Skip to main content

Advertisement

SpringerLink
Log in

Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Background

The use at bedside of C-reactive protein (CRP), procalcitonin (PCT) or mid-regional pro-atrial natriuretic peptide (ANP) has been advocated to help management of patients with community-acquired pneumonia (CAP) in emergency medicine.

Objective

To assess the effectiveness of CRP, PCT, and ANP measures in assisting emergency physicians deciding hospital admission for CAP with low risk of complication.

Design

Multicenter, prospective, observational study with blind evaluation.

Setting

Emergency departments of 12 French hospitals.

Patients

Five hundred forty-nine consecutive, immunocompetent adult patients with mild CAP.

Measurements

Centralized and blind measure of baseline CRP, PCT, and ANP; sensitivity, specificity, and positive and negative likelihood ratios for determining hospital admission. Gold standard for admission was defined by experts’ advice combined with admission requirement or death at 28 days. Optimal threshold values were determined by receiver operating characteristic (ROC) curves, and area under curve (AUC) of the three biomarkers was compared.

Results

According to gold standard, 310 (56%) patients required admission and 239 (44%) needed to be discharged. PCT and ANP levels increased with Pneumonia Severity Index risk categories. ANP (AUC 0.76 [95% CI 0.72–0.80]) more accurately predicted admission requirement than did PCT (AUC 0.65 [95% CI 0.61–0.70]) or CRP (AUC 0.59 [95% CI 0.54–0.64]) (both p values <0.01). We determined that 135 pmol/L was a threshold for ANP level to discriminate admission requirement (positive likelihood ratio 7.45 [95% CI 4.22–8.16]).

Conclusions

In a selected population of CAP with low risk of complication, a single ANP measurement was more accurate than CRP and PCT to predict appropriate admission. These results should be confirmed by additional studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Chahvakilian P (2001) Quelques données sur les infections bronchopulmonaires. In: Leophonte P, Mouton Y (ed) «Repères sur les infections pulmonaires», 3rd edn, pp 14–24. PIL ed. Feb 2001

  2. Garibaldi RA (1985) Epidemiology of community-acquired respiratory tract infections in adults: incidence, etiology, and impact. Am J Med 78:32–37

    Article  CAS  PubMed  Google Scholar 

  3. Kaplan V, Clermont G, Griffin MF, Kasal J, Watson RS, Linde-Zwirble WT, Angus DC (2003) Pneumonia: still the old man’s friend? Arch Intern Med 163:317–323

    Article  PubMed  Google Scholar 

  4. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554

    Article  PubMed  Google Scholar 

  5. Martin GS, Mannino DM, Moss M (2006) The effect of age on the development and outcome of adult sepsis. Crit Care Med 34:15–21

    Article  PubMed  Google Scholar 

  6. Lave JR, Lin CJ, Fine MJ, Hughes-Cromwick P (1999) The cost of treating patients with community-acquired pneumonia. Semin Respir Crit Care Med 20:189–197

    Article  Google Scholar 

  7. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, Musher DM, Fine MJ (2000) Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis 31:347–382

    Article  CAS  PubMed  Google Scholar 

  8. Niederman MS, Mandell LA, Anzueto A, Bass JB, Broughton WA, Campbell GD, Dean N, File T, Fine MJ, Gross PA, Martinez F, Marrie TJ, Plouffe JF, Ramirez J, Sarosi GA, Torres A, Wilson R, Yu VL, American Thoracic Society (2001) Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 163:1730–1754

    CAS  PubMed  Google Scholar 

  9. Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C, Infectious Diseases Society of America (2003) Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 37:1405–1433

    Article  PubMed  Google Scholar 

  10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336:243–250

    Article  CAS  PubMed  Google Scholar 

  11. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT (2003) Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58:377–382

