Pneumology - Original Articles
June 12, 2025

Pentraxin-3 as a novel biomarker in predicting outcomes of nosocomial pneumonia: a prospective observational study

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
0
Views
0
Downloads

Authors

Pneumonia, among all nosocomial infections, is known for its dismal prognosis, imposing substantial morbidity and mortality. While the diagnostic performance of various blood biomarkers has undergone scrutiny, their prognostic implications remain relatively unexplored. This study aimed to evaluate the prognostic significance of clinical factors, microbial etiology, and blood biomarkers, including procalcitonin, C-reactive protein (CRP), and pentraxin-3, in determining the outcome of nosocomial pneumonia. We enrolled 72 patients with microbiologically confirmed hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Patient data comprising demographics, comorbidities, duration of hospitalization, isolated pathogen, and laboratory parameters, including CRP, procalcitonin, and pentraxin-3 levels, were compiled to assess their correlation with 28-day survival outcomes. The study included 58 VAP and 14 HAP patients. The mean age was 52.78±16.98 years, and the majority were males (68.06%). Out of 72, 30 (41.67%) died. Carbapenem-resistant Acinetobacter baumannii (44.44%) and Carbapenem-resistant Enterobacteriaceae (25%) were the most common isolated pathogens. On univariate analysis, male gender, smoking, opium addiction, underlying neurological condition as comorbidity, presence of septic shock, elevated blood urea, and serum pentraxin-3 levels were significantly associated with 28-day mortality. However, multivariate analysis of subgroup data revealed serum pentraxin-3 levels to be an independent risk factor for mortality in VAP patients. Serum pentraxin-3 levels may be a potential and superior prognostic marker compared to CRP and procalcitonin in predicting mortality in VAP patients.

Altmetrics

Downloads

Download data is not yet available.

