RESPIRATORY INFECTION

Markers of treatment failure in hospitalised community acquired pneumonia

R Menéndez^1,2, M Cavalcanti³, S Reyes¹, J Mensa^2,4, R Martinez¹, M A Marcos¹, X Filella⁵, M Niederman⁶, A Torres^2,7

¹ Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
² CIBER de Enfermedades Respiratorias (CIBERES)
³ PPG Pneumologia-UFRGS, Brasil
⁴ Servei de Malalties Infeccioses, Hospital Clínic, Barcelona, Spain
⁵ Servei de Bioquímica, Hospital Clínic, Barcelona, Spain
⁶ Winthrop University Hospital, Mineola, New York, USA
⁷ Servei de Pneumologia, Hospital Clínic, Barcelona, Spain

Dr R Menéndez, Servicio de Neumología, Hospital Universitario La Fe, Avda de Campanar 21, 46009 Valencia, Spain; rmenend{at}separ.es

Background: Lack of response to treatment in community acquired pneumonia (CAP) worsens outcome. We evaluated the systemic cytokine profile (tumour necrosis factor , 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.

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