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Higher Prognostic Value of Hypoxemia Than C-Reactive Protein in Bacteremic Pneumococcal Pneumonia FREE TO VIEW

Francisco Sanz, PhD; Estrella Fernández-Fabrellas, PhD; Ángela Cervera, MD; Maria Luisa Briones, PhD; María Carmen Aguar, PhD; Eusebi Chiner, PhD; Laura Novella, MD; José Noberto Sancho, MD; Pedro Landete, MD; M. Miralles, MD; José Blanquer, PhD
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Consorci Hospital General Universitari de Valencia, Valencia, Spain

Chest. 2014;145(3_MeetingAbstracts):144A. doi:10.1378/chest.1775716
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SESSION TITLE: Respiratory Infections Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: To assess the accuracy of different biomarkers (PaO2/FiO2 vs C-Reactive Protein, CRP) in predicting complications and mortality in bacteremic pneumococcal pneumonia (CAP-SP).

METHODS: We analyzed the values of CRP and PaO2/FiO2 regarding pneumonia severity and the development of complications and mortality in a bacteremic pneumococcal pneumonia database. Means were compared with U Mann-Whitney test, and we performed analysis of variance (ANOVA) and ROC curves comparing both variables and outcomes.

RESULTS: We analyzed 117 patients of which 73.5% (86 cases) presented with severe pneumonia (PSI IV-V). Complications were developed in 69 cases (58.9%), and the most frequent were systemic and respiratory complications in 45 patients both (38.5%), followed by the presence of septic shock (40 cases, 34.2%) and ICU admission (28 patients, 23.9%). Overall 30-day mortality was 34.2% (40 patients). PaO2/FiO2 values worsened with PSI severity (p<0.01) but CRP levels showed no differences between risk classes (p=0.06). Patients with systemic and respiratory complications, septic shock and ICU admission had significantly lower levels of PaO2/FiO2, while no statistically significant differences in CRP values were found between patients who had a worse outcome compared to those who not. The ability to predict complications and 30-day mortality was higher for PaO2/FiO2 vs CRP (AUC PaO2/FiO2 0.72 vs. CRP 0.49; p<0.01) and AUC (PaO2/FiO2 0.67 vs. CRP 0.56; p=0.004), respectively.

CONCLUSIONS: In our series of bacteremic pneumococcal pneumonia, PaO2/FiO2 is a more accurate biomarker than CRP in predicting complications and mortality.

CLINICAL IMPLICATIONS: The assessment of a marker of target organ injury in CAP may offer a more useful prognostic information that the use of biomarkers of systemic infection.

DISCLOSURE: The following authors have nothing to disclose: Francisco Sanz, Estrella Fernández-Fabrellas, Ángela Cervera, Maria Luisa Briones, María Carmen Aguar, Eusebi Chiner, Laura Novella, José Noberto Sancho, Pedro Landete, M. Miralles, José Blanquer

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