Predicting treatment failure in patients with community acquired pneumonia : A case-control study
Martin-Loeches, Ignacio (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Vallès, Xavier (Hospital Clínic i Provincial de Barcelona)
Menendez, Rosario (Hospital Universitari i Politècnic La Fe (València))
Sibila, Oriol (Institut d'Investigació Biomèdica Sant Pau)
Montull, Beatriz (Hospital Universitari i Politècnic La Fe (València))
Cilloniz, Catia (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Artigas Raventós, Antoni (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Torres, Antoni (Hospital Clínic i Provincial de Barcelona)
Universitat Autònoma de Barcelona

Date:	2014
Abstract:	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. Trial registration: IRB Register: http://2009/5451. © 2014 Martin-Loeches et al. ; licensee BioMed Central Ltd.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Community acquired pneumonia ; Cytokines ; Pneumonia ; Treatment failure
Published in:	Respiratory Research, Vol. 15 Núm. 1 (may 2014) , p. 75, ISSN 1465-993X

DOI: 10.1186/1465-9921-15-75
PMID: 24996572

8 p, 540.7 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles