Download PDF
Semin Respir Crit Care Med 2012; 33(03): 272-283
DOI: 10.1055/s-0032-1315639
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Assessing Severity of Patients with Community-Acquired Pneumonia

Jose Manuel Pereira
1   Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
,
Jose Artur Paiva
1   Emergency and Intensive Care Department, Centro Hospitalar S. João EPE, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
,
Jordi Rello
2   Critical Care Department, Vall d'Hebron University Hospital, Institut de Recerca Vall d'Hebron, CIBERes, Universitat Autonoma Barcelona, Barcelona, Spain.
› Author Affiliations
Further Information

Publication History

Publication Date:
20 June 2012 (online)

    Permissions and Reprints

Abstract

Despite all advances in its management, community-acquired pneumonia (CAP) is still an important cause of morbidity and mortality requiring a great consumption of health, social, and economic resources. An early and adequate severity assessment is of paramount importance to provide optimized care to these patients. In the last 2 decades, this issue has been the subject of extensive research. Based on 30 day mortality, several prediction rules have been proposed to aid clinicians in deciding on the appropriate site of care. In spite of being well validated, their sensitivity and specificity vary, which limits their widespread use. The utility of biomarkers to overcome this problem has been investigated. At this moment, their full clinical value remains undetermined, and no single biomarker is consistently ideal for assessing CAP severity. Biomarkers should be seen as a complement rather than superseding clinical judgment or validated clinical scores. The search for a gold standard is not over, and new tools, like bacterial DNA load, are in the pipeline. Until then, CAP severity assessment should be based in three key points: a pneumonia-specific score, biomarkers, and clinical judgment.

Keywords

severity - community-acquired pneumonia - scores - biomarkers - bacterial load - DNAemia
 

