title: Predicting treatment failure in patients with community acquired pneumonia: a case-control study.
abstract: BACKGROUND
  Treatment failure in community-acquired-pneumonia (CAP) patients is associated with a high mortality rate, and therefore are a matter of great concern in clinical management. Those patients have increased mortality and are a target population for randomized clinical trials.
  
  
  METHODS
  A case-control study was performed in patients with CAP (non-failure cases vs. failure cases, discriminating by late and early failure). CRP, PCT, interleukin 1, 6, 8 and 10 and TNF were determined at days 1 and 3 of hospitalization.
  
  
  RESULTS
  A total of 253 patients were included in this study where 83 patients presented treatment failure. Of these, 40 (48.2%) had early failure. A discriminative effect was found for a higher CURB-65 score among late failure patients (p = 0.004). A significant increase on day 1 of hospitalization in CRP (p < 0.001), PCT (p = 0.004), IL-6 (p < 0.001) and IL-8 (p = 0.02), and a decrease in IL-1 (p = 0.06) in patients with failure was observed compared with patients without failure. On day 3, only the increase in CRP (p < 0.001), PCT (p = 0.007) and IL-6 (p < 0.001) remained significant. Independent predictors for early failure were higher IL-6 levels on day 1 (OR = 1.78, IC = 1.2-2.6) and pleural effusion (OR = 2.25, IC = 1.0-5.3), and for late failure, higher PCT levels on day 3 (OR = 1.60, IC = 1.0-2.5), CURB-65 score ≥ 3 (OR = 1.43, IC = 1.0-2.0), and multilobar involvement (OR = 4.50, IC = 2.1-9.9).
  
  
  CONCLUSIONS
  There was a good correlation of IL-6 levels and CAP failure and IL-6 & PCT with late CAP failure. Pleural effusion and multilobar involvement were simple clinical predictors of early and late failure, respectively.
  
  
  BACKGROUND
  IRB Register: http://2009/5451.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.forename: Xavier
authors.initials: X
authors.lastname: Valles
authors.forename: Rosario
authors.initials: R
authors.lastname: Menendez
authors.forename: Oriol
authors.initials: O
authors.lastname: Sibila
authors.forename: Beatriz
authors.initials: B
authors.lastname: Montull
authors.forename: Catia
authors.initials: C
authors.lastname: Cilloniz
authors.forename: Antonio
authors.initials: A
authors.lastname: Artigas
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER enfermedades respiratorias, Servei de Pneumologia, Institut del Torax, Villarroel 170, 08036 Barcelona, Spain. ATORRES@clinic.ub.es.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D016207:Cytokines / Q000097:blood; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000097:blood / Q000175:diagnosis / Q000628:therapy; D011014:Pneumonia / Q000097:blood / Q000175:diagnosis* / Q000628:therapy*; D011237:Predictive Value of Tests; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D016207:Cytokines; C508600:IL6 protein, human; D015850:Interleukin-6