Abstract
The diagnosis of community-acquired pneumonia (CAP) with chronic heart failure (CHF) is associated with objective difficulties. Our case–control study aims to establish whether established serum inflammatory biomarkers are relevant to the diagnosis of CAP in patients with CHF. Seventy inpatients with previously diagnosed CHF and suspected non-severe CAP were recruited and then stratified into two subgroups with confirmed and rejected diagnosis of CAP. C-reactive protein (CRP), procalcitonin (PCT), tumor necrosis factor α (TNFα), interleukin-6 (IL-6) and brain natriuretic peptide (BNP) were measured. The value of biomarkers was determined using logistic regression, and their discriminatory efficacy was assessed by analyzing receiver operating characteristic (ROC) curves. Significantly higher levels of CRP 50.0 (35.5–98.5) mg/L, PCT 0.10 (0.05–0.54) ng/mL and IL-6 46.1(21.4–150.3) pg/mL in cases were identified as compared to the control group—15.0 (9.5–25.0) mg/L, 0.05 (0.05–0.05) ng/mL and 13.6 (9.5; 25.0) pg/mL, respectively. The Area Under the ROC Curve (95% CI) was the highest for CRP—0.91 (0.83–0.98), followed by PCT—0.81 (0.72–0.90) and IL-6—0.81 (0.71–0.91). A CRP value of >28.5 mg/L had an optimal sensitivity and specificity ratio (85.7/91.4%). In conclusion, the measurement of serum CRP, PCT and IL-6 levels can be useful for the diagnosis of CAP in patients with CHF. CRP showed optimal diagnostic utility in this population.
Highlights
Community-acquired pneumonia (CAP) is one of the most common acute infections requiring admission to hospital
The diagnosis of CAP in chronic heart failure (CHF) patients is fraught with objective difficulties as CHF can mask the clinical signs of CAP [6,7]
Typical signs of CHF can be explained by a new episode of respiratory tract infection (RTI) including CAP [8]
Summary
Community-acquired pneumonia (CAP) is one of the most common acute infections requiring admission to hospital. The main causative pathogens of CAP are Streptococcus pneumoniae (S. pneumoniae), Influenza A, Mycoplasma pneumoniae and Chlamydophila pneumoniae, and the main risk factors are age, smoking and comorbidities. Out of an estimated 878,000 adults 45 years and older who were hospitalized with a primary diagnosis of CAP in 2010, 71% were 65 years or older, and 10% to 20% required admission to the intensive care unit (ICU) [3]. S. pneumoniae remains the most commonly isolated pathogen in CAP, the relative frequency of other pathogens has increased. Clinical suspicion should be driven by comorbidities and other risk factors [4]. The diagnosis of CAP in chronic heart failure (CHF) patients is fraught with objective difficulties as CHF can mask the clinical signs of CAP [6,7]. Typical signs of CHF can be explained by a new episode of respiratory tract infection (RTI) including CAP [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
