The cost of treating community-acquired pneumonia

Niederman, Michael S.; McCombs, Jeffrey S.; Unger, Alan N.; Kumar, Amit; Popovian, Robert

doi:10.1016/s0149-2918(98)80144-6

Cited by 474 publications

(296 citation statements)

References 13 publications

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“…Treatment failure was also associated with more complications and a longer stay in hospital 28 which contributes to an increase in expenses as the cost per day of hospitalisation represents the highest health care cost for CAP. [29][30][31] This study has identified, at the time of hospital admission, patients who are especially prone to early and late treatment failure with an 11-fold higher mortality. Patients with liver disease, leucopenia, multilobar CAP, initial severity, and cavitation or pleural effusion on chest radiography have a higher risk of treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Menéndez

Torres²,

Zalacaín³

et al. 2004

Thorax

277

235

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Section: Discussionmentioning

confidence: 99%

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Menéndez

Torres²,

Zalacaín³

et al. 2004

Thorax

277

235

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“…(2) It is the most common cause of severe sepsis (3) and infection-related death. (4) Key to the safe and efficient management of CAP is the ability to reliably predict who will fare well or poorly.…”

Section: Introduction Backgroundmentioning

confidence: 99%

Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia

Huang

Weissfeld

Kellum

et al. 2008

Annals of Emergency Medicine

198

136

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Objective-The Pneumonia Severity Index (PSI) and CURB-65 predict outcomes in community acquired pneumonia (CAP), but have limitations. Procalcitonin, a biomarker of bacterial infection, may provide prognostic information in CAP. Our objective was to describe the pattern of procalcitonin in CAP, and determine if procalcitonin provides prognostic information beyond PSI and CURB-65.Methods-We conducted a multi-center prospective cohort study in 28 community and teaching emergency departments. Patients presenting with a clinical and radiographic diagnosis of CAP were enrolled. We stratified procalcitonin levels a priori into four tiers -I: < 0.1; II: ≥ 0.1 to <0.25; III: ≥ 0.25 to < 0.5; and IV: ≥ 0.5 ng/ml. Primary outcome was 30d mortality.Results-1651 patients formed the study cohort. Procalcitonin levels were broadly spread across tiers: 32.8% (I), 21.6% (II), 10.2% (III), 35.4% (IV). Used alone, procalcitonin had modest test characteristics: specificity (35%), sensitivity (92%), positive likelihood ratio (LR) (1.41), and negative LR (0.22). Adding procalcitonin to PSI in all subjects minimally improved performance. Adding procalcitonin to low risk PSI subjects (Class I-III) provided no additional information. However, subjects in procalcitonin tier I had low 30d mortality regardless of clinical risk, including those in higher risk classes (1.5% vs. 1.6% for those in PSI Class I-III vs. Class IV/V). Among high risk PSI subjects (Class IV/V), one quarter (126/546) were in procalcitonin tier I, and the negative LR of procalcitonin tier I was 0.09. Procalcitonin tier I was also associated with lower burden of other adverse outcomes. Similar results were seen with CURB-65 stratification. Reprints not available from the authors.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Selective use of procalcitonin as an adjunct to existing rules may offer additional prognostic information in high risk patients. NIH Public Access

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“…It generates high costs and is the leading cause of death from infectious diseases [1][2][3][4][5] . CAP's mortality rate has been the main focus of previous studies.…”

Section: Discussionmentioning

confidence: 99%

“…There are 5.6 million cases of CAP are diagnosed annually worldwide, and 1.1 million of these require hospitalization [1][2][3] . The morbidity and treatment costs of CAP have a substantial social and economic impact 4 .…”

Section: Introductionmentioning

confidence: 99%

Patients hospitalized for community-acquired pneumonia present reduced functional performance

José¹,

Corso²

2013

Braz. J. Phys. Ther.

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| Background: Symptoms of fatigue and dyspnea, treatment with oral corticosteroids, high circulating levels of cytokines, and oxidant/antioxidant imbalance in patients hospitalized with community-acquired pneumonia (CAP) could affect the patients' exercise tolerance and peripheral muscle strength (PMS). Objective: To evaluate the functional capacity (FC) of patients hospitalized for CAP and to correlate the FC with length of hospital stay. Method: We prospectively evaluated 45 patients (49±16 years; CAP group) and 20 healthy subjects (53±17 years; control group). They were randomized to perform, on separate days, a 6-minute walk test (6MWT), a test of PMS, and the Glittre test (GT). Additionally, the SF-36 questionnaire and the MRC scale were completed and evaluated. Results: There were significant differences between the groups (CAP and controls) for the 6MWT (381.3±108 vs. 587.1±86.8 m) and GT (272.8±104.3 vs. 174±39 sec). The CAP group also presented worse health-related quality of life (HRQoL) scores, reduced strength (quadriceps and biceps), and higher scores of dyspnea. The time required to perform the GT correlated with the length of hospital stay (r=0.35, P=0.02) and dyspnea (r=0.36, P=0.02). Significant correlations were observed between GT and 6MWT (r=-0.66, P=0.0001) and between GT with the physical functioning domain of SF-36 (r=-0.51, P=0.0001). Conclusions:Patients hospitalized for CAP presented with reduced FC, PMS, and HRQoL during hospitalization. In addition, GT performance was related to the length of hospital stay.Keywords: pneumonia; physical therapy; exercise tolerance; quality of life; muscle strength. HOW TO CITE THIS ARTICLE

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The cost of treating community-acquired pneumonia

Cited by 474 publications

References 13 publications

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome

Risk Prediction With Procalcitonin and Clinical Rules in Community-Acquired Pneumonia

Patients hospitalized for community-acquired pneumonia present reduced functional performance

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