Utilizing procalcitonin in a clinical setting to help differentiate between aspiration pneumonia and aspiration pneumonitis

Objective: Aspiration can lead to complications such as aspiration pneumonia (ASPNA) or aspiration pneumonitis. Use of procalcitonin (PCT) assays has been supported to help differentiate between bacterial and nonbacterial etiologies for infection. We hypothesize PCT levels will differ significantly in patients with ASPNA versus aspiration pneumonitis.

Methods: This study retrospectively analyzed patients with an ICD-10 diagnosis of ASPNA or aspiration pneumonitis from September 2017 to September 2019. 228 patients met criteria and were divided into two cohorts: aspiration pneumonitis (45 patients) or ASPNA (183 patients). Initial and 48-hour PCTs were assessed.

Results: The aspiration pneumonitis cohort had a higher percentage of patients with normal initial PCT levels than the ASPNA cohort (86.7% vs 38.8%; P < 0.0001).

Conclusion: This study suggests PCT could be a useful tool to help differentiate between ASPNA and aspiration pneumonitis. We postulate utilizing PCT levels alongside current diagnostic criteria would allow for more appropriate treatment and improved antibiotic stewardship.