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Papers |
1 Hospital Universitario La Fe, Spain
2 research fellow from Pavilhao Pereira Filho, PPG Pneumologia-UFRGS, Brazil
3 Hospital Universitario La Fe, Valencia, Spain
4 Hospital Clinic, Barcelona, Spain
5 Winthrop University Hospital, Mineola, New York, United States
6 Hospital Clinic, Spain
* To whom correspondence should be addressed. E-mail: rmenend{at}separ.es.
Accepted 12 December 2007
| Abstract |
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Background: Lack of response to treatment in community-acquired pneumonia (CAP) worsens outcome. We evaluated the systemic cytokine profile -TNF
, IL1, 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 hospitalized patients with CAP. Cytokines, PCT and CRP measurements were obtained on day 1 and after 72 hours of treatment. Treatment failure was the endpoint evaluated, with separation of those with early (
72hours) or late failure.
Results: 453 patients were included: 84 (18 %) had treatment failure, of which 38(8 %) were early failure. The median levels of IL-6, PCT and CRP on days 1 and 3 and the median level of IL-8 on day 1 were significantly higher in patients with any treatment failure. Logistic regression analysis demonstrated that values above the following cut-off points for IL-6 (
169 pg/ml), IL-8 (
14)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 at day 1 were also independent predictors for early failure. Increased levels for IL-6 and CRP were the best predictors of late failure.
Conclusions: Serum levels of CRP, IL-6 and PCT on days 1 and 3 are independently associated with a higher risk of any treatment failure. Low levels of PCT and CRP on day one have a high negative predictive value for early failure
Keywords: c reactive protein, cytokine, failure, pneumonia, procalcitonin
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