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. 2014 Jul 5;15(1):75.
doi: 10.1186/1465-9921-15-75.

Predicting treatment failure in patients with community acquired pneumonia: a case-control study

Ignacio Martin-Loeches, Xavier Valles, Rosario Menendez, Oriol Sibila, Beatriz Montull, Catia Cilloniz, Antonio Artigas, Antoni Torres  1
Affiliations

Predicting treatment failure in patients with community acquired pneumonia: a case-control study

Ignacio Martin-Loeches et al. Respir Res. .

Abstract

Introduction: Treatment failure in community-acquired-pneumonia (CAP) patients is associated with a high mortality rate, and therefore are a matter of great concern in clinical management. Those patients have increased mortality and are a target population for randomized clinical trials.

Methods: A case-control study was performed in patients with CAP (non-failure cases vs. failure cases, discriminating by late and early failure). CRP, PCT, interleukin 1, 6, 8 and 10 and TNF were determined at days 1 and 3 of hospitalization.

Results: A total of 253 patients were included in this study where 83 patients presented treatment failure. Of these, 40 (48.2%) had early failure. A discriminative effect was found for a higher CURB-65 score among late failure patients (p = 0.004). A significant increase on day 1 of hospitalization in CRP (p < 0.001), PCT (p = 0.004), IL-6 (p < 0.001) and IL-8 (p = 0.02), and a decrease in IL-1 (p = 0.06) in patients with failure was observed compared with patients without failure. On day 3, only the increase in CRP (p < 0.001), PCT (p = 0.007) and IL-6 (p < 0.001) remained significant. Independent predictors for early failure were higher IL-6 levels on day 1 (OR = 1.78, IC = 1.2-2.6) and pleural effusion (OR = 2.25, IC = 1.0-5.3), and for late failure, higher PCT levels on day 3 (OR = 1.60, IC = 1.0-2.5), CURB-65 score ≥ 3 (OR = 1.43, IC = 1.0-2.0), and multilobar involvement (OR = 4.50, IC = 2.1-9.9).

Conclusions: There was a good correlation of IL-6 levels and CAP failure and IL-6 & PCT with late CAP failure. Pleural effusion and multilobar involvement were simple clinical predictors of early and late failure, respectively.

Trial registration: IRB Register: http://2009/5451.

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Figures

Figure 1
Figure 1
Box-plot and OR for trend for treatment failure and CRP at day 1 of hospitalization.
Figure 2
Figure 2
Box-plot and OR for trend for treatment failure and IL-6 at day 1 of hospitalization.
Figure 3
Figure 3
Box-plot and OR for trend for treatment failure and IL-8 at day 1 of hospitalization.
Figure 4
Figure 4
Box-plot and OR for trend for treatment failure and PCT at day 1 of hospitalization.
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