Markers of treatment failure in hospitalised community acquired pneumonia
Markers of treatment failure in hospitalised community acquired pneumonia
复制标题
DOI：
10.1136/thx.2007.086785
复制
发表时间：
2008-05-01
期刊：
影响因子：
10
通讯作者：
Torres, A.
中科院分区：
文献类型：
--
作者：
Menendez, R.;Cavalcanti, M.;Torres, A.
背景：社区获得性肺炎（CAP）缺乏治疗反应会恶化预后。我们评估了治疗失败的CAP患者的全身细胞因子谱（肿瘤坏死因子a、白细胞介素（IL） 1、IL6、IL8和IL10）、C反应蛋白（CRP）和降钙素原（PCT）。方法：对CAP住院患者进行前瞻性研究。在治疗第1天和治疗72小时后测量细胞因子、PCT和CRP。治疗失败是评估的终点，在调整初始严重程度后，分离第1天早期（= 169 pg/ml）， il - 8 （>= 14 pg/ml）和CRP （>= 21.9 mg/dl）的患者对任何治疗失败具有独立的预测价值；相对危险度（OR）分别为1.9、2.2和2.6。第1天CRP和PCT水平升高也是早期衰竭的独立预测因子。升高的il - 6和CRP水平是晚期衰竭的最佳预测指标。结论：第1天和第3天血清CRP、il - 6和PCT水平与任何治疗失败的高风险独立相关。第1天低水平的PCT和CRP对早期衰竭有很高的阴性预测值。
Background: Lack of response to treatment in community acquired pneumonia (CAP) worsens outcome. We evaluated the systemic cytokine profile (tumour necrosis factor a, 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 (= 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.