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Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients.
Clin Infect Dis. 2004 Dec 15; 39(12):1783-90.CI

Abstract

BACKGROUND

The natural history of the resolution of infectious parameters in patients with community-acquired pneumonia (CAP) is not completely known. The aim of our study was to identify those factors related to host characteristics, the severity of pneumonia, and treatment that influence clinical stability.

METHODS

In a prospective, multicenter, observational study, we observed 1424 patients with CAP who were admitted to 15 Spanish hospitals. The main outcome variable was the number of days needed to reach clinical stability (defined as a temperature of <or=37.2 degrees C, a heart rate of <or=100 beats/min, a respiratory rate of <or=24 breaths/min, systolic blood pressure of >or=90 mm Hg, and oxygen saturation >or=90% or arterial oxygen partial pressure of >or=60 mm Hg).

RESULTS

The median time to stability was 4 days. A Cox proportional hazard model identified 6 independent variables recorded during the first 24 h after hospital admission related to the time needed to reach stability: dyspnea (hazard ratio [HR], 0.76), confusion (HR, 0.66), pleural effusion (HR, 0.67), multilobed CAP (HR, 0.72), high pneumonia severity index (HR, 0.73), and adherence to the Spanish guidelines for treatment of CAP (HR, 1.22). A second Cox model was performed that included complications and response to treatment. This model identified the following 10 independent variables: chronic bronchitis (HR, 0.81), dyspnea (HR, 0.79), confusion (HR, 0.61), multilobed CAP (HR, 0.84), initial severity of disease (HR, 0.73), treatment failure (HR, 0.31), cardiac complications (HR, 0.66), respiratory complications (HR, 0.77), empyema (HR, 0.57), and admission to the intensive care unit (HR, 0.57).

CONCLUSIONS

Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability.

Authors+Show Affiliations

Servicio de Neumología, Hospital Universitario La Fe, Valencia, Spain. rmenend@separ.esNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15578400

Citation

Menéndez, Rosario, et al. "Reaching Stability in Community-acquired Pneumonia: the Effects of the Severity of Disease, Treatment, and the Characteristics of Patients." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 39, no. 12, 2004, pp. 1783-90.
Menéndez R, Torres A, Rodríguez de Castro F, et al. Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clin Infect Dis. 2004;39(12):1783-90.
Menéndez, R., Torres, A., Rodríguez de Castro, F., Zalacaín, R., Aspa, J., Martín Villasclaras, J. J., Borderías, L., Benítez Moya, J. M., Ruiz-Manzano, J., Blanquer, J., Pérez, D., Puzo, C., Sánchez-Gascón, F., Gallardo, J., Alvarez, C. J., & Molinos, L. (2004). Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 39(12), 1783-90.
Menéndez R, et al. Reaching Stability in Community-acquired Pneumonia: the Effects of the Severity of Disease, Treatment, and the Characteristics of Patients. Clin Infect Dis. 2004 Dec 15;39(12):1783-90. PubMed PMID: 15578400.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reaching stability in community-acquired pneumonia: the effects of the severity of disease, treatment, and the characteristics of patients. AU - Menéndez,Rosario, AU - Torres,Antoni, AU - Rodríguez de Castro,Felipe, AU - Zalacaín,Rafael, AU - Aspa,Javier, AU - Martín Villasclaras,Juan J, AU - Borderías,Luis, AU - Benítez Moya,José M, AU - Ruiz-Manzano,Juan, AU - Blanquer,José, AU - Pérez,Diego, AU - Puzo,Carmen, AU - Sánchez-Gascón,Fernando, AU - Gallardo,José, AU - Alvarez,Carlos J, AU - Molinos,Luis, AU - ,, Y1 - 2004/11/18/ PY - 2004/06/20/received PY - 2004/08/02/accepted PY - 2004/12/4/pubmed PY - 2005/9/28/medline PY - 2004/12/4/entrez SP - 1783 EP - 90 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 39 IS - 12 N2 - BACKGROUND: The natural history of the resolution of infectious parameters in patients with community-acquired pneumonia (CAP) is not completely known. The aim of our study was to identify those factors related to host characteristics, the severity of pneumonia, and treatment that influence clinical stability. METHODS: In a prospective, multicenter, observational study, we observed 1424 patients with CAP who were admitted to 15 Spanish hospitals. The main outcome variable was the number of days needed to reach clinical stability (defined as a temperature of <or=37.2 degrees C, a heart rate of <or=100 beats/min, a respiratory rate of <or=24 breaths/min, systolic blood pressure of >or=90 mm Hg, and oxygen saturation >or=90% or arterial oxygen partial pressure of >or=60 mm Hg). RESULTS: The median time to stability was 4 days. A Cox proportional hazard model identified 6 independent variables recorded during the first 24 h after hospital admission related to the time needed to reach stability: dyspnea (hazard ratio [HR], 0.76), confusion (HR, 0.66), pleural effusion (HR, 0.67), multilobed CAP (HR, 0.72), high pneumonia severity index (HR, 0.73), and adherence to the Spanish guidelines for treatment of CAP (HR, 1.22). A second Cox model was performed that included complications and response to treatment. This model identified the following 10 independent variables: chronic bronchitis (HR, 0.81), dyspnea (HR, 0.79), confusion (HR, 0.61), multilobed CAP (HR, 0.84), initial severity of disease (HR, 0.73), treatment failure (HR, 0.31), cardiac complications (HR, 0.66), respiratory complications (HR, 0.77), empyema (HR, 0.57), and admission to the intensive care unit (HR, 0.57). CONCLUSIONS: Some characteristics of CAP are useful at the time of hospital admission to identify patients who will need a longer hospital stay to reach clinical stability. Empirical treatment that follows guidelines is associated with earlier clinical stability. Complications and treatment failure delay clinical stability. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/15578400/Reaching_stability_in_community_acquired_pneumonia:_the_effects_of_the_severity_of_disease_treatment_and_the_characteristics_of_patients_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/426028 DB - PRIME DP - Unbound Medicine ER -