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Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia.
  1. Rosario Menéndez (rmenend{at}separ.es)
  1. Hospital Universitario La Fe, Valencia, Spain
    1. Raquel Martinez (rasmartinez{at}hotmail.com)
    1. Hospital Universitario La Fe, Valencia, Spain
      1. Soledad Reyes (reyes{at}comv.es)
      1. Hospital Universitario La Fe, Valencia, Spain
        1. Jose Mensa
        1. Hospital Clinic, Barcelona, Spain
          1. Xavier Filella
          1. Hospital Clinic, Barcelona, Spain
            1. Maria A. Marcos
            1. Hospital Clinic, Barcelona, Spain
              1. Angela Martinez
              1. Hospital Universitario La Fe, Valencia, Spain
                1. Cristina Esquinas
                1. Hospital Clinic, Barcelona, Spain
                  1. Paula Ramirez
                  1. Hospital Universitario La Fe, Valencia, Spain
                    1. Antoni Torres (atorres{at}clinic.ub.es)
                    1. Hospital Clinic, Barcelona, Spain

                      Abstract

                      Background: Prognostic scales provide a useful tool to predict mortality in community-acquired pneumonia (CAP). However, the inflammatory response of the host, crucial in resolution and outcome, is not included in the prognostic scales.

                      Methods: We aimed to investigate whether information about the initial inflammatory cytokine profile and markers increases the accuracy of prognostic scales to predict 30-days mortality. To this aim a prospective cohort study in two tertiary care hospitals was designed. Procalcitonin (PCT), C-reactive protein (CRP), and the systemic cytokines tumor necrosis factorα(TNFα), interleukines IL-6, IL-8 and IL-10 were measured at admission. Initial severity was assessed by PSI (pneumonia severity index), CURB-65 and CRB-65 scales. 453 hospitalized CAP patients were included.

                      Results: The 36 patients who died (7.8 %) had significantly increased levels of IL-6, IL-8, PCT and CRP. In regression logistic analyses, high levels of CRP and IL-6 showed independent predictive value for predicting 30-days mortality, after adjustment for prognostic scales. Adding CRP to PSI significantly increased the area under the ROC curve (AUC) from 0.80 to 0.85, that of CURB-65 from 0.82 to 0.85 and that of CRB65 from 0.79 to 0.85. Adding IL-6 or PCT values to CRP did not significantly increase AUC of any scale. When using simultaneously both scales and CRP the AUC was 0.88.

                      Conclusions: Adding CRP levels to PSI, CURB-65 and CRB-65 scales improves the 30-days mortality prediction. The highest predictive value is reached with a combination of both scales and CRP. Further validation of that improvement is needed

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