Evaluation of Plasma Lipocalin-2 as a Predictor of Etiology and Severity in Adult Patients with Community-Acquired Pneumonia

• Published in: Microorganisms (Basel) 2023-04, Vol.11 (5), p.1160
• Main Authors: Boix-Palop, Lucía, Vergara, Andrea, Padilla, Emma, Martínez, Diego, Blanco, Ana, Pérez, Josefa, Calbo, Esther, Vila, Jordi, Casals-Pascual, Climent
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteremia; Bacteria; Bacterial infections; Bacterial pneumonia; biomarker; Biomarkers; C-reactive protein; Carrier proteins; Causes of; Chemiluminescence; Community-acquired infections; community-acquired pneumonia; Diagnosis; Diagnostic systems; Dyspnea; Emergency medical care; Enzyme immunoassay; Etiology; Health aspects; Immunoassay; Laboratories; Lipocalin; lipocalin-2; Measurement; Multivariate analysis; Observational studies; Patients; Performance evaluation; Plasma; pneumococcal pneumonia; Pneumonia; Risk; Risk groups; severity; Streptococcus infections; Tumor necrosis factor-TNF; Viral infections
• ISSN: 2076-2607; 2076-2607
• DOI: 10.3390/microorganisms11051160

The aim of this study was to evaluate the diagnostic performance of plasma Lipocalin-2 (LCN2) concentration in adult patients with community-acquired pneumonia (CAP) to determine its etiology, severity and prognosis. A prospective observational study involving adults with CAP from November 2015 to May 2017 was conducted. Plasma LCN2 concentration was measured upon admission by a modified enzyme immunoassay coupled with chemiluminescence (Architect, Abbott Laboratories). The diagnostic performance of LCN2, C-reactive protein (CRP) and white blood cell to predict bacterial CAP was assessed. A total of 130 patients with CAP were included: 71 (54.6%) bacterial CAP, 42 (32.3%) unknown origin CAP and 17 (13.1%) viral CAP. LCN2 was higher in bacterial CAP than in non-bacterial CAP (122.0 vs. 89.7 ng/mL, respectively) ( = 0.03) with a limited ability to distinguish bacterial and non-bacterial CAP (AUROC: 0.62 [95% CI 0.52-0.72]). The LCN2 cutoff ≥ 204 ng/mL predicted the presence of pneumococcal bacteremia with an AUROC of 0.74 (sensitivity 70%, specificity 79.1%). Regarding severity, as defined by CURB-65 and PSI scores, there was a significant linear trend in the mean concentration of LCN2, exhibiting a shift from the low-risk to the intermediate-risk and high-risk group ( < 0.001 and 0.001, respectively). LCN2 concentration was associated with severity in adult patients with CAP. However, its utility as a biomarker to discriminate viral and bacterial etiology in CAP is limited.