Menéndez R, Cavalcanti M, Reyes S, Mensa J, Martinez R, Marcos M A, Filella X, Niederman M, Torres A
Servicio de Neumología, Hospital Universitario La Fe, Avda de Campanar 21, 46009 Valencia, Spain.
Thorax. 2008 May;63(5):447-52. doi: 10.1136/thx.2007.086785. Epub 2008 Feb 1.
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.
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.
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.
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.
社区获得性肺炎（CAP）治疗无反应会使预后恶化。我们评估了治疗失败的CAP患者的全身细胞因子谱（肿瘤坏死因子α、白细胞介素（IL）-1、IL-6、IL-8和IL-10）、C反应蛋白（CRP）和降钙素原（PCT）。
对住院的CAP患者进行了一项前瞻性研究。在第1天和治疗72小时后进行细胞因子、PCT和CRP测量。以治疗失败作为评估终点，区分早期（≤72小时）或晚期失败患者。
纳入453例患者：84例（18%）治疗失败，其中38例（8%）为早期失败。任何治疗失败患者第1天和第3天的IL-6、PCT和CRP中位数水平以及第1天的IL-8中位数水平显著更高。逻辑回归分析表明，在调整初始严重程度后，第1天IL-6（≥169 pg/ml）、IL-8（≥14 pg/ml）和CRP（≥21.9 mg/dl）高于切点值对任何治疗失败具有独立预测价值；发现的相对风险（OR）分别为1.9、2.2和2.6。第1天CRP和PCT水平升高也是早期失败的独立预测因素。IL-6和CRP水平升高是晚期失败的最佳预测因素。
第1天和第3天的血清CRP、IL-6和PCT水平与任何治疗失败的较高风险独立相关。第1天PCT和CRP水平低对早期失败具有较高的阴性预测价值。
