Influence of Age on Symptoms at Presentation in Patients With Community-Acquired Pneumonia

Metlay, Joshua P.; Schulz, Richard; Li, Y H; Singer, Daniel E.; Marrie, Thomas J.; Coley, Christopher M.; Hough, Linda J.; Obrosky, D. Scott; Kapoor, Wishwa N.; Fine, Michael J.

doi:10.1001/archinte.1997.00440340089009

Cited by 321 publications

(77 citation statements)

References 24 publications

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“…Of patients admitted for CAP, 17% were uninfected; most had congestive heart failure. Pulmonary edema may be difficult to distinguish from pneumonia: (1) symptoms and signs (including WBC counts 37,38 ) overlap; (2) pneumonia symptoms in older persons are nonspecific 39 ; and (3) fever may not be present in pneumonia (only onehalf of our patients with pneumonia had temperature !99.4 F in their first 24 h in the hospital). Once unmasked, procalcitonin levels were found to be much lower in uninfected patients than in those with bacterial pneumonia; such a finding might reinforce the willingness to withhold antibiotics in these cases.…”

Section: Discussionmentioning

confidence: 94%

Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: Results of a one-year study

Musher

Roig

Cazares

et al. 2013

Journal of Infection

196

133

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Only 23.2% of 259 patients admitted with a CAP syndrome had documented bacterial infection; another 26.6% had no identified bacterial etiology, but findings closely resembled those of bacterial infection. Nevertheless, all 259 received antibacterial therapy. Careful attention to the clinical picture may identify uninfected patients or those with viral infection, perhaps with reassurance by a non-elevated procalcitonin. Determining an etiologic diagnosis remains elusive. Better discriminators of bacterial infection are sorely needed.

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Section: Discussionmentioning

confidence: 94%

Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: Results of a one-year study

Musher

Roig

Cazares

et al. 2013

Journal of Infection

196

133

View full text Add to dashboard Cite

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“…This finding might be explained by the inverse correlation of inflammatory response and age [10, 29]. …”

Section: Discussionmentioning

confidence: 99%

Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patients

Kutz¹,

Grolimund²,

Thomann

et al. 2014

BMC Anesthesiol

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BackgroundBlood biomarkers are increasingly used to diagnose, guide therapy in, and risk-stratify community-acquired pneumonia (CAP) patients in emergency departments (EDs). How pre-analytic factors affect these markers’ initial levels in this population is unknown.MethodsIn this secondary analysis of consecutive ED patients with CAP from a large multicentre antibiotic stewardship trial, we used adjusted multivariate regression models to determine the magnitude and statistical significance of differences in mean baseline concentrations of five biomarkers (procalcitonin [PCT], C-reactive protein [CRP], white blood cells count [WBC], proadrenomedullin [ProADM], copeptin) associated with six pre-analytic factors (antibiotic or corticosteroid pretreatment, age, gender, chronic renal failure or chronic liver insufficiency).ResultsOf 925 CAP patients (median age 73 years, 58.8% male), 25.5% had antibiotic pretreatment, 2.4%, corticosteroid pretreatment, 22.3%, chronic renal failure, 2.4% chronic liver insufficiency. Differences associated with pre-analytic factors averaged 6.1% ±4.6%; the three largest statistically significant changes (95% confidence interval) were: PCT, +14.2% (+2.1% to +26.4%, p = 0.02) with liver insufficiency; ProADM, +13.2% (+10.2% to +16.1%, p < 0.01) with age above median; CRP, -12.8% (-25.4% to -0.2%, p = 0.05) with steroid pretreatment. In post hoc sensitivity analyses, reclassification statistics showed that these factors did not result in significant changes of biomarker levels across clinically used cut-off ranges.ConclusionsDespite statistically significant associations of some pre-analytic factors and biomarker levels, a clinically relevant influence seems unlikely. Our observations reinforce the concept of using biomarkers in algorithms with widely-separated cut-offs and overruling criteria considering the entire clinical picture.Trial registrationIdentifier ISRCTN95122877.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2253-14-102) contains supplementary material, which is available to authorized users.

