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Master Thesis

Évaluation de l'intérêt diagnostique du dosage de la procalcitonine dans la pneumonie d'inhalation communautaire de l'adulte

Abstract : Introduction: Aspiration pneumonia (AP) is a complication of coma that can have chemical and/or bacterial clinical presentation. Quick determination of inhalation type may avoid unjustified antibiotic therapy. Procalcitonin (PCT) is an interesting biomarker to differentiate sepsis and inflammation. Our study aimed at evaluating the PCT assay value in the diagnosis of AP. Methods: Prospective, single-­‐center study, in 103 patients admitted to intensive care for coma. AP was diagnosed upon a positive bacteriological sampling and suggestive clinical picture (radiological infiltrate, fever, cough, sputum, dyspnea, pleuritic pain, encephalopathy, pulmonary condensation syndrome, leukocytosis). Assays of PCT, CRP and leukocytosis were carried out at H0, H6, H12, D1 and up to ICU discharge. The areas under the ROC curve (AUC) and likelihood ratios (LRs) were calculated for the threshold values to the best compromise of sensitivity and specificity. Results: In patients with AP, PCT significantly increased from H0 to D3. PCT’s AUC at H0, H6 and D2 were greater than those of CRP and leukocytes with respectively: (0.63 versus 0.58 and 0.53); (0.69 versus 0.63 and 0.54) and (0.73 versus 0.72 and 0.58). At H12, AUC demonstrated (0.68 versus 0.70 and 0.58) and at H24 (0.69 versus 0.73 and 0.66). LR of PCT were: H0 (0.068 ng / mL, 1, LR+, LR-­‐ 0.7); H6 (0.09 ng / mL, LR+ 2, LR-­‐ 0.5); H12 (0.13 ng / mL, LR+ 2.3, LR-­‐ 0.5); H24 (0.19 ng / mL, LR+ 3.5, LR-­‐0.5) and Day 2 (0.1 ng / mL, LR+ 2.7, LR-­‐ 0.4). Conclusion: PCT measurement is better than CRP and leukocytosis in the early dignosis of AP. Its moderate diagnostic value limits its contribution in the initiation antibiotic therapy in this context.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01252354
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Submitted on : Thursday, January 7, 2016 - 2:48:22 PM
Last modification on : Friday, October 23, 2020 - 4:42:52 PM
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Bénédicte Grigoresco. Évaluation de l'intérêt diagnostique du dosage de la procalcitonine dans la pneumonie d'inhalation communautaire de l'adulte. Médecine humaine et pathologie. 2015. ⟨dumas-01252354⟩

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