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

Détails

ID Serval
serval:BIB_BA036A256EB7
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department.
Périodique
BMC Pulmonary Medicine
Auteur(s)
Fiumefreddo R., Zaborsky R., Haeuptle J., Christ-Crain M., Trampuz A., Steffen I., Frei R., Müller B., Schuetz P.
ISSN
1471-2466[electronic]
Statut éditorial
Publié
Date de publication
2009
Volume
9
Pages
4
Langue
anglais
Résumé
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.
Mots-clé
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
Oui
Création de la notice
19/01/2010 15:25
Dernière modification de la notice
20/08/2019 15:28
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