Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia

Bruns, A.H.W.; Oosterheert, Jan Jelrik; Hak, Eelko; Hoepelman, Andy I. M.

doi:10.1183/09031936.00003608

Cited by 93 publications

(71 citation statements)

References 27 publications

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“…CRP has been described as a valuable tool for pneumonia patients' follow-up, as the levels decrease in accordance with clinical recovery [12,36,46,47]. In our experience, the levels of CRP and neopterin also decreased, although this did not reach statistical significance.…”

Section: Discussionsupporting

confidence: 55%

Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia

Lacoma

Rodríguez

Prat

et al. 2011

Eur J Clin Microbiol Infect Dis

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The aim of this study was to investigate whether procalcitonin (PCT), neopterin, C-reactive protein (CRP), and mid regional pro-atrial natriuretic peptide (MR-proANP) levels at admission and during the clinical course can be useful for the management of patients with pneumonia. The study population consisted of 75 patients with clinical and radiological diagnosis of pneumonia. Serum samples were collected at admission and during hospitalization. Complications were defined as intensive care unit (ICU) admission or death. The levels of PCT were significantly higher in pneumonia of definite bacterial origin in comparison to probable bacterial or unknown origin. The PCT levels were higher in pneumococcal pneumonia. The PCT and MR-proANP levels increased significantly according to the Pneumonia Severity Index (PSI). All biomarkers levels are higher in patients developing complications and who were dying. The serial levels of MR-proANP remain significantly elevated in patients developing complications and in patients classified in PSI and CURB-65 risk groups. In patients not developing complications, there is a significant decrease in the PCT levels. PCT can be useful for identifying pneumonia etiology. PCT and MR-proANP levels correlate with pneumonia severity rules. PCT and MR-proANP serial measurements can be useful for predicting short-term prognosis. Systemic biomarkers can provide additional information regarding clinical evolution, because these are dynamic and can be measured daily.

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Section: Discussionsupporting

confidence: 55%

Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia

Lacoma

Rodríguez

Prat

et al. 2011

Eur J Clin Microbiol Infect Dis

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“…The most established markers PCT and CRP provide additional information to the clinical scores by identifying low risk patients with low admission levels [56][57][58][59] and monitoring treatment response using kinetic data [57,[62][63][64][65]. Adequate antibiotic therapy and good prognosis has been demonstrated by decreasing CRP levels after 3-4 days [57,64,65]. Persistent or rising CRP at day 3-4 [64,65] or PCT at day 3 [62,63] indicates inadequate treatment and poor prognosis.…”

Section: Inflammatory Biomarkersmentioning

confidence: 99%

“…Adequate antibiotic therapy and good prognosis has been demonstrated by decreasing CRP levels after 3-4 days [57,64,65]. Persistent or rising CRP at day 3-4 [64,65] or PCT at day 3 [62,63] indicates inadequate treatment and poor prognosis. In clinical treatment failure low PCT levels might raise suspicion of a non-infectious cause, like organising pneumonia [66].…”

Section: Inflammatory Biomarkersmentioning

confidence: 99%

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

2012

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Community-acquired pneumonia (CAP) represents a major life-threatening infection, but disease course and outcome is highly variable. Major drivers of prognosis are respiratory failure, sepsis-related organ dysfunction and unstable comorbidities.Current risk stratification tools have been primarily designed to predict mortality and identify low risk patients potentially suitable for ambulatory management. Detection of patients at high risk for clinical deterioration by current scores remains suboptimal.Therefore, management-related risk stratification tools designed to predict benefit from early intensified monitoring and treatment strategies in hospitalised CAP are advocated. An approach including early and repeatedly evaluated clinical markers of respiratory failure, sepsis-related organ dysfunction or decompensating comorbidity combined with individual definition of treatment goals is suggested.Inflammatory biomarkers can add prognostic information. New cardiovascular or stress-related biomarkers like copeptin, midregional proadrenomedullin and cortisol have been repeatedly linked with outcome and disease course in CAP and improved clinical scoring in observational studies. Thus they represent promising tools for individualised risk stratification. A major task in future CAP research will be the evaluation of their additional value in large interventional trials with control groups incorporating strict management guidance by clinical criteria.

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“…[24][25][26][27] It is considered to be a more reliable marker of disease activity than either white blood cell count or erythrocyte sedimentation rate. [28][29][30] In our case we found it particularly beneficial as an additional element for supporting the decision of when to consider repeating the brain imaging, as well as an indicator of therapeutic response.…”

Section: Discussionmentioning

confidence: 89%

Brain Abscesses Complicating Acute Pneumococcal Meningitis During Etanercept Therapy

Kasirye

Epperla

Manne

et al. 2012

Clinical Medicine & Research

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A man, aged 61 years, on etanercept treatment for ankylosing spondylitis, presented to the emergency room with altered mental status. He had been discovered at his vacation cabin by emergency services after his family was unable to contact him. His past medical history was significant for systemic hypertension and tobacco abuse. He had no known allergies, nor any recent head trauma, splenectomy, immunodeficiency disorders, or history of alcoholism. He had been receiving etanercept 50 µg subcutaneously every week on a continuous basis for the past 4 years. Other medications included acetaminophen, metoprolol, and omeprazol. His vaccinations were up to date, including a 23-valent pneumococcal polysaccharide vaccine that had been given before starting etanercept.The initial physical examination on arrival to the emergency room revealed an unresponsive male with a Glasgow coma scale of 6/15 (eye opening, 2; verbal response, 1; motor response, 3). His vitals signs included blood pressure 140/80 mmHg, pulse 150 beats/minute, temperature 103ºF, respirations 50 breaths/ minute with stridor, and oxygen saturation of 82% on room air. The patient was also noted to have nuchal rigidity, left-sided hemiparesis, and facial drooping, as well as a positive Kerning's and Brudzinski's sign (more evident on the right side). The remainder of the physical examination, including ear canal and tympanum were unremarkable. The patient had a generalized seizure for which he received intravenous (IV) lorazepam and phenytoin. He was intubated for airway protection and admitted to the intensive care unit. An electrocardiogram Brain abscess formation as a sequelae of community-acquired pneumococcal meningitis is extremely rare, accounting for less than 1% of all meningitis complications. Although metastatic seeding from a distal peripheral septic focus has been observed, this phenomenon most commonly occurs in the context of ear, nose and throat infections, post-cranial neurosurgical procedures, traumatic open cranial injury, or immunosuppression. We present the case of a man, 61 years old, on etanercept therapy for ankylosing spondylitis who developed multiple brain abscesses as a complication of pneumococcal meningitis. We believe that the predisposition to this extremely rare complication of a particularly aggressive pneumococcal meningitis was most likely due to the underlying immunosuppression resulting from etanercept therapy. As far as we know, this case is the first report linking multiple brain abscess formation in a patient with community-acquired pneumococcal meningitis with etanercept therapy.

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Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia

Cited by 93 publications

References 27 publications

Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia

Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia

Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

Brain Abscesses Complicating Acute Pneumococcal Meningitis During Etanercept Therapy

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