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C-reactive protein for discriminating treatment failure from slow responding pneumonia.
- Source :
-
European journal of internal medicine [Eur J Intern Med] 2010 Dec; Vol. 21 (6), pp. 548-52. - Publication Year :
- 2010
-
Abstract
- Background: The management of patients with community-acquired pneumonia (CAP) who fail to improve constitutes a challenge for clinicians. This study investigated the usefulness of C-reactive protein (CRP) changes in discriminating true treatment failure from slow response to treatment.<br />Methods: This prospective multicenter observational study investigated the behavior of plasma CRP levels on days 1 and 4 in hospitalized patients with CAP. We identified non-responding patients as those who had not reached clinical stability by day 4. Among them, true treatment failure and slow response situations were defined when initial therapy had to be changed or not after day 4 by attending clinicians, respectively.<br />Results: By day 4, 78 (27.4%) out of 285 patients had not reached clinical stability. Among them, 56 (71.8%) patients were cured without changes in initial therapy (mortality 0.0%), and in 22 (28.2%) patients, the initial empirical therapy needed to be changed (mortality 40.9%). By day 4, CRP levels fell in 52 (92.9%) slow responding and only in 7 (31.8%) late treatment failure patients (p<0.001). A model developed including CRP behavior and respiratory rate at day 4 identified treatment failure patients with an area under the Receiver Operating Characteristic curve of 0.87 (CI 95%, 0.78-0.96).<br />Conclusion: Changes in CRP levels are useful to discriminate between true treatment failure and slow response to treatment and can help clinicians in management decisions when CAP patients fail to improve.<br /> (Copyright © 2010 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Biomarkers blood
Chlamydophila Infections drug therapy
Chlamydophila Infections mortality
Chlamydophila pneumoniae drug effects
Community-Acquired Infections mortality
Coxiella burnetii drug effects
Drug Resistance, Bacterial
Female
Humans
Legionella pneumophila drug effects
Legionnaires' Disease drug therapy
Legionnaires' Disease mortality
Male
Middle Aged
Mycoplasma pneumoniae drug effects
Pneumococcal Infections drug therapy
Pneumococcal Infections mortality
Pneumonia, Bacterial mortality
Pneumonia, Mycoplasma drug therapy
Pneumonia, Mycoplasma mortality
Q Fever drug therapy
Q Fever mortality
Streptococcus pneumoniae drug effects
Treatment Failure
Anti-Bacterial Agents therapeutic use
C-Reactive Protein metabolism
Community-Acquired Infections drug therapy
Drug Monitoring methods
Pneumonia, Bacterial drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0828
- Volume :
- 21
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- European journal of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 21111942
- Full Text :
- https://doi.org/10.1016/j.ejim.2010.09.006