Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients - PubMed (original) (raw)
Multicenter Study
. 2004 Dec 15;39(12):1783-90.
doi: 10.1086/426028. Epub 2004 Nov 18.
Antoni Torres, Felipe Rodríguez de Castro, Rafael Zalacaín, Javier Aspa, Juan J Martín Villasclaras, Luis Borderías, José M Benítez Moya, Juan Ruiz-Manzano, José Blanquer, Diego Pérez, Carmen Puzo, Fernando Sánchez-Gascón, José Gallardo, Carlos J Alvarez, Luis Molinos; Neumofail Group
Affiliations
- PMID: 15578400
- DOI: 10.1086/426028
Multicenter Study
Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients
Rosario Menéndez et al. Clin Infect Dis. 2004.
Abstract
Background: The natural history of the resolution of infectious parameters in patients with community-acquired pneumonia (CAP) is not completely known. The aim of our study was to identify those factors related to host characteristics, the severity of pneumonia, and treatment that influence clinical stability.
Methods: In a prospective, multicenter, observational study, we observed 1424 patients with CAP who were admitted to 15 Spanish hospitals. The main outcome variable was the number of days needed to reach clinical stability (defined as a temperature of <or=37.2 degrees C, a heart rate of <or=100 beats/min, a respiratory rate of <or=24 breaths/min, systolic blood pressure of >or=90 mm Hg, and oxygen saturation >or=90% or arterial oxygen partial pressure of >or=60 mm Hg).
Results: The median time to stability was 4 days. A Cox proportional hazard model identified 6 independent variables recorded during the first 24 h after hospital admission related to the time needed to reach stability: dyspnea (hazard ratio [HR], 0.76), confusion (HR, 0.66), pleural effusion (HR, 0.67), multilobed CAP (HR, 0.72), high pneumonia severity index (HR, 0.73), and adherence to the Spanish guidelines for treatment of CAP (HR, 1.22). A second Cox model was performed that included complications and response to treatment. This model identified the following 10 independent variables: chronic bronchitis (HR, 0.81), dyspnea (HR, 0.79), confusion (HR, 0.61), multilobed CAP (HR, 0.84), initial severity of disease (HR, 0.73), treatment failure (HR, 0.31), cardiac complications (HR, 0.66), respiratory complications (HR, 0.77), empyema (HR, 0.57), and admission to the intensive care unit (HR, 0.57).
Conclusions: Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability.
Comment in
- Understanding the natural history of community-acquired pneumonia resolution: vital information for optimizing duration of therapy.
Niederman MS. Niederman MS. Clin Infect Dis. 2004 Dec 15;39(12):1791-3. doi: 10.1086/426031. Epub 2004 Nov 18. Clin Infect Dis. 2004. PMID: 15578401 No abstract available. - Important factors to consider for patients with community-acquired pneumonia.
De Maria A, Rana E, Canonica GW. De Maria A, et al. Clin Infect Dis. 2005 May 1;40(9):1374-5; author reply 1375-6. doi: 10.1086/429508. Clin Infect Dis. 2005. PMID: 15825045 No abstract available.
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