BACKGROUND: There is almost no data about the influence of antimicrobial pre-treatment (APT) on levels of inflammatory markers in community acquired pneumonia (CAP). The aim of this study was to investigate the influence of APT on inflammatory markers in CAP. METHODS: 991 hospitalized patients (64.3±17.6 years, 61% male) with CAP were enrolled. In all patients procalcitonin (PCT), C-reactive protein (CRP), and leukocyte count (WBC) were determined. Patients were followed-up for 28 days for survival. RESULTS: 232 patients (23.4%) had APT, 759 had no APT. Patients without APT had significantly higher levels of PCT and WBC but not of CRP compared to those with APT. In patients without APT, survivors compared to non-survivors had lower values of PCT (0.20 ng/mL; 0.02-169.10 vs. 0.83 ng/mL; 0.04-516.30, p<0.0001), WBC (12.4×10(9)/L; 1.3-49.9 vs. 14.9×10(9)/L; 3.7-34.5, p=0.047) and CRP (107.0mg/mL; 0.3-567.0 vs. 143.5mg/mL; 5.0-589.0, p=0.006). However, in patients with APT, the values of PCT, WBC and CRP were not significantly different in survivors and non-survivors. Cox regression analysis confirmed that PCT, CRP and WBC were predictive for 28 day mortality in patients without APT but not in those with APT. CONCLUSIONS: PCT and WBC but not CRP levels are higher in patients without APT compared to those with APT. PCT, CRP and WBC are predictive for 28 days mortality exclusively in patients without APT. Interpretation of inflammatory parameters has to take into account possible APT.
BACKGROUND: There is almost no data about the influence of antimicrobial pre-treatment (APT) on levels of inflammatory markers in community acquired pneumonia (CAP). The aim of this study was to investigate the influence of APT on inflammatory markers in CAP. METHODS: 991 hospitalized patients (64.3±17.6 years, 61% male) with CAP were enrolled. In all patients procalcitonin (PCT), C-reactive protein (CRP), and leukocyte count (WBC) were determined. Patients were followed-up for 28 days for survival. RESULTS: 232 patients (23.4%) had APT, 759 had no APT. Patients without APT had significantly higher levels of PCT and WBC but not of CRP compared to those with APT. In patients without APT, survivors compared to non-survivors had lower values of PCT (0.20 ng/mL; 0.02-169.10 vs. 0.83 ng/mL; 0.04-516.30, p<0.0001), WBC (12.4×10(9)/L; 1.3-49.9 vs. 14.9×10(9)/L; 3.7-34.5, p=0.047) and CRP (107.0mg/mL; 0.3-567.0 vs. 143.5mg/mL; 5.0-589.0, p=0.006). However, in patients with APT, the values of PCT, WBC and CRP were not significantly different in survivors and non-survivors. Cox regression analysis confirmed that PCT, CRP and WBC were predictive for 28 day mortality in patients without APT but not in those with APT. CONCLUSIONS: PCT and WBC but not CRP levels are higher in patients without APT compared to those with APT. PCT, CRP and WBC are predictive for 28 days mortality exclusively in patients without APT. Interpretation of inflammatory parameters has to take into account possible APT.
Authors: Alexander Kutz; Matthias Briel; Mirjam Christ-Crain; Daiana Stolz; Lila Bouadma; Michel Wolff; Kristina B Kristoffersen; Long Wei; Olaf Burkhardt; Tobias Welte; Stefan Schroeder; Vandack Nobre; Michael Tamm; Neera Bhatnagar; Heiner C Bucher; Charles-Edouard Luyt; Jean Chastre; Florence Tubach; Beat Mueller; Philipp Schuetz Journal: Crit Care Date: 2015-03-06 Impact factor: 9.097
Authors: Alexander Kutz; Eva Grolimund; Mirjam Christ-Crain; Robert Thomann; Claudine Falconnier; Claus Hoess; Christoph Henzen; Werner Zimmerli; Beat Mueller; Philipp Schuetz Journal: BMC Anesthesiol Date: 2014-11-15 Impact factor: 2.217
Authors: Olga Rajas; Mara Ortega-Gómez; José María Galván Román; José Curbelo; Guillermo Fernández Jiménez; Lorena Vega Piris; Francisco Rodríguez Salvanes; Belén Arnalich; Sergio Luquero Bueno; Ana Díaz López; Hortensia de la Fuente; Carmen Suárez; Julio Ancochea; Javier Aspa Journal: BMC Pulm Med Date: 2014-12-12 Impact factor: 3.317