Pneumonia in multiple injured patients: a prospective controlled trial on early prediction using clinical and immunological parameters.
OBJECTIVE
In a prospective trial 266 multiple injured patients were included to evaluate clinical risk factors and immune parameters related to pneumonia.


METHODS
Clinical and humoral parameters were assessed and multivariate analysis performed.


RESULTS
The multivariate analysis (odds ratio with 95% confidence interval (CI)) revealed male gender (3.65), traumatic brain injury (TBI) (2.52), thorax trauma (AIS(thorax) > or = 3) (2.05), antibiotic prophylaxis (1.30), injury severity score (ISS) (1.03 per ISS point) and the age (1.02 per year) as risk factors for pneumonia. The main pathogens were Acinetobacter Baumannii (40%) and Staphylococcus aureus (25%). A tendency towards higher Procalcitonin (PCT) and Interleukin (IL)-6 levels two days after trauma was observed for pneumonia patients.


CONCLUSIONS
The immune parameters (PCT, IL-6, IL-10, soluble tumor necrosis factor p-55 and p-75) could not confirm the diagnosis of pneumonia earlier than the clinical parameters.
Andermahr
J
J
Clinic of Trauma-, Hand- and Reconstructive Surgery, University of Cologne, Köln, Germany. JAndermahr@t-online.de
Greb
A
A
Hensler
T
T
Helling
H J
HJ
Bouillon
B
B
Sauerland
S
S
Rehm
K E
KE
Neugebauer
E
E
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000917:Antibody Formation / Q000276:immunology; D003422:Critical Care; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D014946:Wound Infection / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology
D000900:Anti-Bacterial Agents; D018836:Inflammation Mediators