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Stability in community-acquired pneumonia. one step forward with markers?
  1. Rosario Menéndez (rmenend{at}separ.es)
  1. Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain
    1. Raquel Martínez
    1. Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain
      1. Soledad Reyes
      1. Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain
        1. José Mensa
        1. Servicio de Infecciosas, Hospital Clinic, Barcelona, Spain
          1. Eva Polverino
          1. Servicio de Neumología, Hospital Clinic, Barcelona, Spain
            1. Xavier Filella
            1. Servicio de Bioquimica, Hospital Clinic, Barcelona, Spain
              1. Cristina Esquinas
              1. Servicio de Neumología, Hospital Clinic, Barcelona, Spain
                1. Angela Martínez
                1. Servicio de Neumologia, Hospital Universitario La Fe, Valencia, Spain
                  1. Paula Ramirez
                  1. Unidad de Cuidados Intensivos, Hospital Universitario La Fe, Valencia, Spain
                    1. Antoni Torres
                    1. Servicio de Neumología, Hospital Clinic, Ciber de enfermedades respiratorias (CIBERES), Barcelona, Spain

                      Abstract

                      Background: Biological markers as expression of systemic inflammation have been recognized as useful to evaluate host response in community-acquired pneumonia (CAP). The objective of our study was to evaluate whether biological markers, namely procalcitonin (PCT) and C reactive protein (CRP) might reflect stability after 72 hours of treatment and absence of subsequent severe complications.

                      Methods: A prospective cohort study was designed in 394 hospitalized patients with CAP. Clinical stability was evaluated using modified Halm's criteria: temperature ≤ 37.2ºC; heart rate ≤100 beats/min; respiratory rate ≤24 breaths/min; systolic blood pressure ≥90 mm Hg; and oxygen saturation≥90% or arterial oxygen partial pressure≥60 mmHg. PCT and CRP were measured on day 1 and after 72 hours. Severe complications were defined as mechanical ventilation, shock and/or intensive care unit (ICU) admission, or death after 72 hours of treatment.

                      Results: 220 patients reached clinical stability at 72 hours and had significantly lower levels of CRP (4.2 vs 7 mg/dL) and of PCT (0.33 vs 0.48 ng/mL). Regression logistic analyses were performed to calculate several areas under the ROC curve (AUC) to predict severe complications. The AUC for clinical stability was 0.77; 0.84 (p=0.059) when CRP was added; and 0.77(p=0.45) when PCT was added. When clinical stability was achieved within 72 hours and marker levels were below the cut-off points (0.25 for PCT and 3 for CRP) no severe complications appeared.

                      Conclusions: Low levels of CRP and PCT at 72 hours in addition to clinical criteria might improve prediction of absence of severe complications.

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