidelines on antibiotic use in lower respiratory tract infections: the ProHOSP randomized controlled trial. JAMA 302:1059–1066CrossRefPubMedGoogle Scholar
  12. 12.
    Lacoma A, Rodriguez N, Prat C et al (2012) Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 31:823–833CrossRefGoogle Scholar
  13. 13.
    Kruger S, Ewig S, Marre R et al (2008) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia. Eur Resp J 31:349–355CrossRefGoogle Scholar
  14. 14.
    Pilotto A, Cella A, Pilotto A et al (2017) Three decades of comprehensive geriatric assessment: evidence coming from different healthcare settings and specific clinical conditions. J Am Med Dir Assoc 18:192.e1–192.e11CrossRefGoogle Scholar
  15. 15.
    Faverio P, Aliberti S, Bellelli G et al (2014) The management of community acquired pneumonia in the elderly. Eur J Intern Med 25:312–319CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Alberto Pilotto
    • 1
  • Simone Dini
    • 1
  • Julia Daragjati
    • 2
  • Manuela Miolo
    • 3
  • Monica Maria Mion
    • 3
  • Andrea Fontana
    • 4
  • Mario Lo Storto
    • 2
  • Martina Zaninotto
    • 3
  • Alberto Cella
    • 1
  • Paolo Carraro
    • 3
  • Filomena Addante
    • 4
  • Massimiliano Copetti
    • 4
  • Mario Plebani
    • 3
  1. 1.Department of Geriatric Care, Orthogeriatrics and Rehabilitation, Frailty AreaE.O. Galliera Hospital, National Relevance & High Specialization HospitalGenovaItaly
  2. 2.Geriatrics unitAzienda ULSS 16PadovaItaly
  3. 3.Department of Laboratory MedicineAzienda ULSS 16 and Azienda OspedalieraPadovaItaly
  4. 4.IRCCS Casa Sollievo della SofferenzaSan Giovanni RotondoItaly

Personalised recommendations