title: Markers of treatment failure in hospitalised community acquired pneumonia.
abstract: BACKGROUND
  Lack of response to treatment in community acquired pneumonia (CAP) worsens outcome. We evaluated the systemic cytokine profile (tumour necrosis factor alpha, interleukin (IL)1, IL6, IL8 and IL10), C reactive protein (CRP) and procalcitonin (PCT) in patients with CAP who had treatment failure.
  
  
  METHODS
  A prospective study was performed in hospitalised patients with CAP. Cytokines, PCT and CRP measurements were obtained on day 1 and after 72 h of treatment. Treatment failure was the endpoint evaluated, with separation of those with early (< or = 72 h) or late failure.
  
  
  RESULTS
  453 patients were included: 84 (18%) had treatment failure, of whom 38 (8%) were early failures. Median levels of IL6, PCT and CRP on days 1 and 3 and median levels of IL8 on day 1 were significantly higher in patients with any treatment failure. Logistic regression analysis demonstrated that values above the cut-off points for IL6 (> or = 169 pg/ml), IL8 (> or = 14 pg/ml) and CRP (> or = 21.9 mg/dl) on day 1 had independent predictive value for any treatment failure after adjustment for initial severity; relative risks (OR) found were 1.9, 2.2 and 2.6, respectively. Increased levels for CRP and PCT on day 1 were also independent predictors for early failure. Increased levels for IL6 and CRP were the best predictors of late failure.
  
  
  CONCLUSIONS
  Serum levels of CRP, IL6 and PCT on days 1 and 3 were independently associated with a higher risk of any treatment failure. Low levels of PCT and CRP on day 1 had a high negative predictive value for early failure.
authors.affiliation: Servicio de Neumología, Hospital Universitario La Fe, Avda de Campanar 21, 46009 Valencia, Spain. rmenend@separ.es
authors.forename: R
authors.initials: R
authors.lastname: Menéndez
authors.forename: M
authors.initials: M
authors.lastname: Cavalcanti
authors.forename: S
authors.initials: S
authors.lastname: Reyes
authors.forename: J
authors.initials: J
authors.lastname: Mensa
authors.forename: R
authors.initials: R
authors.lastname: Martinez
authors.forename: M A
authors.initials: MA
authors.lastname: Marcos
authors.forename: X
authors.initials: X
authors.lastname: Filella
authors.forename: M
authors.initials: M
authors.lastname: Niederman
authors.forename: A
authors.initials: A
authors.lastname: Torres
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D002116:Calcitonin / Q000378:metabolism*; D015740:Calcitonin Gene-Related Peptide; D017714:Community-Acquired Infections / Q000097:blood / Q000188:drug therapy; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D018410:Pneumonia, Bacterial / Q000097:blood / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism*; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D016207:Cytokines; D011498:Protein Precursors; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide