* P < 0.05 compared with CAP.Morbidity and mortalityThe overall 28-day mortality rate was 18.3% (n = 32) and the median ICU length of stay (LOS) was 16 (9 to 28.5) days (range 1 to 142 days). The 28-day mortality was higher in patients http://www.selleckchem.com/products/GDC-0449.html with severe CAP compared with those with HAP or VAP (36.8% vs. 10.5% and 8.2%, respectively, P < 0.01 each). Likewise, the maximum degree of organ dysfunction as assessed by the maximum SOFA score was higher in CAP compared with HAP and VAP patients. PCT levels were consistently higher in non-survivors than survivors throughout the observation period (Figure (Figure2).2). Initial PCT values of VAP patients were significantly higher in non-survivors than in survivors with a median PCT of 0.6 ng/ml in the latter group (Figure (Figure3).3).

This difference between survivors and non-survivors was also observed in HAP but did not reach statistical significance. In the survivors, PCT values dropped to a median of 50.0% (27.3 to 100.0%) of the baseline value (P < 0.001) during the first five study days. A drop of similar magnitude with 53.7% (27.6 to 148.0%) was observed in the non-survivors without reaching statistical significance (P = 0.08).Figure 2Time course of procalcitonin levels in patients with pneumonia depending on survival. Box plot representing the time course of PCT over the two weeks following study enrolment in survivors and non-survivors. * P < 0.05 compared with survivors. ...Figure 3Initial PCT-values for CAP, HAP, and VAP separated for survivors and non-survivors. *: P < 0.05 (survivors vs. non-survivors), #: P < 0.

05 (Bonferroni corrected) compared to VAP.Initial and maximal PCT levels correlated with maximum SOFA score (r2 = 0. 51 and r2 = 0.57, respectively). The association between initial and maximum PCT levels and SOFA score was independent of the type of pneumonia (Figure (Figure4).4). In a ROC analysis on discrimination of 28-day mortality, the area under the curves (AUC) for maximum PCT, initial PCT, and admission-day APACHE II score were 0.74, 0.70, and 0.69, respectively (Figure (Figure5).5). The AUCs were not statistically different. The best cut-off of initial PCT to predict 28-day mortality was 1.1 ng/ml (odds ratio 7.0 (95% CI 2.6 to 25.2)) and that of the maximum PCT was 7.8 ng/ml (odds ratio 5.7 (95% CI 2.5 to 13.1)). The highest AUC was observed in VAP patients with 0.71 (95% CI 0.

92 to 1.01) compared to CAP with 0.41 (95% CI 0.24 to 0.92) and HAP with 0.56 (95% CI 0.58 to 0.96).Figure 4Correlation of initial or maximum PCT with maximum SOFA-score. Scatter plots representing the initial PCT (panel A) and the maximum PCT (panel B) vs. maximum SOFA score over the two weeks following inclusion. Square of correlation coefficients were r …Figure 5Receiver operator characteristic (ROC) curve for 28-day mortality prediction. Areas under the curve: maximum PCT AV-951 0.74 (95% CI: 0.65 to 0.83), initial PCT 0.70 (95% CI: 0.60 to 0.80), and APACHE II 0.