Báo cáo y học: Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course...
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Báo cáo y học: "Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course" Available online http://ccforum.com/content/11/4/R92Research Open AccessVol 11 No 4Usefulness of C-reactive protein in monitoring the severecommunity-acquired pneumonia clinical courseLuís Coelho, Pedro Póvoa, Eduardo Almeida, Antero Fernandes, Rui Mealha, Pedro Moreira andHenrique SabinoUnidade de Cuidados Intensivos, Hospital Garcia de Orta, Almada, PortugalCorresponding author: Luís Coelho, luismiguelcoelho16@gmail.comReceived: 5 Jun 2007 Revisions requested: 4 Jul 2007 Revisions received: 10 Aug 2007 Accepted: 28 Aug 2007 Published: 28 Aug 2007Critical Care 2007, 11:R92 (doi:10.1186/cc6105)This article is online at: http://ccforum.com/content/11/4/R92© 2007 Coelho et al., licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.AbstractBackground The aim of the present study was to evaluate the response and 74% of patients with a slow response patternC-reactive protein level, the body temperature and the white cell survived, whereas those patients with the patterns ofcount in patients after prescription of antibiotics in order to nonresponse and of biphasic response had a mortality rate ofdescribe the clinical resolution of severe community-acquired 100% and 33%, respectively (P < 0.001). On day 3 of antibioticpneumonia. therapy, a decrease in C-reactive protein levels by 0.31 or more from the previous days level was a marker of good prognosisMethods A cohort of 53 consecutive patients with severe (sensitivity, 0.75; specificity, 0.85).community-acquired pneumonia was studied. The C-reactiveprotein levels, body temperature and white cell count weremonitored daily. Conclusion Daily C-reactive protein measurement after antibiotic prescription is useful in identification, as early as dayResults By day 3 a C-reactive protein level 0.5 times the initial 3, of severe community-acquired pneumonia patients with poorlevel was a marker of poor outcome (sensitivity, 0.91; specificity, outcome. The identification of the C-reactive protein pattern of0.59). Patients were divided according to their C-reactive response to antibiotic therapy was useful in the recognition ofprotein patterns of response to antibiotics, into fast response, the individual clinical course, either improving or worsening, asslow response, nonresponse, and biphasic response. About well as the rate of improvement, in patients with severe96% of patients with a C-reactive protein pattern of fast community-acquired pneumonia.Introduction It has been estimated that approximately 10–25% of patientsCommunity-acquired pneumonia (CAP) remains a common with CAP do not resolve within the anticipated time [5]. Treat-and serious illness, with an estimated incidence of 2–12 ment failure can result from a lack of response by the host orcases/1,000 population per year [1]. The majority of cases are from the development of an infectious complication, such asmanaged outside hospital, but approximately 20% require postobstructive pneumonia, empyema, or lung abscess. Inhospital admission. Out of this group of patients, around 10% addition, treatment failure may be wrongly presumed whendevelop severe CAP [2] requiring treatment in an intensive radiologic infiltrates are resolving slowly but the patient has acare unit (ICU) with a mortality rate exceeding 50% [1,3]. The superimposed problem, such as drug fever, malignancy,largest numbers of deaths occur in the first few days of hospi- inflammatory conditions, heart failure, or a hospital-acquiredtalization [4], so the early recognition of patients with severe infection from another source [3]. In such clinical situations, itCAP not only aids in the early initiation of antibiotic therapy but is very difficult to identify the cause ...