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Markers Of Treatment Failure In Hospitalized Community-Acquired Pneumonia
  1. Rosario Menéndez (rmenend{at}separ.es)
  1. Hospital Universitario La Fe, Spain
    1. Manuela Cavalcanti
    1. research fellow from Pavilhao Pereira Filho, PPG Pneumologia-UFRGS, Brazil
      1. Soledad Reyes
      1. Hospital Universitario La Fe, Valencia, Spain
        1. José Mensa
        1. Hospital Clinic, Barcelona, Spain
          1. Raquel Martinez
          1. Hospital Universitario La Fe, Valencia, Spain
            1. María A Marcos
            1. Hospital Clinic, Barcelona, Spain
              1. Xavier Filella
              1. Hospital Clinic, Barcelona, Spain
                1. Michael Niederman
                1. Winthrop University Hospital, Mineola, New York, United States
                  1. Antoni Torres
                  1. Hospital Clinic, Spain

                    Abstract

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

                    • c reactive protein
                    • cytokine
                    • failure
                    • pneumonia
                    • procalcitonin

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