  • References

  • 1 Osler W. The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine. New York, NY: D. Appleton; 1892
    Google Scholar
  • 2 Angus DC, Marrie TJ, Obrosky DS , et al. Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society Diagnostic criteria. Am J Respir Crit Care Med 2002; 166 (5) 717-723
    CrossrefPubMedGoogle Scholar
  • 3 Brown RB, Iannini P, Gross P, Kunkel M. Impact of initial antibiotic choice on clinical outcomes in community-acquired pneumonia: analysis of a hospital claims-made database. Chest 2003; 123 (5) 1503-1511
    CrossrefPubMedGoogle Scholar
  • 4 Bodí M, Rodríguez A, Solé-Violán J , et al; Community-Acquired Pneumonia Intensive Care Units (CAPUCI) Study Investigators. Antibiotic prescription for community-acquired pneumonia in the intensive care unit: impact of adherence to Infectious Diseases Society of America guidelines on survival. Clin Infect Dis 2005; 41 (12) 1709-1716
    CrossrefPubMedGoogle Scholar
  • 5 Kamath A, Pasteur MC, Slade MG, Harrison BD. Recognising severe pneumonia with simple clinical and biochemical measurements. Clin Med 2003; 3 (1) 54-56
    CrossrefPubMedGoogle Scholar
  • 6 Myint PK, Kamath AV, Vowler SL, Maisey DN, Harrison BD ; British Thoracic Society. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing 2006; 35 (3) 286-291
    CrossrefPubMedGoogle Scholar
  • 7 Lim WS, van der Eerden MM, Laing R , et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58 (5) 377-382
    CrossrefPubMedGoogle Scholar
  • 8 Rodríguez A, Mendia A, Sirvent JM , et al; CAPUCI Study Group. Combination antibiotic therapy improves survival in patients with community-acquired pneumonia and shock. Crit Care Med 2007; 35 (6) 1493-1498
    CrossrefPubMedGoogle Scholar
  • 9 Mandell LA, Wunderink RG, Anzueto A , et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 (Suppl. 02) S27-S72
    CrossrefPubMedGoogle Scholar
  • 10 Lim WS, Baudouin SV, George RC , et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009; 64 (Suppl. 03) iii1-55
    CrossrefPubMedGoogle Scholar
  • 11 Christ-Crain M, Müller B. Biomarkers in respiratory tract infections: diagnostic guides to antibiotic prescription, prognostic markers and mediators. Eur Respir J 2007; 30 (3) 556-573
    CrossrefPubMedGoogle Scholar
  • 12 Singanayagam A, Chalmers JD, Hill AT. Severity assessment in community-acquired pneumonia: a review. QJM 2009; 102 (6) 379-388
    CrossrefPubMedGoogle Scholar
  • 13 Tang CM, Macfarlane JT. Early management of younger adults dying of community acquired pneumonia. Respir Med 1993; 87 (4) 289-294
    CrossrefPubMedGoogle Scholar
  • 14 Neill AM, Martin IR, Weir R , et al. Community acquired pneumonia: aetiology and usefulness of severity criteria on admission. Thorax 1996; 51 (10) 1010-1016
    CrossrefPubMedGoogle Scholar
  • 15 McQuillan P, Pilkington S, Allan A , et al. Confidential inquiry into quality of care before admission to intensive care. BMJ 1998; 316 (7148) 1853-1858
    CrossrefPubMedGoogle Scholar
  • 16 Fine MJ, Auble TE, Yealy DM , et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336 (4) 243-250
    CrossrefPubMedGoogle Scholar
  • 17 Man SY, Lee N, Ip M , et al. Prospective comparison of three predictive rules for assessing severity of community-acquired pneumonia in Hong Kong. Thorax 2007; 62 (4) 348-353
    CrossrefPubMedGoogle Scholar
  • 18 Buising KL, Thursky KA, Black JF , et al. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61 (5) 419-424
    CrossrefPubMedGoogle Scholar
  • 19 Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121 (3) 219-225
    CrossrefPubMedGoogle Scholar
  • 20 Aujesky D, Auble TE, Yealy DM , et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am J Med 2005; 118 (4) 384-392
    CrossrefPubMedGoogle Scholar
  • 21 Chalmers JD, Mandal P, Singanayagam A , et al. Severity assessment tools to guide ICU admission in community-acquired pneumonia: systematic review and meta-analysis. Intensive Care Med 2011; 37 (9) 1409-1420
    CrossrefPubMedGoogle Scholar
  • 22 Muller MP, McGeer AJ, Hassan K, Marshall J, Christian M ; Toronto Invasive Bacterial Disease Network. Evaluation of pneumonia severity and acute physiology scores to predict ICU admission and mortality in patients hospitalized for influenza. PLoS ONE 2010; 5 (3) e9563
    CrossrefPubMedGoogle Scholar
  • 23 Brandão-Neto RA, Goulart AC, Santana AN , et al. The role of pneumonia scores in the emergency room in patients infected by 2009 H1N1 infection. Eur J Emerg Med 2011; Jul 22. [Epub ahead of print] PubMed
    PubMedGoogle Scholar
  • 24 Chalmers JD, Singanayagam A, Hill AT. Systolic blood pressure is superior to other haemodynamic predictors of outcome in community acquired pneumonia. Thorax 2008; 63 (8) 698-702
    CrossrefPubMedGoogle Scholar
  • 25 Capelastegui A, España PP, Quintana JM , et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 2006; 27 (1) 151-157
    CrossrefPubMedGoogle Scholar
  • 26 Bauer TT, Ewig S, Marre R, Suttorp N, Welte T ; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260 (1) 93-101
    CrossrefPubMedGoogle Scholar
  • 27 Ewig S, Welte T. CRB-65 for the assessment of pneumonia severity: who could ask for more?. Thorax 2008; 63 (8) 665-666
    CrossrefPubMedGoogle Scholar
  • 28 Bont J, Hak E, Hoes AW, Macfarlane JT, Verheij TJ. Predicting death in elderly patients with community-acquired pneumonia: a prospective validation study reevaluating the CRB-65 severity assessment tool. Arch Intern Med 2008; 168 (13) 1465-1468
    CrossrefPubMedGoogle Scholar
  • 29 Loke YK, Kwok CS, Niruban A, Myint PK. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax 2010; 65 (10) 884-890
    CrossrefPubMedGoogle Scholar
  • 30 Mortensen EM, Coley CM, Singer DE , et al. Causes of death for patients with community-acquired pneumonia: results from the Pneumonia Patient Outcomes Research Team cohort study. Arch Intern Med 2002; 162 (9) 1059-1064
    CrossrefPubMedGoogle Scholar
  • 31 Mortensen EM, Kapoor WN, Chang CC, Fine MJ. Assessment of mortality after long-term follow-up of patients with community-acquired pneumonia. Clin Infect Dis 2003; 37 (12) 1617-1624
