Procalcitonin and neopterin correlation with aetiology and severity of pneumonia

Objective: Clinical outcome of pneumonia depends on a multifaceted treatment approach. Not only diagnostic methods but also early indicators of the degree of inflammatory response can aid in therapeutic decisions. The objective was to evaluate the usefulness of procalcitonin and neopterin in distinguishing among aetiotogies as well as severity in patients with pneumonia. Patients: A total of one hundred sixteen patients with clinical, radiographic and microbiological diagnosis of pneumonia were grouped by aetiotogy, pneumonia severity index, and by the presence of unilobar or multilobar radiographic pulmonary infiltrates. Procatcitonin and neopterin were measured by immunoassays. Results: Patients with pneumococcal pneumonia presented elevated procalcitonin and neopterin levels, being higher in bacteraemic than in non-bacteraemic pneumonia. Patients with Legionella pneumonia presented elevated neopterin levels and slightly elevated procalcitonin levels. Patients with tuberculosis and Pneumocystis jirovecii pneumonia presented elevated neopterin and Low or not detectable procalcitonin. Procalcitonin and neopterin levels were increased in high-risk classes of pneumonia severity index. Both parameters yielded significant correlation to the radiographic extent and also to young age. Conclusions: Procatcitonin and neopterin levels vary depending on age, aetiotogy and severity of pneumonia. Together with clinical and microbiological data, combined measurement can help to identify patients who might benefit from additional therapies. (c) 2005 The British Infection Society. Published by Elsevier Ltd. All rights reserved.