    Article  CAS  PubMed  Google Scholar 

  12. Fine MJ, Stone RA, Singer DE, Colcy CM, Marrie TJ, Lave JR, Hough LJ, Obrosky S, Schulz R, Ricci EM, Rogers JC, Kapoor WN (1999) Processes and outcomes of care for patients with community-acquired pneumonia. Arch Intern Med 159:970–980

    Article  CAS  PubMed  Google Scholar 

  13. Labarere J, Stone RA, Obrosky DS, Yealy DM, Meehan TP, Fine JM, Graff LG, Fine MJ (2007) Comparision of outcome for low-risk outpatients and inpatients with pneumonia: a propensity-adjusted analysis. Chest 131:480–488

    Article  PubMed  Google Scholar 

  14. Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK (2003) Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest 124:2148–2155

    Article  PubMed  Google Scholar 

  15. Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, Kovacs G, Mitchell M, Lewandowski B, Kovacs MJ (2003) Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 349:1227–1235

    Article  CAS  PubMed  Google Scholar 

  16. Hamm CW, Goldmann BU, Heescen C, Kreymann G, Berger J, Meinertz T (1997) Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or troponin I. N Engl J Med 337:1648–1653

    Article  CAS  PubMed  Google Scholar 

  17. Christ-Crain M, Jaccard-Stolz D, Bingisser R, Gencay MM, Huber PR, Tamm M, Muller B (2004) Effect of procalcitonin-guided treatment on antibiotic use and outcome in lower respiratory tract infections: cluster-randomised, single-blinded intervention trial. Lancet 36:3600–3607

    Google Scholar 

  18. Hausfater P, Garric S, Ayed SB, Rosenheim M, Bernard M, Riou B (2002) Usefulness of procalcitonin as a marker of systemic infection in emergency department patients: a prospective study. Clin Infect Dis 34:895–901

    Article  CAS  PubMed  Google Scholar 

  19. Almirall J, Bolibar I, Toran P, Pera G, Boquet X, Balanzo X, Sauca G, Community-Acquired Pneumonia Maresme StudyGroup (2004) Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 125:1335–1342

    Article  PubMed  Google Scholar 

  20. Smith RP, Lipworth BJ (1995) C-reactive protein in simple community-acquired pneumonia. Chest 107:1028–1031

    Article  CAS  PubMed  Google Scholar 

  21. Korppi M, Heiskanen-Kosma T, Leinonen M (1997) White blood cells, C-reactive protein and erythrocyte sedimentation rate in pneumococcal pneumonia in children. Eur Respir J 10:1125–1129

    Article  CAS  PubMed  Google Scholar 

  22. McCarthy PL, Frank AL, Ablow RC, Masters SJ, Dolan TF Jr (1978) Value of the C-reactive protein in the differentiation of bacterial and viral pneumonia. J Paediatr 92:454–456

    Article  CAS  Google Scholar 

  23. Ortqvist A, Hedlund J, Wretlind B, Carlstrom A, Kalin M (1995) Diagnostic and prognostic value of IL-6 and C-reactive protein in community-acquired pneumonia. Scand J Infect Dis 27:457–462

    Article  CAS  PubMed  Google Scholar 

  24. Morgenthaler NG, Struck J, Christ-Crain M, Bergmann A, Muller B (2005) Pro-atrial natriuretic peptide is a prognostic marker in sepsis, similar to the APACHE II score: an observational study. Crit Care 9:R37–R45

    Article  PubMed  Google Scholar 

  25. (2006) [15 consensus conference in infectious disease. Management of community-acquired pneumonia in immunocompetent adults]. Med Mal Infect 36:235–244

  26. Aujesky D, Auble TE, Yealy DM, Stone RA, Obrosky DS, Meehan TP, Graff LG, Fine JM, Fine MJ (2005) Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 118:384–392

    Article  PubMed  Google Scholar 

  27. Pascal P, Beyerle F (2006) Quality standards for medical laboratories. Pathol Biol 54:317–324

    Article  CAS  PubMed  Google Scholar 

  28. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  CAS  PubMed  Google Scholar 

