Procalcitonin, brain natriuretic peptide and albumin as markers to predict prognosis in hospitalized older Japanese patients with a risk of infection

• Published in: Geriatrics & gerontology international Vol. 24; no. 6; pp. 571 - 576
• Main Authors: Higashikawa, Toshihiro, Ito, Toru, Ito, Tomohiko, Mizuno, Takuro, Ishigami, Keiichirou, Kuroki, Kengo, Maekawa, Naoto, Usuda, Daisuke, Yoshida, Michiteru, Morita, Takuro, Hamada, Kazu, Yano, Hiroshi, Takeshima, Kento, Haraguchi, Takatoshi, Yamada, Shinya, Yamada, Sohsuke, Ushimoto, Tomoyuki, Sangen, Ryusho, Izumida, Toshihide, Kiyosawa, Jun, Ono, Taisuke, Iguchi, Masaharu, Wato, Yukihiro, Nakahashi, Takeshi, Kasamaki, Yuji, Fukuda, Akihiro, Kanda, Tsugiyasu, Morimoto, Shigeto, Okuro, Masashi
• Format: Journal Article
• Language: English
• Published: Kyoto, Japan John Wiley & Sons Australia, Ltd 01-06-2024; Blackwell Publishing Ltd
• Subjects: albumin; brain natriuretic peptide; Clinical outcomes; Elder care; Hospitalization; Infections; Medical prognosis; Mortality; Older people; Peptides; procalcitonin; Proteins; Survival analysis; Japan; brain natriuretic peptide; procalcitonin; hospitalization; albumin
• ISSN: 1444-1586; 1447-0594
• DOI: 10.1111/ggi.14887

Aim
Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection.
Methods
In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables.
Results
The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable‐adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5–2 versus <0.5 ng/mL: 1.61(1.04–2.49), PCT 2–10 versus <0.5 ng/mL: 1.91(1.15–3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84–4.59), high BNP 1.26 (0.89–1.76) and low Alb 0.68 (0.52–0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased.
Conclusions
Concentration‐dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; 24: 571–576.
These figures show Kaplan–Meier plots indicating cumulative survival rate according to four levels of procalcitonin concentration (<0.5, 0.5–2, 2–10 and ≥10 ng/mL), two levels of brain natriuretic peptide concentration (<300 and ≥300 pg/mL) and two levels of albumin concentration (<2.5 and ≥2.5 g/dL). The survival rate was decreased as the serum procalcitonin concentration increased from <0.5 to ≥10 ng/mL, as was also the case with brain natriuretic peptide concentration from <300 to ≥300 pg/mL, whereas low albumin (<2.5 g/dL) showed a lower survival rate than high albumin (≥2.5 g/dL; P < 0.01, by log‐rank test).