PT  - JOURNAL ARTICLE
AU  - R Menéndez
AU  - M Cavalcanti
AU  - S Reyes
AU  - J Mensa
AU  - R Martinez
AU  - M A Marcos
AU  - X Filella
AU  - M Niederman
AU  - A Torres
TI  - Markers of treatment failure in hospitalised community acquired pneumonia
AID  - 10.1136/thx.2007.086785
DP  - 2008 May 01
TA  - Thorax
PG  - 447--452
VI  - 63
IP  - 5
4099  - http://thorax.bmj.com/content/63/5/447.short
4100  - http://thorax.bmj.com/content/63/5/447.full
SO  - Thorax2008 May 01; 63
AB  - 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.