  29. Irwig L, Bossuyt P, Glasziou P, Gatsonis C, Lijmer J (2002) Designing studies to ensure that estimates of test accuracy are transferable. BMJ 324:669–671

    Article  PubMed  Google Scholar 

  30. Knottnerus JA, van Weel C, Muris JW (2002) Evaluation of diagnostic procedures. BMJ 324:477–480

    Article  PubMed  Google Scholar 

  31. Pewsner D, Battaglia M, Minder C, Marx A, Bucher HC, Egger M (2004) Ruling a diagnosis in or out with “SpPIn” and “SnNOut”: a note of caution. BMJ 329:209–213

    Article  PubMed  Google Scholar 

  32. Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH, The Canadian CAP Working Group (2000) Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society; the Canadian Community-Acquired Working group. Clin Infect Dis 31:383–421

    Article  CAS  PubMed  Google Scholar 

  33. Goss CH, Rubenfeld GD, Park DR, Sherbin VL, Goodman MS, Root RK (2003) Cost and incidence of social comorbidities in low-risk patients with community-acquired pneumonia admitted to a public hospital. Chest 124:2148–2155

    Article  PubMed  Google Scholar 

  34. Carratala J, Fernandez-Sabe N, Ortega L, Castellsague X, Roson B, Dorca J, Fernandez-Aguera A, Verdaguer R, Martınez J, Manresa F, Gudiol F (2005) Outpatient care compared with hospitalization for community-acquired pneumonia. Ann Intern Med 142:165–172

    PubMed  Google Scholar 

  35. Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H, Moritz F, Cibien JF, Guérin T, Carré E, Lafontaine A, Bertrand MP, Santin A, Brun-Buisson C, Fine MJ, Roupie E, Pneumocom Study Investigators (2007) Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter prospective observational controlled cohort study. Clin Infect Dis 44:41–49

    Article  PubMed  Google Scholar 

  36. Renaud B, Coma E, Hayon J, Gurgui M, Longo C, Blancher M, Jouannic I, Betoulle S, Roupie E, PNEUMOCOM Fine MJ study investigators (2007) Investigation of the ability of the Pneumonia Severity Index to accurately predict clinically relevant outcomes: a European study. Clin Microbiol Infect 13:923–931

    Article  CAS  PubMed  Google Scholar 

  37. Masiá M, Gutiérrez F, Shum C, Padilla S, Navarro JC, Flores E, Hernández I (2005) Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 128:2223–2229

    Article  PubMed  Google Scholar 

  38. Hausfater P, Juillien G, Madonna-Py B, Haroche J, Bernard M, Riou B (2007) Serum procalcitonin measurement as diagnostic and prognostic marker in febrile adult patients presenting to the emergency department. Crit Care 11:R60

    Article  PubMed  Google Scholar 

  39. Hedlund J, Hansson LO (2000) Procalcitonin and C-reactive protein levels in community-acquired pneumonia: correlation with etiology and prognosis. Infection 28:68–73

    Article  CAS  PubMed  Google Scholar 

  40. Polzin A, Pletz M, Erbes R, Raffenberg M, Mauch H, Wagner S, Arndt G, Lode H (2003) Procalcitonin as a diagnostic tool in lower respiratory tract infections and tuberculosis. Eur Respir J 21:939–943

    Article  CAS  PubMed  Google Scholar 

  41. Huang DT, Weissfeld LA, Kellum JA, Yealy DM, Kong L, Martino M, Angus DC, for the GenIMS Investigators (2008) Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med 52:48–58

    Article  PubMed  Google Scholar 

  42. Boussekey N, Leroy O, Georges H, Devos P, d’Escrivan T, Guery B (2005) Diagnostic and prognostic values of admission procalcitonin levels in community-acquired pneumonia in an intensive care unit. Infection 33:257–263

