Abstract
Pneumonia is the leading infectious cause of mortality worldwide and one of the most common lower respiratory tract infections that is contributing significantly to the burden of antibiotic consumption. Due to the complexity of its pathophysiology, it is widely accepted that clinical diagnosis and prognosis are inadequate for the accurate assessment of the severity of the disease. The most challenging task for a physician is the risk stratification of patients with community-acquired pneumonia. Herein, early diagnosis is essential in order to reduce hospitalization and mortality. Procalcitonin and C-reactive protein remain the most widely used biomarkers, while interleukin 6 has been of particular interest in the literature. However, none of them appear to be ideal, and the search for novel biomarkers that will most sufficiently predict the severity and treatment response in pneumonia has lately intensified. Although our insight has significantly increased over the last years, a translational approach with the application of genomics, metabolomics, microbiomics, and proteomics is required to better understand the disease. In this review, we discuss this rapidly evolving area and summarize the application of novel biomarkers that appear to be promising for the accurate diagnosis and risk stratification of pneumonia.
Highlights
Increasing antimicrobial resistance is a life-threatening worldwide phenomenon
Kartal et al [74] reported that neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are significantly increased in Community-acquired pneumonia (CAP) and proposed that they can both be used as a predictor for the presence of CAP; they are not good inflammatory biomarkers for impatient and outpatient distinction
Grover et al [103] found that Triggering receptor expressed on myeloid cells 1 (TREM-1) is a good predictor of ventilator-associated pneumonia (VAP); Palazzo et al [104] claimed that TREM-1 can be found elevated in the bronchoalveolar lavage (BAL) fluid of patients with and without confirmed VAP
Summary
Increasing antimicrobial resistance is a life-threatening worldwide phenomenon. Lower respiratory tract infections are one of the leading causes for antibiotic consumption and for the emergence of resistant microbial strains [1]. Community-acquired pneumonia (CAP) is the third most common cause of death globally, the major cause of death and sepsis in developed countries, and accounts for between 5% and 12% of all cases of adult lower respiratory tract infections (LRTIs) managed by primary care physicians [5,6,7,8]. It is one of the most common infectious diseases, with significant mortality and frequent need for intensive care support due to the occurrence of respiratory insufficiency and multiorgan involvement [9]. There is a great need for a clinical tool that will improve the precise diagnosis and the decision-making process in order to avoid over-diagnosis (and antibiotic overuse) or under-diagnosis and late diagnosis, both of which may result in worse outcomes [16]
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