The behavior and diagnostic utility of procalcitonin and five other inflammatory molecules in critically ill patients with respiratory distress and suspected 2009 influenza a H1N1 infection

During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients...

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Bibliographic Details
Published in:	Clinics (São Paulo, Brazil) Vol. 67; no. 4; pp. 327 - 334
Main Authors:	Paiva, Mariana Benevides Santos, Botoni, Fernando Antônio, Teixeira, Antônio Lúcio, de Miranda, Aline Silva, de Oliveira, Clara Rodrigues Alves, de Oliveira Abrahão, Jamila, Faria, Guilherme Marques, Nobre, Vandack
Format:	Journal Article
Language:	English
Published:	Brazil Elsevier España, S.L.U 01-01-2012 Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo Faculdade de Medicina / USP Elsevier España
Subjects:	Adolescent Adult Biomarker Biomarkers - blood C-reactive protein C-Reactive Protein - analysis Calcitonin - blood Calcitonin Gene-Related Peptide Clinical Science Critical Illness Diagnosis, Differential Female Humans Influenza A Virus, H1N1 Subtype Influenza, Human - complications Influenza, Human - diagnosis Interleukin-1beta - blood Male MEDICINE, GENERAL & INTERNAL Prospective Studies Protein Precursors - blood Real-Time Polymerase Chain Reaction Respiratory Distress Syndrome, Adult - etiology Sensitivity Severe respiratory distress syndrome Specificity Virus Diseases - diagnosis Young Adult Biomarker Sensitivity Specificity C-reactive protein Severe respiratory distress syndrome
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Summary:	During the 2009 influenza A H1N1 pandemic, it became difficult to differentiate viral infections from other conditions in patients admitted to the intensive care unit. We sought to evaluate the behavior and diagnostic utility of procalcitonin, C-reactive protein and four other molecules in patients with suspected 2009 Influenza A H1N1 infection. The serum levels of procalcitonin, C-reactive protein, tumor necrosis factor α, interferon γ, interleukin 1β, and interleukin 10 were tested on admission and on days 3, 5, and 7 in 35 patients with suspected 2009 H1N1 infection who were admitted to two ICUs. Twelve patients had confirmed 2009 influenza A H1N1 infections, 6 had seasonal influenza infections, and 17 patients had negative swabs. The procalcitonin levels at inclusion and on day 3, and the C-reactive protein levels on day 3 were higher among subjects with 2009 influenza A H1N1 infections. The baseline levels of interleukin 1β were higher among the 2009 influenza A H1N1 patients compared with the other groups. The C-reactive protein levels on days 3, 5, and 7 and procalcitonin on days 5 and 7 were greater in non-surviving patients. Higher levels of procalcitonin, C-reactive protein and interleukin-1β might occur in critically ill patients who had a 2009 H1N1 infection. Neither procalcitonin nor CRP were useful in discriminating severe 2009 H1N1 pneumonia. Higher levels of CRP and procalcitonin appeared to identify patients with worse outcomes.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Paiva MB designed the study, supervised data collection, collected data, and drafted the manuscript. Botoni FA participated in the study design and data collection. Teixeira Jr AL and Miranda AS performed the immunoassays. Oliveira CRA and Abrahão JO helped to draft the manuscript. Faria GM helped with the data collection. Nobre V conceived the study, participated in its design and coordination and helped to draft the manuscript.
ISSN:	1807-5932 1980-5322 1980-5322
DOI:	10.6061/clinics/2012(04)05