    Article  CAS  PubMed  Google Scholar 

  43. Christ-Crain M, Stolz D, Bingisser R, Müller C, Miedinger D, Huber PR, Zimmerli W, Harbarth S, Tamm M, Müller B (2006) Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 174:84–93

    Article  CAS  PubMed  Google Scholar 

  44. Smith RP, Lipworth BJ (1995) C-reactive protein in simple community-acquired pneumonia. Chest 107:1028–1031

    Article  CAS  PubMed  Google Scholar 

  45. Krüger S, Ewig S, Marre R, Papassotiriou J, Richter K, von Baum H, Suttorp N, Welte T, CAPNETZ Study Group (2008) Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 31:349–355

    Article  PubMed  Google Scholar 

  46. Krüger S, Papassotiriou J, Marre R, Richter K, Schumann C, von Baum H, Morgenthaler NG, Suttorp N, Welte T, CAPNETZ Study Group (2007) Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med 33:2069–2078

    Article  PubMed  Google Scholar 

  47. Masiá M, Papassotiriou J, Morgenthaler NG, Hernández I, Shum C, Gutiérrez F (2007) Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia. Clin Chem 53:2193–2201

    Article  PubMed  Google Scholar 

  48. Prat C, Lacoma A, Dominguez J, Papassotiriou J, Morgenthaler NG, Andreo F, Tudela P, Ruiz-Manzano J, Ausina V (2007) Midregional pro-atrial natriuretic peptide as a prognostic marker in pneumonia. J Infect 55:400–407

    Article  PubMed  Google Scholar 

  49. Meleagros L, Gibbs JS, Ghatei MA, Bloom SR (1988) Increase in plasma concentrations of cardiodilatin (amino terminal pro-atrial natriuretic peptide) in cardiac failure and during recumbency. Br Heart J 60:39–44

    Article  CAS  PubMed  Google Scholar 

  50. Wang TJ, Larson MG, Levy D, Benjamin EJ, Leip EP, Omland T, Wolf PA, Vasan RS (2004) Plasma natriuretic peptide levels and the risk of cardiovascular events and death. N Engl J Med 350:655–663

    Article  CAS  PubMed  Google Scholar 

  51. Vila G, Resl M, Stelzeneder D, Struck J, Maier C, Riedl M, Hülsmann M, Pacher R, Luger A, Clodi M (2008) Plasma NT-proBNP increases in response to LPS administration in healthy men. J Appl Physiol 105:1741–1745

    Article  CAS  PubMed  Google Scholar 

  52. Pirracchio R, Deye N, Lukaszewicz AC, Mebazaa A, Cholley B, Matéo J, Mégarbane B, Launay JM, Peynet J, Baud F, Payen D (2008) Impaired plasma B-type natriuretic peptide clearance in human septic shock. Crit Care Med 36:2542–2546

    Article  CAS  PubMed  Google Scholar 

  53. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, Lijmer JG, Moher D, Rennie D, de Vet HC, Standards for Reporting of Diagnostic Accuracy (2003) Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Ann Intern Med 138:40–44

    PubMed  Google Scholar 

Download references

Acknowledgments

We are indebted to Prof. Jean-Marc Treluyer, Dr. Raphaël Serreau, Mélanie Anoussamy, Cécile Klochendler, Sandra Colas, and the staff of the Clinical Research Department (Unité de Recherche Clinique, URC), Cochin-Paris Centre for their valuable technical and logistical support. We would like to thank Dr. Romain Lecomte and Brahms, Inc. for providing the Kryptor and corresponding reagents to obtain high-quality levels of PCT and ANP. We thank Dr. Ohanessian Ekindjian who supervised measurement of biomarkers. We acknowledge Prof. Patrick Gerbeaux, Dr. Julien Charpentier, and Dr. David Boutoille, who reviewed each patient’s chart for the need of admission. This study was supported by the “Délégation Régionale de la Recherche Clinique,” APHP, Paris, France, and we acknowledge grant support by the Programme Hospitalier de Recherche Clinique, 2003.