Citations

Magill SS, Edwards JR, Fridkin SK, Emerging Infections Program Healthcare-Associated Infections Antimicrobial Use Prevalence Survey Team. Survey of health care-associated infections. N Engl J Med 2014;370:2542-3. DOI: https://doi.org/10.1056/NEJMc1405194
Melsen WG, Rovers MM, Groenwold RH, et al. Attributable mortality of ventilator associated pneumonia: a meta-analysis of individual patient data from randomised prevention studies. Lancet Infect Dis 2013;13:665-71. DOI: https://doi.org/10.1016/S1473-3099(13)70081-1
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016;63:e61-111.
Kollef MH: Ventilator-associated pneumonia. JAMA 1993;270:1965-70. DOI: https://doi.org/10.1001/jama.1993.03510160083034
Ugarte H, Silva E, Mercan D, et al. Procalcitonin used as a marker of infection in the intensive care unit. Crit Care Med 1999;27:498-504. DOI: https://doi.org/10.1097/00003246-199903000-00024
Yentis SM, Soni N, Sheldon J. C-reactive protein as an indicator of resolution of sepsis in the intensive care unit. Intensive Care Med 1995;21:602-5. DOI: https://doi.org/10.1007/BF01700168
Luyt CE, Guerin V, Combes A, et al. Procalcitonin kinetics as a prognostic marker of ventilator-associated pneumonia. Am J Respir Crit Care Med 2005;171:48-53. DOI: https://doi.org/10.1164/rccm.200406-746OC
Pettila V, Hynninen M, Takkunen O, et al. Predictive value of procalcitonin and interleukin 6 in critically ill patients with suspected sepsis. Intensive Care Med 2002;28:1220-5. DOI: https://doi.org/10.1007/s00134-002-1416-1
Wanner GA, Keel M, Steckholzer U, et al. Relationship between procalcitonin plasma levels and severity of injury, sepsis, organ failure, and mortality in injured patients. Crit Care Med 2000;28:950-7. DOI: https://doi.org/10.1097/00003246-200004000-00007
Guo S, Mao X, Liang M. The moderate predictive value of serial serum CRP and PCT levels for the prognosis of hospitalized community-acquired pneumonia. Respir Res 2018;19:193. DOI: https://doi.org/10.1186/s12931-018-0877-x
Rhee C. Using procalcitonin to guide antibiotic therapy. Open Forum Infect Dis 2016;4:ofw249. DOI: https://doi.org/10.1093/ofid/ofw249
Perez-San Martin S, Suberviola B, Garcia-Unzueta MT, et al. Prognostic value of plasma pentraxin 3 levels in patients with septic shock admitted to intensive care. PLoS One 2020;15:e0243849. DOI: https://doi.org/10.1371/journal.pone.0243849
Vega CA, Mommert M, Boccard M, et al. Source of circulating pentraxin 3 in septic shock patients. Front Immunol 2018;9:3048. DOI: https://doi.org/10.3389/fimmu.2018.03048
Hansen CB, Bayarri-Olmos R, Kristensen MK, et al. Complement related pattern recognition molecules as markers of short-term mortality in intensive care patients. J Infect 2020;80:378-87. DOI: https://doi.org/10.1016/j.jinf.2020.01.010
Hu C, Zhou Y, Liu C, Kang Y. Pentraxin-3, procalcitonin and lactate as prognostic markers in patients with sepsis and septic shock. Oncotarget 2018;9:5125-36. DOI: https://doi.org/10.18632/oncotarget.23701
Song J, Moon S, Park DW, et al. Biomarker combination and SOFA score for the prediction of mortality in sepsis and septic shock: A prospective observational study according to the Sepsis-3 definitions. Medicine 2020;99:e20495. DOI: https://doi.org/10.1097/MD.0000000000020495
Ronanki K, Bairwa M, Kant R, et al. Pentraxin 3 (PTX3) as a predictor of severity of sepsis in patients admitted to an intensive care unit: a cross-sectional study from North India. Cureus 2022;14:e28282. DOI: https://doi.org/10.7759/cureus.28282
Uusitalo-Seppälä R, Huttunen R, Aittoniemi J, et al. Pentraxin 3 (PTX3) is associated with severe sepsis and fatal disease in emergency room patients with suspected infection: a prospective cohort study. PLoS One 2013;8:e53661. DOI: https://doi.org/10.1371/journal.pone.0053661
Tamma PD, Heil EL, Justo JA, et al. Infectious Diseases Society of America 2024 guidance on the treatment of antimicrobial-resistant Gram-negative infections. Clin Infect Dis. 2024. doi:10.1093/cid/ciae403. DOI: https://doi.org/10.1093/cid/ciae403
Sangmuang S, Nuntnarumit P, Phukerd S, et al. Factors associated with mortality in immunocompetent patients with hospital-acquired pneumonia. J Glob Infect Dis 2019;11:13-8. DOI: https://doi.org/10.4103/jgid.jgid_33_18
Lee JY, Jaye DL, Waites KB, et al. Procalcitonin in patients with pneumonia. Korean J Lab Med 2010;30:406-13. DOI: https://doi.org/10.3343/kjlm.2010.30.4.406
Duflo F, Debon R, Monneret G, et al. Alveolar and serum procalcitonin diagnostic and prognostic value in ventilator-associated pneumonia. Anesthesiology 2002;96:74-9. DOI: https://doi.org/10.1097/00000542-200201000-00018
Luyt CE, Combes A, Reynaud C, et al. Usefulness of procalcitonin for the diagnosis of ventilator-associated pneumonia. Intensive Care Med 2008;34:1434-40. DOI: https://doi.org/10.1007/s00134-008-1112-x
Lin Q, Fu F, Shen L, et al. Pentraxin 3 in the assessment of ventilator-associated pneumonia: an early marker of severity. Heart Lung 2013;42:139-45. DOI: https://doi.org/10.1016/j.hrtlng.2012.11.005
Mauri T, Coppadoro A, Bellani G, et al. Alveolar pentraxin 3 as an early marker of microbiologically confirmed pneumonia: a threshold-finding prospective observational study. Crit Care 2014;18:562. DOI: https://doi.org/10.1186/s13054-014-0562-5
Ozsu S, Abul Y, Mentese A, et al. Pentraxin-3: a novel biomarker for discriminating parapneumonic from other exudative effusions. Respirology 2013;18:657-62. DOI: https://doi.org/10.1111/resp.12038
