Применение полуколичественного экспресс-теста на прокальцитонин в диагностике внебольничной пневмонии у пациентов с ВИЧ-инфекцией

Abstract

Timely diagnosis of community-acquired pneumonia (CAP) and optimal timing of initiation of antibiotic therapy are important for reducing mortality in patients with HIV infection. It is reported that the assessment of procalcitonin (PCT) levels in this category of patients can be a useful diagnostic tool. Aim. To determine the levels of a new semi-quantitative rapid test (RT) for PCT in patients with CAP depending on the presence or absence of HIV infection. Design. Cross-sectional comparative study. Material and methods. The study involved 123 patients hospitalized with a diagnosis of CAP. 15 (12.2%) patients, including 10 (66.7%) men and 5 (33.3%) women (average age 59.3 ± 22.4 years), were diagnosed with HIV infection 3th stage. The comparison group included 108 people (48 (44.4%) men and 60 (55.6%) women, average age 48.1 ± 20.5 years) who did not have HIV infection. Before starting antibacterial therapy, all patients underwent a general clinical examination, the concentration of PCT in plasma was determined quantitatively using the enzyme-linked immunosorbent assay, as well as using a new semi-quantitative ET method using a one-step immunochromatographic analysis. Results. In the group of patients with CAP without HIV infection, borderline values of PCT ET (0.5 to < 2 ng/ml) were encountered 3.3 times more often than in patients with concomitant HIV infection (0.5 to < 2 ng/ml) — 22.2% versus 6.7 %; p = 0.030. High levels of PCT ET (from 2 to <10 ng/ml) were 7 times more likely to be detected in patients with CAP and HIV infection than without it - 13.3% versus 1.9%; p = 0.030. The quantitative content of PCT in the blood was also 4.5 times higher in patients with CAP in the presence of HIV infection (0.49 [0.11; 0.76] and 0.11 [0.01; 0.52] ng/ml; p = 0.038) relative to the comparison group. In the group of patients with CAP and HIV infection, a positive correlation was established between PCT RT and the degree of respiratory failure (r = 0.656; p = 0.008) and quantitative PCT (r = 0,453; р = 0,048), test negative correlations with the content of platelets (r = –0.542; p = 0.037), sodium (r = –0.700; p = 0.016 ) and saturation level (r = 0.335; p = 0.022). Conclusion. Patients with CAP and HIV infection in comparison with persons without HIV infection are characterized by higher PCT values determined by both classical quantitative and new semi-quantitative RT, which makes it possible to use the latter for rapid diagnosis of CAP in this group of patients. Key words: community-acquired pneumonia, HIV infection, diagnostics, procalcitonin, procalcitonin rapid test