Conflict of interest statement

None.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Hôpital Cochin, APHP, 27 rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France

    Yann-Erick Claessens

  2. Department of Emergency Medicine, Hôpital Gabriel Montpied, 58 rue Montalembert, 63003, Clermont-Ferrand Cedex 1, France

    Thierry Mathevon

  3. Department of Emergency Medicine, Hôpital Hôtel-Dieu, APHP, 1, place du Parvis Notre-Dame, 75181, Paris Cedex 4, France

    Gérald Kierzek

  4. Department of Biostatistics, Hôpital Cochin, APHP, 27 rue du Faubourg Saint-Jacques, 75679, Paris Cedex 14, France

    Sophie Grabar & David Jegou

  5. Department of Emergency Medicine, Hôpital Hôtel-Dieu, Place Alexis Ricordeau, 44093, Nantes Cedex 1, France

    Eric Batard

  6. Department of Emergency Medicine, Hôpital Sainte-Camille, 2 rue des Pères Camilliens, 94366, Bry-sur-Marne, France

    Clarisse Loyer

  7. Department of Emergency Medicine, Hôpital Européen Georges Pompidou, APHP, 20-40 rue Leblanc, 75908, Paris Cedex 15, France

    Alain Davido

  8. Department of Emergency Medicine, Hôpital Pitié-Salpétriêre, APHP, 47-83, boulevard de l’Hôpital, 75651, Paris Cedex 13, France

    Pierre Hausfater

  9. Division of Anesthesiology, Critical Care, Pain and Emergency Medicine, University Hospital Carémeau, Rue du Professeur Debré, 30029, Nîmes Cedex 9, France

    Hélène Robert

  10. Department of Emergency Medicine, Hôpital Beaujon, AP-HP, 100 boulevard du Général Leclerc, 92110, Clichy Cedex, France

    Leila Lavagna-Perez

  11. Department of Emergency Medicine, Hôpital Jean Verdier, APHP, Avenue du 14 Juillet, 93140, Bondy, France

    Bruno Bernot

  12. Department of Emergency Medicine, Hôpital Lariboisière, APHP, 2 rue Ambroise-Paré, 75475, Paris Cedex 10, France

    Patrick Plaisance

  13. Department of Emergency Medicine, Hôpital Louis Mourier, APHP, 178 1 rue des Renouillers, 92701, Colombes Cedex, France

    Christophe Leroy

  14. Department of Emergency Medicine, Hôpital Henri Mondor, APHP, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France

    Bertrand Renaud

  15. Université Paris Descartes, 1, place de l’Odéon, 75005, Paris, France

    Yann-Erick Claessens, Gérald Kierzek, Sophie Grabar & David Jegou

Authors
  1. Yann-Erick Claessens
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thierry Mathevon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gérald Kierzek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sophie Grabar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Jegou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Batard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Clarisse Loyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Alain Davido
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Pierre Hausfater
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hélène Robert
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Leila Lavagna-Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Bruno Bernot
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Patrick Plaisance
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Christophe Leroy
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Bertrand Renaud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yann-Erick Claessens.

Additional information

On behalf of the BIS Study Group.

