Predicting treatment failure in patients with community acquired pneumonia: a case-control study
Por:
Martin-Loeches, I, Valles, X, Menendez, R, Sibila, O, Montull, B, Cilloniz, C, Artigas, A, Torres, A
Publicada:
5 jul 2014
Resumen:
Introduction: Treatment failure in community-acquired-pneumonia (CAP) patients is associated with a high mortality rate, and therefore are a matter of great concern in clinical management. Those patients have increased mortality and are a target population for randomized clinical trials.
Methods: A case-control study was performed in patients with CAP (non-failure cases vs. failure cases, discriminating by late and early failure). CRP, PCT, interleukin 1, 6, 8 and 10 and TNF were determined at days 1 and 3 of hospitalization.
Results: A total of 253 patients were included in this study where 83 patients presented treatment failure. Of these, 40 (48.2%) had early failure. A discriminative effect was found for a higher CURB-65 score among late failure patients (p = 0.004). A significant increase on day 1 of hospitalization in CRP (p < 0.001), PCT (p = 0.004), IL-6 (p < 0.001) and IL-8 (p = 0.02), and a decrease in IL-1 (p = 0.06) in patients with failure was observed compared with patients without failure. On day 3, only the increase in CRP (p < 0.001), PCT (p = 0.007) and IL-6 (p < 0.001) remained significant. Independent predictors for early failure were higher IL-6 levels on day 1 (OR = 1.78, IC = 1.2-2.6) and pleural effusion (OR = 2.25, IC = 1.0-5.3), and for late failure, higher PCT levels on day 3 (OR = 1.60, IC = 1.0-2.5), CURB-65 score >= 3 (OR = 1.43, IC = 1.0-2.0), and multilobar involvement (OR = 4.50, IC = 2.1-9.9).
Conclusions: There was a good correlation of IL-6 levels and CAP failure and IL-6 & PCT with late CAP failure. Pleural effusion and multilobar involvement were simple clinical predictors of early and late failure, respectively.
Filiaciones:
Martin-Loeches, I:
Parc Tauli Univ Inst, CIBER Enfermedades Resp, Crit Care Ctr, Sabadell Hosp, Sabadell, Spain
Valles, X:
Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, Barcelona 08036, Spain
Menendez, R:
Hosp Univ & Politecn La Fe, Serv Neumol, Valencia, Spain
Sibila, O:
Hosp Santa Creu & Sant Pau, Dept Pneumol, Barcelona, Spain
Montull, B:
Hosp Univ & Politecn La Fe, Serv Neumol, Valencia, Spain
Cilloniz, C:
Parc Tauli Univ Inst, CIBER Enfermedades Resp, Crit Care Ctr, Sabadell Hosp, Sabadell, Spain
Artigas, A:
Parc Tauli Univ Inst, CIBER Enfermedades Resp, Crit Care Ctr, Sabadell Hosp, Sabadell, Spain
Torres, A:
Univ Barcelona, IDIBAPS, Hosp Clin, CIBER Enfermedades Resp,Serv Pneumol,Inst Torax, Barcelona 08036, Spain
Gold, Green Published
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