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“…However, the BPP group was predominantly composed of elderly individuals, in whom tachypnea is more common, (18) Tachypnea is also a well-known indicator of severity found in many patients with bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica

et al. 2012

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Objective: Bacteremia is the most common presentation of invasive disease in community-acquired pneumonia (CAP) due to Streptococcus pneumoniae. We investigated whether bacteremia in pneumococcal CAP worsens outcomes and whether it is related to pneumococcal vaccination (PV). Methods: Secondary analysis of a cohort of patients with pneumococcal CAP confirmed by blood culture, sputum culture, or urinary antigen testing. Demographic, clinical, radiographic, and biochemical data were collected, as were Acute Physiology and Chronic Health Evaluation II (APACHE II) and pneumonia severity index (PSI) scores, comorbidities, and PV history. We drew comparisons between patients with bacteremic pneumococcal CAP (BPP) and those with non-bacteremic pneumococcal CAP (NBPP). Results: Forty-seven patients had BPP, and 71 had NBPP (confirmed by sputum culture in 45 and by urinary antigen testing in 26); 107 had some indication for PV. None of the BPP patients had received PV, compared with 9 of the NBPP patients (p = 0.043). Among the BPP patients, the mean age was higher (76.4 ± 11.5 vs. 67.5 ± 20.9 years), as were APACHE II and PSI scores (16.4 ± 4.6 vs. 14.1 ± 6.5 and 129.5 ± 36 vs. 105.2 ± 45, respectively), as well as the rate of ICU admission for cardiopathy or chronic renal failure (42.5% vs. 22.5%), whereas hematocrit and plasma sodium levels were lower (35.7 ± 5.8 vs. 38.6 ± 6.7% and 133.9 ± 6.0 vs. 137.1 ± 5.5 mEq/L, respectively), although mortality was similar (29.8% vs 28.2%). Conclusions: In this population at high risk for CAP due to S. pneumoniae, the PV rate was extremely low (8.4%). Although BPP patients were more severely ill, mortality was similar between the two groups. Because PV reduces the incidence of BPP, the vaccination rate in at-risk populations should be increased.Keywords: Pneumococcal vaccines; Pneumonia, bacterial; Streptococcus pneumoniae; Pneumococcal infections; Mortality; Epidemiology. ResumenObjetivo: Bacteriemia es la forma invasiva más común de neumonía adquirida en la comunidad (NAC) por Streptococcus pneumoniae. Investigamos si la bacteriemia en NAC neumocócica empeora los resultados y si ella guarda relación con la vacunación antineumocócica (VAN). Métodos: Análisis secundario de una cohorte de pacientes con NAC neumocócica confirmada por cultivo de sangre o esputo o antígeno urinario. Se registraron datos demográficos, clínicos, radiográficos y de laboratorio, escores Higher Acute Physiology and Chronic Health Evaluation II (APACHE II) y pneumonia severity index (PSI), comorbilidades y antecedente de VAN. Se compararon pacientes con NAC neumocócica bacteriémica (NNB) vs. no bacteriémica (NNNB). Resultados: Cuarenta y siete pacientes tenían NNB y 71 NNNB (45 por cultivo de esputo y 26 por antígeno urinario); 107 tenían alguna indicación de VAN. Ningún paciente con NNB, pero 9 con NNNB, habían recibido VAN (p = 0,043). Los pacientes con NNB eran mayores (76,4 ± 11,5 vs. 67,5 ± 20,9 años), tenían mayor APACHE II (16,4 ± 4,6 vs. 14,1 ± 6,5) y PSI (129,5 ± 36 vs. 105,2 ± 45), más f...

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Influence of Age on Symptoms at Presentation in Patients With Community-Acquired Pneumonia

Cited by 321 publications

References 24 publications

Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: Results of a one-year study

Can an etiologic agent be identified in adults who are hospitalized for community-acquired pneumonia: Results of a one-year study

Pre-analytic factors and initial biomarker levels in community-acquired pneumonia patients

Impacto de la bacteriemia en una cohorte de pacientes con neumonía neumocócica

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