Can we predict pneumococcal bacteremia in patients with severe community-acquired pneumonia?

J Crit Care. 2013 Dec;28(6):970-4. doi: 10.1016/j.jcrc.2013.04.016.


Purpose: This study aimed to evaluate the role of biomarkers as markers of pneumococcal bacteremia in severe community-acquired pneumonia (SCAP).

Materials and methods: A prospective, single-center, observational cohort study of 108 patients with SCAP admitted to the intensive care department of a university hospital in Portugal was conducted. Leucocytes, C-reactive protein (CRP), lactate, procalcitonin (PCT), d-dimer, brain natriuretic peptide (BNP), and cortisol were measured within 12 hours after the first antibiotic dose.

Results: Fifteen patients (14%) had bacteremic pneumococcal pneumonia (BPP). They had significantly higher levels of median CRP (301 [interquartile range, or IQR], 230-350] mg/L vs 201 [IQR, 103-299] mg/L; P = .023), PCT (40 [IQR, 25-102] ng/mL vs 8 [IQR, 2-26] ng/mL; P < .001), BNP (568 [IQR, 478-2841] pg/mL vs 407 [IQR, 175-989] pg/mL; P = .027), and lactate (5.5 [IQR, 4.5-9.8] mmol/L vs 3.1 [IQR, 1.9-6.2] mmol/L; P = .009) than did patients without BPP. The discriminatory power evaluated by the area under the receiver operating characteristic curve (aROC) for PCT (aROC, 0.79) was superior to lactate (aROC, 0.71), BNP (aROC, 0.67), and CRP (aROC, 0.70). At a cutoff point of 17 ng/mL, PCT showed a sensitivity of 87%, a specificity of 67%, a positive predictive value of 30% and a negative predictive value of 97%, as a marker of pneumococcal bacteremia.

Conclusions: In this cohort, significantly higher PCT, BNP, lactate, and CRP levels were found in BPP, and PCT presented the best ability to identify pneumococcal bacteremia. A PCT serum level lower than 17 ng/mL could identify patients with SCAP unlikely to have pneumococcal bacteremia.

Keywords: 25th to 75th interquartile range; BNP; Bacteremia; Biomarkers; Brain natriuretic peptide; C-reactive protein; CAP; COPD; CRP; Community-acquired pneumonia; ICU; IQR; PCT; PIRO; PSI; Pneumococcus; Pneumonia Severity Index; Predisposition, Insult, Response, Organ Failure; Procalcitonin; ROC; SAPS; SD; SOFA; Sepsis-related Organ Failure Assessment; Simplified Acute Physiology Score; WBC; aROC; area under the receiver operating characteristics curve; chronic obstructive pulmonary disease; community-acquired pneumonia; intensive care unit; leukocyte count; procalcitonin; receiver operating characteristics; sTREM; soluble form of triggering receptor expressed on myeloid cells 1; standard deviation.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bacteremia / epidemiology
  • Bacteremia / microbiology*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism
  • Calcitonin / blood
  • Calcitonin Gene-Related Peptide
  • Community-Acquired Infections / blood*
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology*
  • Female
  • Health Status Indicators
  • Humans
  • Lactates / blood
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / blood
  • Pneumonia, Pneumococcal / blood*
  • Pneumonia, Pneumococcal / epidemiology
  • Portugal / epidemiology
  • Predictive Value of Tests
  • Prospective Studies
  • Protein Precursors / blood
  • Severity of Illness Index


  • Biomarkers
  • CALCA protein, human
  • Lactates
  • Protein Precursors
  • Natriuretic Peptide, Brain
  • Calcitonin
  • C-Reactive Protein
  • Calcitonin Gene-Related Peptide