Low C-reactive protein values at admission predict mortality in patients with severe community-acquired pneumonia caused by Streptococcus pneumoniae that require intensive care management.

Abstract

PURPOSE:

To identify risk factors associated with mortality in patients with severe community-acquired pneumonia (CAP) caused by S. pneumoniae who require intensive care unit (ICU) management, and to assess the prognostic values of these risk factors at the time of admission.

METHODS:

Retrospective analysis of all consecutive patients with CAP caused by S. pneumoniae who were admitted to the 32-bed medico-surgical ICU of a community and referral university hospital between 2002 and 2011. Univariate and multivariate analyses were performed on variables available at admission.

RESULTS:

Among the 77 adult patients with severe CAP caused by S. pneumoniae who required ICU management, 12 patients died (observed mortality rate 15.6%). Univariate analysis indicated that septic shock and low C-reactive protein (CRP) values at admission were associated with an increased risk of death. In a multivariate model, after adjustment for age and gender, septic shock [odds ratio (OR), confidence interval 95%; 4.96, 1.11-22.25; p = 0.036], and CRP (OR 0.99, 0.98-0.99 p = 0.034) remained significantly associated with death. Finally, we assessed the discriminative ability of CRP to predict mortality by computing its receiver operating characteristic curve. The CRP value cut-off for the best sensitivity and specificity was 169.5 mg/L to predict hospital mortality with an area under the curve of 0.72 (0.55-0.89).

CONCLUSIONS:

The mortality of patients with S. pneumoniae CAP requiring ICU management was much lower than predicted by severity scores. The presence of septic shock and a CRP value at admission <169.5 mg/L predicted a fatal outcome.

• Authors: Yok-Ai Que, Virginie Virgini, Elise Dupuis Lozeron, Géraldine Paratte, Guy Prod'hom, Jean-Pierre Revelly, Jean-Luc Pagani, Emmanuel Charbonney, Philippe Eggimann
• Journal: Infection (Infection) Vol. 43 Issue 2 Pg. 193-9 (Apr 2015) ISSN: 1439-0973 [Electronic] Germany
• PMID: 25732200 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• C-Reactive Protein

Topics

• Adult
• Aged
• Aged, 80 and over
• C-Reactive Protein
• Community-Acquired Infections
• Comorbidity
• Critical Care
• Female
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Odds Ratio
• Outcome Assessment, Health Care
• Patient Admission
• Pneumonia, Pneumococcal (blood, diagnosis, drug therapy, mortality)
• ROC Curve
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Streptococcus pneumoniae