The members of BIS Study Group are given in Appendix

Appendix

Appendix

Cochin (Paris, France): J.C Allo, C. Barbotin, J.C Boulard, Y.E Claessens (P.I), A. Dabreteau, G. Der Sahakian, S. Esain, A. Gayet, C. Ginsburg (P.I), I. Iraqi-Chentouf, J Kansao, F. Lecomte, I. Mazariegos, O. Meyniard, F. Perruche, S. Pineau, R. Ranerison, K. Takun, C. Vartanian, L. Zarnitsky; Pitié-Salpétrière (Paris, France): R. Achkar, K. An, A. Arhan, M. Bendahou, J.F Benezet, P. Bonnet, A. Dardalon, N Delot-ElFakhri, S. Delerm, P. Hausfater (P.I), M.O Josse, J.S Marx, B. Madonna-Py, P. Ray, B. Riou, K. Saighi, B. Wellner; Hôpital Caremeau (Nîmes, France): P.G Claret, J.E de la Coussaye, T. Duclos, J. Flechet, P. Fournier, A. Gache, F. Hernandez, C. Hilaire, F. Jourdan, G. Kayser, S. Louvard, O. Onde, O. Paul, I. Rajeebally, P. Richard, H. Robert (P.I), J. Rousset, E. Vernes, P. Wagner-Kerdranvat; Hôpital Gabriel Montpied (Clermont-Ferrand, France): C. Billault, S. Boizat, A. Bommelaer, J.L Buisson, C. Carrias, M. Entwhistle, E. Jehle, A. Lenat, J. Liotier, T. Mathevon (P.I), C. Perrier, D. Pic, C. Pourrat, C. Rougier, J. Schmidt, F. Vaysse; Hôtel-Dieu (Nantes, France): I. Arnaudet, N. Asseray-Madani, P. Auneau, E. Batard (P.I), J. Dary, S. DiBernardo, D. ElKouri, C. Ferron, I. Gueffet, J. Jenvrin, V. Kuczer, P. Leconte, E. Legeard, C. Longo, J. Lorber, G. Potel, M.D Touze, D. Trewick, F. Vignaud, D. Yatim-Lequeret; Hôtel-Dieu (Paris, France): M. Baud, M.L Catinois, D. Cantin-Bertaux, F. Dumas, T. Jactat, L. Kachout, G. Kierzek (P.I), E. Hinglais, G. LeGuerrroue, J.L Pourriat, F. Trarieux, C. Wertheimer; Hôpital Européen Geoges Pompidou (Paris, France): M. Aitkaci, M.C Ballester, M Bouyx, T.H Cao, A. Davido, A. Gounaropoulos, A. Levy, O. Limaiem-Joumni, R. Masmoudi, C. Moreau, P. Meraud, A. Patzak (P.I), M.P Playe, M.P Sadier, N. Smbach, A. Severin, C. Vidal; Hôpital Bicêtre (Kremlin-Bicête, France): C. Choquet, J. Depret-Vassal, T. Gudj, S. Sarnel; Hôpital Bichat-Claude Bernard (Paris, France): M. Aliouane, E. Casalino (P.I), M. Dimitroff, LB. Rimaud, P. Werner; Hôpital Jean-Verdier (Bondy, France): J. Benkel, B. Bernot, C. Chassaignon, E. Debuc, G. Lenoir, D. Pateron (P.I), F. Pevirieri; Hôpital Lariboisière (Paris, France): C. Aparicio, J. Boni-Malka, J.P Courret, A. Debatisse, B. Galichon, S. Gallula, P. Gamand, S. Laribi, K. Mezaib, L. Pasgrimaud, F. Penit, P. Plaisance (P.I), F. Renai; Hôpital Louis Mourier (Colombes, France): A. Briere-Savard, P. Brun (P.I), B. Canderan, S. Hirsch, C. Lagarde, C. Leroy, F. Nikpay-Aslie, R. Sadat, F. Tessiere; Hôpital Sainte-Camille (Bry-sur-Marne, France): P. Collet, P. Hamlin, P. Lebrin, C. Loyer, G. Pinello, L.V.P Vong. Hôpital Beaujon (Clichy, France): P. Juvin, L. Lavagna-Perez (P.I).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Claessens, YE., Mathevon, T., Kierzek, G. et al. Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia. Intensive Care Med 36, 799–809 (2010). https://doi.org/10.1007/s00134-010-1818-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-010-1818-4

Keywords

Search

Navigation