scholarly journals Management of community-acquired pneumonia: essential tips for the physician on call

2020 ◽  
Vol 81 (5) ◽  
pp. 1-9 ◽  
Author(s):  
Malcolm Avari ◽  
Jeremy S Brown
Keyword(s):  
Clinical Problem ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Care Bundle ◽  
Clinical Markers ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Acute Hospitals ◽  
History Of ◽  
Short Courses

Community-acquired pneumonia is a common clinical problem requiring admission to hospital, with a particularly high incidence in the elderly population and those with significant comorbidities. Diagnosis is made on the combination of a short history of respiratory symptoms and systemic ill-health with new examination and/or radiological features of consolidation. Multiple other infective and non-infective conditions can mimic community-acquired pneumonia, leading to misdiagnosis in 5–17% of cases. The CURB-65 score can identify patients with community-acquired pneumonia with a higher risk of mortality, but is insensitive at identifying patients requiring intensive care support and needs to be combined with clinical markers of potential severity. Both high admission levels of C-reactive protein and the failure of levels of C-reactive protein to decline by >50% by day 4 after admission are associated with higher risk of complications, need for ventilation or inotropic support, and mortality. Empirical antibiotic therapy for most patients admitted to hospital is combination of a ß-lactam and a macrolide. Short courses of antibiotics do not result in significantly different outcomes to longer courses unless the patient has developed complications such as a complex parapneumonic effusion. Implementation of a community-acquired pneumonia care bundle into clinical practice reduces mortality, and should be a high priority for all acute hospitals.

scholarly journals Faktor–Faktor yang Berhubungan dengan Diagnosis Pneumonia pada Pasien Usia Lanjut

2017 ◽  
Vol 3 (4) ◽  
pp. 183 ◽  
Author(s):  
Elza Febria Sari ◽  
C Martin Rumende ◽  
Kuntjoro Harimurti
Keyword(s):  
Urinary Incontinence ◽  
Functional Status ◽  
Clinical Laboratory ◽  
The Elderly ◽  
Community Acquired Pneumonia ◽  
Operating Characteristics ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Characteristics Analysis ◽  
Atypical Manifestations

