title: Predicting In-Hospital Treatment Failure (≤ 7 days) in Patients with COPD Exacerbation Using Antibiotics and Systemic Steroids.
abstract: Although pharmacological treatment of COPD exacerbation (COPDE) includes antibiotics and systemic steroids, a proportion of patients show worsening of symptoms during hospitalization that characterize treatment failure. The aim of our study was to determine in-hospital predictors of treatment failure (≤ 7 days). Prospective data on 110 hospitalized COPDE patients, all treated with antibiotics and systemic steroids, were collected; on the seventh day of hospitalization, patients were divided into treatment failure (n = 16) or success (n = 94). Measures of inflammatory serum biomarkers were recorded at admission and at day 3; data on clinical, laboratory, microbiological, and severity, as well data on mortality and readmission, were also recorded. Patients with treatment failure had a worse lung function, with higher serum levels of C-reactive protein (CRP), procalcitonin (PCT), tumour necrosis factor-alpha (TNF-α), interleukin (IL) 8, and IL-10 at admission, and CRP and IL-8 at day 3. Longer length of hospital stay and duration of antibiotic therapy, higher total doses of steroids and prevalence of deaths and readmitted were found in the treatment failure group. In the multivariate analysis, +1 mg/dL of CRP at admission (OR, 1.07; 95% CI, 1.01 to 1.13) and use of penicillins or cephalosporins (OR, 5.63; 95% CI, 1.26 to 25.07) were independent variables increasing risk of treatment failure, whereas cough at admission (OR, 0.20; 95% CI, 0.05 to 0.75) reduces risk of failure. In hospitalized COPDE patients CRP at admission and use of specific class of antibiotics predict in-hospital treatment failure, while presence of cough has a protective role.
authors.affiliation: a 1 Cardio-Thoracic Department, Pneumology and Respiratory Intensive Care Unit, "Carlo Poma" Hospital , Mantova , Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Crisafulli
authors.affiliation: b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Torres
authors.affiliation: b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain.
authors.forename: Arturo
authors.initials: A
authors.lastname: Huerta
authors.affiliation: b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Guerrero
authors.affiliation: b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Gabarrús
authors.affiliation: c 3 Pneumology Department, Hospital Universitario y politecnico La Fe, CIBERES , Valencia , Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gimeno
authors.affiliation: c 3 Pneumology Department, Hospital Universitario y politecnico La Fe, CIBERES , Valencia , Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Martinez
authors.affiliation: b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain.
authors.forename: Néstor
authors.initials: N
authors.lastname: Soler
authors.affiliation: b 2 Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona (UB) , Barcelona , Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Fernández
authors.affiliation: d 4 Centre for Respiratory Medicine, Royal Free Campus, University College London Medical School , London , United Kingdom.
authors.forename: Jadwiga A
authors.initials: JA
authors.lastname: Wedzicha
authors.affiliation: c 3 Pneumology Department, Hospital Universitario y politecnico La Fe, CIBERES , Valencia , Spain.
authors.forename: Rosario
authors.initials: R
authors.lastname: Menéndez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000378:metabolism; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D005938:Glucocorticoids / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D007375:Interleukin-1 / Q000378:metabolism; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009026:Mortality; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D018410:Pneumonia, Bacterial / Q000188:drug therapy; D011379:Prognosis; D011446:Prospective Studies; D011498:Protein Precursors / Q000378:metabolism; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; C000606589:CALCA protein, human; C508606:CXCL8 protein, human; D005938:Glucocorticoids; C508609:IL10 protein, human; C508600:IL6 protein, human; D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D011498:Protein Precursors; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002116:Calcitonin; D002097:C-Reactive Protein; D015740:Calcitonin Gene-Related Peptide
keywords: Chronic obstructive pulmonary disease; disease exacerbation; inflammatory response; predictors; treatment failure