Markers of treatment failure in hospitalised community acquired pneumonia

被引:137
作者
Menendez, R. [1 ,2 ]
Cavalcanti, M. [3 ]
Reyes, S. [1 ]
Mensa, J. [2 ,4 ]
Martinez, R. [1 ]
Marcos, M. A. [1 ]
Filella, X. [5 ]
Niederman, M. [6 ]
Torres, A. [2 ,7 ]
机构
[1] Hosp Univ La Fe, Serv Neumol, Valencia 46009, Spain
[2] CIBERES, Barcelona, Spain
[3] PPG Pneumol UFRGS, Porto Alegre, RS, Brazil
[4] Hosp Clin Barcelona, Serv Malalt Infeccioses, Barcelona, Spain
[5] Hosp Clin Barcelona, Serv Bioquim, Barcelona, Spain
[6] Winthrop Univ Hosp, Mineola, NY 11501 USA
[7] Hosp Clin Barcelona, Serv Pneumol, Barcelona, Spain
关键词
D O I
10.1136/thx.2007.086785
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background: Lack of response to treatment in community acquired pneumonia (CAP) worsens outcome. We evaluated the systemic cytokine profile (tumour necrosis factor a, interleukin (IL) 1, IL6, IL8 and IL10), C reactive protein (CRP) and procalcitonin (PCT) in patients with CAP who had treatment failure. Methods: A prospective study was performed in hospitalised patients with CAP. Cytokines, PCT and CRP measurements were obtained on day 1 and after 72 h of treatment. Treatment failure was the endpoint evaluated, with separation of those with early (<= 72 h) or late failure. Results: 453 patients were included: 84 (18%) had treatment failure, of whom 38 (8%) were early failures. Median levels of IL6, PCT and CRP on days 1 and 3 and median levels of IL8 on day 1 were significantly higher in patients with any treatment failure. Logistic regression analysis demonstrated that values above the cut-off points for IL6 (>= 169 pg/ml), IL8 (>= 14 pg/ml) and CRP (>= 21.9 mg/dl) on day 1 had independent predictive value for any treatment failure after adjustment for initial severity; relative risks ( OR) found were 1.9, 2.2 and 2.6, respectively. Increased levels for CRP and PCT on day 1 were also independent predictors for early failure. Increased levels for IL6 and CRP were the best predictors of late failure. Conclusions: Serum levels of CRP, IL6 and PCT on days 1 and 3 were independently associated with a higher risk of any treatment failure. Low levels of PCT and CRP on day 1 had a high negative predictive value for early failure.
引用
收藏
页码:447 / 452
页数:6
相关论文
共 32 条
[1]   Systemic cytokine levels in community-acquired pneumonia and their association with disease severity [J].
Antunes, G ;
Evans, SA ;
Lordan, JL ;
Frew, AJ .
EUROPEAN RESPIRATORY JOURNAL, 2002, 20 (04) :990-995
[2]   Antimicrobial treatment failures in patients with community-acquired pneumonia - Causes and prognostic implications [J].
Arancibia, F ;
Ewig, S ;
Martinez, JA ;
Ruiz, M ;
Bauer, T ;
Marcos, MA ;
Mensa, J ;
Torres, A .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 162 (01) :154-160
[3]   Trends in infectious disease mortality in the United States during the 20th century [J].
Armstrong, GL ;
Conn, LA ;
Pinner, RW .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 281 (01) :61-66
[4]   Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia [J].
Boussekey, N ;
Leroy, O ;
Alfandari, S ;
Devos, P ;
Georges, H ;
Guery, B .
INTENSIVE CARE MEDICINE, 2006, 32 (03) :469-472
[5]   Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia a Randomized trial [J].
Christ-Crain, Miriam ;
Stolz, Daiana ;
Bingisser, Roland ;
Muller, Christian ;
Miedinger, David ;
Huber, Peter R. ;
Zimmerli, Werner ;
Harbarth, Stephan ;
Tamm, Michael ;
Mueller, Beat .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 174 (01) :84-93
[6]  
CONFALONIERI M, 2004, AM J RESP CRIT CARE, V19, P19
[7]   Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock [J].
Dellinger, RP ;
Carlet, JM ;
Masur, H ;
Gerlach, H ;
Calandra, T ;
Cohen, J ;
Gea-Banacloche, J ;
Keh, D ;
Marshall, JC ;
Parker, MM ;
Ramsay, G ;
Zimmerman, JL ;
Vincent, JL ;
Levy, MM .
CRITICAL CARE MEDICINE, 2004, 32 (03) :858-873
[8]   The systemic response to lung infection [J].
Deng, JC ;
Standiford, TJ .
CLINICS IN CHEST MEDICINE, 2005, 26 (01) :1-+
[9]   Severe community-acquired pneumonia - Assessment of severity criteria [J].
Ewig, S ;
Ruiz, M ;
Mensa, J ;
Marcos, MA ;
Martinez, JA ;
Arancibia, F ;
Niederman, MS ;
Torres, A .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1998, 158 (04) :1102-1108
[10]   A prediction rule to identify low-risk patients with community-acquired pneumonia [J].
Fine, MJ ;
Auble, TE ;
Yealy, DM ;
Hanusa, BH ;
Weissfeld, LA ;
Singer, DE ;
Coley, CM ;
Marrie, TJ ;
Kapoor, WN .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (04) :243-250