Pendahuluan. Menegakkan diagnosis pneumonia pada pasien usia lanjut seringkali sulit mengingat gejala dan tanda klinis sering tidak lengkap dan manifestasi klinis yang tidak khas serta pemeriksaan penunjang yang sulit diinterpretasi. Hal ini mengkibatkan under ataupun over diagnosis dengan konsekuensi meningkatnya morbiditas dan mortalitas. Data faktor-faktor yang berhubungan dengan diagnosis pneumonia baik manifestasi khas ataupun tidak khas pada pasien usia lanjut belum banyak tersedia.Metode. Penelitian diagnostik dilakukan terhadap 158 pasien usia lanjut dengan kecurigaan pneumonia yang dirawat di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) Jakarta pada kurun waktu Januari-Oktober 2010. Hubungan data klinis, laboratoris serta radiologis yang mencakup manifestasi spesifik (batuk, sputum produktif, sesak napas, demam, ronki, leukositosis , infiltrat) dan manifestasi tidak spesifik (intake sulit, jatuh, penurunan status fungsional inkontinensia urin) dengan diagnosis pneumonia komunitas dianalisis dengan regresi logistik. Kemudian, ditentukan kontribusi masing-masing determinan diagnosis terhadap diagnosis pneumonia. Kemampuan C-reactive protein dalam menegakkan diagnosis pneumonia dinilai dengan membuat kurva ROC dan menghitung AUC.Hasil. Dari 158 subjek, 106 didiagnosis pneumonia sesuai kriteria baku emas. Pada model akhir regresi logistik didapatkan tiga faktor yang berhubungan dengan diagnosis pneumonia yaitu batuk, ronki dan infiltrat dengan nilai p masing-masing secara berturut-turut yaitu <0,0001; 0,02; dan 0,0001. Nilai AUC yang diperoleh dari metode ROC untuk mengetahui kemampuan CRP dalam mendiagnosis pneumonia adalah 0,57 (IK 95%; 0,47-0,66).Simpulan. Faktor-faktor yang berhubungan dengan diagnosis pneumonia pada usia lanjut adalah batuk, ronki dan infiltrat. Sementara itu, c-reactive protein tidak memiliki peran dalam memprediksi diagnosis pneumonia pada pasien usia lanjut.Kata Kunci: diagnosis, pneumonia komunitas, usia lanjut  Factors Related to Diagnosis of Community-Acquired Pneumonia in the ElderlyIntroduction. Diagnosing community-acquired pneumonia (CAP) in the elderly remains a clinical challenge for various reasons. The clinical manifestation in the elderly is not frank and atypical manifestations, e.g. falls, decrease of functional status and food intake or urinary incontinence, may be present. These reasons may be associated with under or over diagnosis, which consequently contribute to the higher observed mortality rate in the elderly population with CAP. Study about factors related to diagnosis of CAP in the elderly was ra rely performed. Methods. From January to October 2010, 158 elderly patients suspected of having pneumonia at RSCM were registered. Relationship between clinical, laboratory and radiologic factors which consist of classic manifestations (cough, productive cough, dyspnea, fever, rales, leucocytosis, infiltrates) and atypical manifestations (decrease of intake and functional status, falls, urinary incontinence) with diagnosis community acquired pneumonia were analyzed. Receiver operating characteristics analysis of C-reactive protein was performed to find its association with diagnosis of pneumonia.Results. Of 158 subject, 106 were confirmed of having pneumonia. Final model of multiple logistics regression analysis revealed three factors: cough (p<0,0001), rales (p=0,02) and infiltrate (p<0,0001) related to diagnosis of pneumonia. All four atypical manifestations were proved unrelated with diagnosis of pneumonia. The area under the ROC curve for c-reactive protein was 0,57 (95% CI 0,47- 0,66). Conclusions. Factors related with diagnosis of community-acquired penumoni in the elderly are cough, rhales and infiltrates. All four atypical manifestations are proven unrelated with diagnosis of pneumonia. C-reactive protein does not predict diagnosis of CAP in the eldery. Keywords: community-acquired pneumonia, diagnostic factors, elderly

Relationship of C-Reactive Protein to Risk of Cardiovascular Disease in the Elderly

1997 ◽  
Vol 17 (6) ◽  
pp. 1121-1127 ◽  
Author(s):  
Russell P. Tracy ◽  
Rozenn N. Lemaitre ◽  
Bruce M. Psaty ◽  
Diane G. Ives ◽  
Rhobert W. Evans ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
The Elderly ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Relationship Of

scholarly journals Utility of procalcitonin, C-reactive protein and white blood cells alone and in combination for the prediction of clinical outcomes in community-acquired pneumonia

2015 ◽  
Vol 53 (4) ◽  
Author(s):  
Andriy Zhydkov ◽  
Mirjam Christ-Crain ◽  
Robert Thomann ◽  
Claus Hoess ◽  
Christoph Henzen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Blood Cells ◽  
White Blood Cells ◽  
Community Acquired Pneumonia ◽  
Adverse Clinical Outcome ◽  
C Reactive Protein ◽  
Prognostic Information ◽  
Reactive Protein