de Miguel-Yanes JM, Lopez-de-Andres A, et al. Incidence, outcomes and sex-related disparities in pneumonia: a matched-pair analysis with data from Spanish hospitals (2016-2019). J Clin Med 2021;10:4339. DOI: https://doi.org/10.3390/jcm10194339
Yamanaka T, Sadikot RT. Opioid effect on lungs. Respirology 2013;18:255-62. DOI: https://doi.org/10.1111/j.1440-1843.2012.02307.x
Park YJ, Yo CH, Hsu WT, et al. Use of opioids and outcomes of pneumonia: results from the US Nationwide Inpatient Sample. J Acute Med 2021;11:113-28.
Lee H, Moon J, Shin HR, et al. Pneumonia in hospitalized neurologic patients: trends in pathogen distribution and antibiotic susceptibility. Antimicrob Resist Infect Control 2019;8:25. DOI: https://doi.org/10.1186/s13756-019-0475-9
Baharoon S, Telmesani A, Tamim H, et al. Community- versus nosocomial-acquired severe sepsis and septic shock in patients admitted to a tertiary intensive care in Saudi Arabia, etiology and outcome. J Infect Public Health 2015;8:418-24. DOI: https://doi.org/10.1016/j.jiph.2014.12.003
Dey A, Bairy I. Incidence of multidrug-resistant organisms causing ventilator-associated pneumonia in a tertiary care hospital: a nine months’ prospective study. Ann Thorac Med 2007;2:52-7. DOI: https://doi.org/10.4103/1817-1737.32230
Chawla R. Epidemiology, etiology and diagnosis of hospital acquired pneumonia and ventilator associated pneumonia in Asian countries. Am J Infect Control 2008;36:93-100. DOI: https://doi.org/10.1016/j.ajic.2007.05.011
Goel V, Hogade SA. Ventilator-associated pneumonia in a medical intensive care unit: Microbial aetiology, susceptibility patterns of isolated organisms and outcome. Indian J Anaesth 2012;56:558-62. DOI: https://doi.org/10.4103/0019-5049.104575
Patil HV, Patil VC. Incidence, bacteriology, and clinical outcome of ventilator-associated pneumonia at tertiary care hospital. J Nat Sc Biol Med 2017;8:46-55. DOI: https://doi.org/10.4103/0976-9668.198360
Rice LB. Challenges in identifying new antimicrobial agents effective for treating infections with Acinetobacter baumannii and Pseudomonas aeruginosa. Clin Infect Dis 2006;43:100-5. DOI: https://doi.org/10.1086/504487
Tamma PD, Aitken SL, Buehrle DJ, et al. Infectious Diseases Society of America antimicrobial-resistant treatment guidance: gram-negative bacterial infections. Clin Infect Dis 2023;ciad428. DOI: https://doi.org/10.1093/cid/ciad428
Carrabba M, Zarantonello M, Bonara P, et al. Severity assessment of healthcare-associated pneumonia and pneumonia in immunosuppression. Eur Respir J 2012;40:1201-10. DOI: https://doi.org/10.1183/09031936.00187811
Celikhisar H, Kucuk H, Yilmaz N, et al. Prognostic factors in elderly patients admitted to the intensive care unit with community-acquired pneumonia. Aging Male 2020;23:1425-31. DOI: https://doi.org/10.1080/13685538.2020.1775192
Tanriverdi H, Tor MM, Kart L, et al. Prognostic value of serum procalcitonin and C-reactive protein levels in critically ill patients who developed ventilator-associated pneumonia. Ann Thorac Med 2015;10:137-42. DOI: https://doi.org/10.4103/1817-1737.151442
Guo SY, Zhou Y, Hu QF, et al. Procalcitonin is a marker of gram-negative bacteremia in patients with sepsis. Am J Med Sci 2015;349:499-504. DOI: https://doi.org/10.1097/MAJ.0000000000000477
Kim DH, Jung HW, Kang HK. Prognostic value of procalcitonin in pneumonia among patients admitted to intensive care unit. Kosin Med J 2019;34:15-23. DOI: https://doi.org/10.7180/kmj.2019.34.1.15
Seligman R, Seligman BG, Teixeira PJ. Comparing the accuracy of predictors of mortality in ventilator-associated pneumonia. J Bras Pneumol 2011;37:495-503. DOI: https://doi.org/10.1590/S1806-37132011000400012
Meisner M, Tschaikowsky K, Palmaers T, Schmidt J. Comparison of procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations at different SOFA scores during the course of sepsis and MODS. Crit Care 1999;3:45-50. DOI: https://doi.org/10.1186/cc306
Ahmed E, Abu Elkhashab RS, Swelem RS, et al. Etiological and prognostic values of procalcitonin in hospital-acquired pneumonia. Egyptian J Chest Dis Tuberc 2014;63:201-6. DOI: https://doi.org/10.1016/j.ejcdt.2013.09.015
Kao SJ. Plasma long pentraxin 3 (PTX3) concentration is a novel marker of disease activity in patients with community-acquired pneumonia. Clin Chem Lab Med 2013;51:907-13. DOI: https://doi.org/10.1515/cclm-2012-0459
Mauri T, Coppadoro A, Bellani G et al. Pentraxin 3 in acute respiratory distress syndrome: an early marker of severity. Crit Care Med 2008;36:2302-8. DOI: https://doi.org/10.1097/CCM.0b013e3181809aaf
Liu S, Qu X, Liu F, Wang C. Pentraxin 3 as a prognostic biomarker in patients with systemic inflammation or infection. Mediators Inflamm 2014;2014:421429. DOI: https://doi.org/10.1155/2014/421429
Capra AP, Crupi L, Pantò G, et al. Serum pentraxin 3 as a promising biomarker for the long-lasting inflammatory response of COVID-19. Int J Mol Sci 2023;24:14195. DOI: https://doi.org/10.3390/ijms241814195

Ethics Approval

The study protocol was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences, Jodhpur, Rajasthan (AIIMS/IEC/2022/3940).

How to Cite



“Pentraxin-3 As a Novel Biomarker in Predicting Outcomes of Nosocomial Pneumonia: A Prospective Observational Study”. 2025. Monaldi Archives for Chest Disease, June. https://doi.org/10.4081/monaldi.2025.3225.