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How and when to use common biomarkers in community-acquired pneumonia
1Division of Pulmonology and Critical Care, Department of Internal Medicine, Area 552 Charlotte Maxeke Johannesburg Academic Hospital, Jubilee Road, Parktown, Johannesburg, 2193 South Africa.
Insights
Community-acquired pneumonia (CAP) remains a significant cause of death, with outcomes unchanged since the 1950s. Biomarkers show promise in predicting CAP patient outcomes and guiding treatment, aiding antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Biomarker Discovery
Background:
- Community-acquired pneumonia (CAP) is a major global cause of mortality, particularly affecting the very young and elderly.
- Despite advances, 30-day case fatality rates for CAP remain high (10-12%), with limited improvement in patient outcomes since the 1950s.
- Current strategies for identifying high-risk CAP patients include severity scores (e.g., pneumonia severity index, CURB-65) for ICU admission.
Purpose of the Study:
- To review the role of biomarkers in predicting mortality, complications, and treatment response in CAP patients.
- To highlight novel approaches for identifying CAP patients at risk of poor outcomes.
- To emphasize the utility of biomarkers in optimizing antibiotic therapy and supporting antibiotic stewardship.
Main Methods:
- Review of existing literature on biomarkers in Community-Acquired Pneumonia.
- Analysis of studies investigating the predictive value of various biomarkers for CAP outcomes.
- Examination of evidence for procalcitonin and C-reactive protein in assessing treatment response.
Main Results:
- Biomarkers have demonstrated efficacy in predicting mortality and complications in CAP.
- Certain biomarkers can effectively predict patient response to specific antibiotic treatments.
- Procalcitonin and C-reactive protein levels can guide treatment decisions and antibiotic stewardship.
Conclusions:
- Biomarkers offer a novel and effective method for risk stratification and outcome prediction in CAP.
- Monitoring biomarkers like procalcitonin and C-reactive protein can optimize antibiotic use and improve patient management.
- The use of biomarkers in CAP care supports evidence-based treatment and enhances antibiotic stewardship efforts.
Abstract:
Community-acquired pneumonia (CAP) is a leading cause of death in both the developed and developing world. The very young and elderly are especially vulnerable. Even with appropriate early antibiotics we still have not improved the outcomes in these patients since the 1950s, with 30-day case fatality rates of between 10-12%. Interventions to improve outcomes include immunomodulatory agents such as macrolides and corticosteroids. Treating doctors identify CAP patients who are likely to have poor outcomes by using severity scores such as the pneumonia severity index and CURB-65, which allows these patients to be placed in ICU settings from the start of the admission. Another novel way to identify these patients is with the use of biomarkers. This review illustrates how various biomarkers have been shown to predict mortality, complications and response to treatment in CAP patients. The evidence using either procalcitonin or C-reactive protein to demonstrate response to treatment and hence that the antibiotics chosen are appropriate can play an important role in antibiotic stewardship.
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