AbstractThe added value of biomarkers, such as procalcitonin (PCT), C-reactive protein (CRP), and white blood cells (WBC), as adjuncts to clinical risk scores for predicting the outcome of patients with community-acquired pneumonia (CAP) is in question. We investigated the prognostic accuracy of initial and follow-up levels of inflammatory biomarkers in predicting death and adverse clinical outcomes in a large and well-defined cohort of CAP patients.We measured PCT, CRP and WBC on days 1, 3, 5, and 7 and followed the patients over 30 days. We applied multivariate regression models and area under the curve (AUC) to investigate associations between these biomarkers, the clinical risk score CURB-65, and clinical outcomes [i.e., death and intensive care unit (ICU) admission].Of 925 patients with CAP, 50 patients died and 118 patients had an adverse clinical outcome. None of the initial biomarker levels significantly improved the CURB-65 score for mortality prediction. Follow-up biomarker levels showed significant independent association with mortality at days 3, 5, and 7 and with improvements in AUC. Initial PCT and CRP levels were independent prognostic predictors of adverse clinical outcome, and levels of all biomarkers during the course of disease provided additional prognostic information.This study provides robust insights into the added prognostic value of inflammatory markers in CAP. Procalcitonin, CRP, and to a lesser degree WBC provided some prognostic information on CAP outcomes, particularly when considering their kinetics at days 5 and 7 and when looking at adverse clinical outcomes instead of mortality alone.

C-reactive protein: a marker or a player?

2007 ◽  
Vol 113 (2) ◽  
pp. 79-81 ◽  
Author(s):  
Thomas Nyström
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Events ◽  
Protein A ◽  
Low Grade ◽  
Phase Reaction ◽  
Clinical Markers ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp

It has been suggested that Type 2 diabetes may, in part, be precipitated or accelerated by an acute-phase reaction as part of the innate immune response, in which large amounts of cytokines are released from adipose tissue, creating a low-grade inflammatory milieu. There is also firm evidence that atherosclerosis is an immune-mediated inflammatory disease. Therefore it is reasonable to imply that low-grade inflammation is an important pathogenetic factor in atherosclerosis and cardiovascular events in patients with Type 2 diabetes. Over the last few years, there have been a lot of promising clinical markers proposed to link inflammation and atherosclerosis. Of these markers, hs-CRP (high-sensitivity C-reactive protein) might be a prognostic marker for further cardiovascular events, although this has been refuted recently. In this issue of Clinical Science, Castoldi and co-workers have demonstrated that, in patients with Type 2 diabetes categorized into low (<1.0 mg/l), medium (1.0–3.0 mg/l) and high (>3.0 mg/l) hs-CRP groups, serum levels of hs-CRP correlated with lipopolysaccharide-stimulated release of interleukin-1β and interleukin-6 in whole blood. This finding may indicate that low-grade inflammatory activity might influence cytokine production in these patients.

scholarly journals Chondrosternal Arthritis in Infant: An Unusual Entity

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athina Nikolarakou ◽  
Dana Dumitriu ◽  
Pierre-Louis Docquier
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Local Tenderness ◽  
Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

scholarly journals Effects of statins on clinical outcomes in hospitalized patients with community-acquired pneumonia

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093858
Author(s):  
Rony M. Zeenny ◽  
Hanine Mansour ◽  
Wissam K Kabbara ◽  
Nibal Chamoun ◽  
Myriam Audi ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Length Of Stay ◽  
Hospital Length ◽  
Community Acquired Pneumonia ◽  
Hospital Length Of Stay ◽  
Comorbid Conditions ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
Chronic Use

Objective We evaluated the effect of chronic use of statins based on C-reactive protein (CRP) levels and hospital length of stay (LOS) in patients admitted with community-acquired pneumonia (CAP). Methods We conducted a retrospective study over 12 months at a teaching hospital in Lebanon comparing patients with CAP taking chronic statins with patients not taking statins. Included patients with CAP were older than age 18 years and had two CRP level measures during hospitalization. CURB-65 criteria were used to assess the severity of pneumonia. A decrease in CRP levels on days 1 and 3, LOS, and normalization of fever were used to assess the response to antibiotics. Results Sixty-one patients were taking statins and 90 patients were not taking statins. Patients on statins had significantly more comorbid conditions; both groups had comparable CURB-65 scores. In both groups, no statistically significant difference was seen for the decrease in CRP level on days 1 and 3 and LOS. No difference in days to normalization of fever was detected in either group. Conclusion No association was found between the chronic use of statins and CRP levels, LOS, or days to fever normalization in patients with CAP.

Sign in / Sign up

Export Citation Format

Share Document