Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department.

Details

Serval ID
serval:BIB_BA036A256EB7
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department.
Journal
BMC Pulmonary Medicine
Author(s)
Fiumefreddo R., Zaborsky R., Haeuptle J., Christ-Crain M., Trampuz A., Steffen I., Frei R., Müller B., Schuetz P.
ISSN
1471-2466[electronic]
Publication state
Published
Issued date
2009
Volume
9
Pages
4
Language
english
Abstract
BACKGROUND: Legionella species cause severe forms of pneumonia with high mortality and complication rates. Accurate clinical predictors to assess the likelihood of Legionella community-acquired pneumonia (CAP) in patients presenting to the emergency department are lacking. METHODS: We retrospectively compared clinical and laboratory data of 82 consecutive patients with Legionella CAP with 368 consecutive patients with non-Legionella CAP included in two studies at the same institution. RESULTS: In multivariate logistic regression analysis we identified six parameters, namely high body temperature (OR 1.67, p < 0.0001), absence of sputum production (OR 3.67, p < 0.0001), low serum sodium concentrations (OR 0.89, p = 0.011), high levels of lactate dehydrogenase (OR 1.003, p = 0.007) and C-reactive protein (OR 1.006, p < 0.0001) and low platelet counts (OR 0.991, p < 0.0001), as independent predictors of Legionella CAP. Using optimal cut off values of these six parameters, we calculated a diagnostic score for Legionella CAP. The median score was significantly higher in Legionella CAP as compared to patients without Legionella (4 (IQR 3-4) vs 2 (IQR 1-2), p < 0.0001) with a respective odds ratio of 3.34 (95%CI 2.57-4.33, p < 0.0001). Receiver operating characteristics showed a high diagnostic accuracy of this diagnostic score (AUC 0.86 (95%CI 0.81-0.90), which was better as compared to each parameter alone. Of the 191 patients (42%) with a score of 0 or 1 point, only 3% had Legionella pneumonia. Conversely, of the 73 patients (16%) with > or =4 points, 66% of patients had Legionella CAP. CONCLUSION: Six clinical and laboratory parameters embedded in a simple diagnostic score accurately identified patients with Legionella CAP. If validated in future studies, this score might aid in the management of suspected Legionella CAP.
Keywords
Aged, Aged, 80 and over, Body Temperature/physiology, C-Reactive Protein/metabolism, Community-Acquired Infections/blood, Community-Acquired Infections/diagnosis, Emergency Service, Hospital/statistics & numerical data, Female, Humans, L-Lactate Dehydrogenase/blood, Legionella pneumophila, Legionnaires' Disease/blood, Legionnaires' Disease/diagnosis, Logistic Models, Male, Middle Aged, Platelet Count, Pneumonia/blood, Pneumonia/diagnosis, Predictive Value of Tests, ROC Curve, Reproducibility of Results, Retrospective Studies, Sodium/blood, Sputum/microbiology
Pubmed
Open Access
Yes
Create date
19/01/2010 15:25
Last modification date
20/08/2019 15:28
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