Abstract
IntroductionTreatment 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.MethodsA 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.ResultsA 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).ConclusionsThere 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 registrationIRB Register: http://2009/5451.
Highlights
Treatment failure in community-acquired-pneumonia (CAP) patients is associated with a high mortality rate, and are a matter of great concern in clinical management
A significant increase on day 1 of hospitalization in C-reactive protein (CRP) (p < 0.001), PCT (p = 0.004), interleukin 6 (IL-6) (p < 0.001) and interleukin 8 (IL-8) (p = 0.02), and a decrease in interleukin 1 (IL-1) (p = 0.06) in patients with failure was observed compared with patients without failure
There was a good correlation of IL-6 levels and CAP failure and IL-6 & PCT with late CAP failure
Summary
Treatment failure in community-acquired-pneumonia (CAP) patients is associated with a high mortality rate, and are a matter of great concern in clinical management. Among the cytokines involved in the inflammatory response, we can include interleukin 10 (IL-10) as a critical anti-inflammatory cytokine that attenuates inflammatory responses in macrophages and T cells, tumor necrosis factor (TNF-α), interleukin 1 (IL-1), interleukin 6 (IL-6) and interleukin 8 (IL-8) [5] Some inflammation markers, such as C-reactive protein (CRP) and procalcitonin (PCT), have been recognized for some time in clinical management, [6]. We aimed to determine clinical and cytokine-level predictors of CAP-failure, including the different types of failure (early and late). The aim of this research is to ascertain the parameters, including cytokine levels, for predicting CAP failure in general, and late and early failure
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