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Markers of treatment failure in hospitalised community acquired pneumonia
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  1. R Menéndez1,2,
  2. M Cavalcanti3,
  3. S Reyes1,
  4. J Mensa2,4,
  5. R Martinez1,
  6. M A Marcos1,
  7. X Filella5,
  8. M Niederman6,
  9. A Torres2,7
  1. 1
    Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain
  2. 2
    CIBER de Enfermedades Respiratorias (CIBERES)
  3. 3
    PPG Pneumologia-UFRGS, Brasil
  4. 4
    Servei de Malalties Infeccioses, Hospital Clínic, Barcelona, Spain
  5. 5
    Servei de Bioquímica, Hospital Clínic, Barcelona, Spain
  6. 6
    Winthrop University Hospital, Mineola, New York, USA
  7. 7
    Servei de Pneumologia, Hospital Clínic, Barcelona, Spain
  1. Dr R Menéndez, Servicio de Neumología, Hospital Universitario La Fe, Avda de Campanar 21, 46009 Valencia, Spain; rmenend{at}separ.es

Abstract

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

  • Funding: Supported by: PI041136 and PI030113, El CIBER de Enfermedades Respiratorias (CIBERES) es una iniciativa del ISCiLL.

  • Competing interests: None.

  • Ethical approval: The study was approved by the ethics committee.

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