    CrossrefPubMedGoogle Scholar
  • 32 Restrepo MI, Mortensen EM, Rello J, Brody J, Anzueto A. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest 2010; 137 (3) 552-557
    CrossrefPubMedGoogle Scholar
  • 33 Niederman MS, Mandell LA, Anzueto A , et al; American Thoracic Society. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med 2001; 163 (7) 1730-1754
    CrossrefPubMedGoogle Scholar
  • 34 Brown SM, Jones BE, Jephson AR, Dean NC ; Infectious Disease Society of America/American Thoracic Society 2007. Validation of the Infectious Disease Society of America/American Thoracic Society 2007 guidelines for severe community-acquired pneumonia. Crit Care Med 2009; 37 (12) 3010-3016
    CrossrefPubMedGoogle Scholar
  • 35 Phua J, See KC, Chan YH , et al. Validation and clinical implications of the IDSA/ATS minor criteria for severe community-acquired pneumonia. Thorax 2009; 64 (7) 598-603
    CrossrefPubMedGoogle Scholar
  • 36 Kontou P, Kuti JL, Nicolau DP. Validation of the Infectious Diseases Society of America/American Thoracic Society criteria to predict severe community-acquired pneumonia caused by Streptococcus pneumoniae. Am J Emerg Med 2009; 27 (8) 968-974
    CrossrefPubMedGoogle Scholar
  • 37 Liapikou A, Ferrer M, Polverino E , et al. Severe community-acquired pneumonia: validation of the Infectious Diseases Society of America/American Thoracic Society guidelines to predict an intensive care unit admission. Clin Infect Dis 2009; 48 (4) 377-385
    CrossrefPubMedGoogle Scholar
  • 38 Chalmers JD, Taylor JK, Mandal P , et al. Validation of the Infectious Diseases Society of America/American Thoratic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care. Clin Infect Dis 2011; 53 (6) 503-511
    CrossrefPubMedGoogle Scholar
  • 39 Charles PGP, Wolfe R, Whitby M , et al; Australian Community-Acquired Pneumonia Study Collaboration. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47 (3) 375-384
    CrossrefPubMedGoogle Scholar
  • 40 Chalmers JD, Singanayagam A, Hill AT. Predicting the need for mechanical ventilation and/or inotropic support for young adults admitted to the hospital with community-acquired pneumonia. Clin Infect Dis 2008; 47 (12) 1571-1574
    CrossrefPubMedGoogle Scholar
  • 41 España PP, Capelastegui A, Gorordo I , et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med 2006; 174 (11) 1249-1256
    CrossrefPubMedGoogle Scholar
  • 42 Yandiola PP, Capelastegui A, Quintana J , et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 2009; 135 (6) 1572-1579
    CrossrefPubMedGoogle Scholar
  • 43 Miyashita N, Matsushima T, Oka M ; Japanese Respiratory Society. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med 2006; 45 (7) 419-428
    CrossrefPubMedGoogle Scholar
  • 44 Buising KL, Thursky KA, Black JF , et al. Identifying severe community-acquired pneumonia in the emergency department: a simple clinical prediction tool. Emerg Med Australas 2007; 19 (5) 418-426
    CrossrefPubMedGoogle Scholar
  • 45 Shindo Y, Sato S, Maruyama E , et al. Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirology 2008; 13 (5) 731-735
    CrossrefPubMedGoogle Scholar
  • 46 Kohno S, Seki M, Watanabe A ; CAP Study Group. Evaluation of an assessment system for the JRS 2005: A-DROP for the management of CAP in adults. Intern Med 2011; 50 (11) 1183-1191
    CrossrefPubMedGoogle Scholar
  • 47 Rello J, Rodriguez A, Lisboa T, Gallego M, Lujan M, Wunderink R. PIRO score for community-acquired pneumonia: a new prediction rule for assessment of severity in intensive care unit patients with community-acquired pneumonia. Crit Care Med 2009; 37 (2) 456-462
    CrossrefPubMedGoogle Scholar
  • 48 Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981; 9 (8) 591-597
    CrossrefPubMedGoogle Scholar
  • 49 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13 (10) 818-829
    CrossrefPubMedGoogle Scholar
  • 50 Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM 2001; 94 (10) 521-526
    CrossrefPubMedGoogle Scholar
  • 51 Lim WS. Severity assessment in community-acquired pneumonia: moving on. Thorax 2007; 62 (4) 287-288
    CrossrefPubMedGoogle Scholar
  • 52 Woodhead M. Assessment of illness severity in community acquired pneumonia: a useful new prediction tool?. Thorax 2003; 58 (5) 371-372
    CrossrefPubMedGoogle Scholar
  • 53 American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992; 20 (6) 864-874
    CrossrefPubMedGoogle Scholar
  • 54 Subbe CP, Kruger M, Rutherford P, Gemmel L. Validation of a modified Early Warning Score in medical admissions. QJM 2001; 94 (10) 521-526
    CrossrefPubMedGoogle Scholar
  • 55 Subbe CP, Davies RG, Williams E, Rutherford P, Gemmell L. Effect of introducing the Modified Early Warning score on clinical outcomes, cardio-pulmonary arrests and intensive care utilisation in acute medical admissions. Anaesthesia 2003; 58 (8) 797-802
    CrossrefPubMedGoogle Scholar
  • 56 McBride J, Knight D, Piper J, Smith GB. Long-term effect of introducing an early warning score on respiratory rate charting on general wards. Resuscitation 2005; 65 (1) 41-44
    CrossrefPubMedGoogle Scholar
  • 57 Barlow GD, Nathwani D, Davey PG. The CURB65 pneumonia severity score outperforms generic sepsis and early warning scores in predicting mortality in community-acquired pneumonia. Thorax 2007; 62 (3) 253-259
    CrossrefPubMedGoogle Scholar
  • 58 Dremsizov T, Clermont G, Kellum JA, Kalassian KG, Fine MJ, Angus DC. Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course?. Chest 2006; 129 (4) 968-978
    CrossrefPubMedGoogle Scholar
  • 59 Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13 (10) 818-829
    CrossrefPubMedGoogle Scholar
  • 60 Kollef KE, Reichley RM, Micek ST, Kollef MH. The modified APACHE II score outperforms Curb65 pneumonia severity score as a predictor of 30-day mortality in patients with methicillin-resistant Staphylococcus aureus pneumonia. Chest 2008; 133 (2) 363-369
    CrossrefPubMedGoogle Scholar
  • 61 Spindler C, Ortqvist A. Prognostic score systems and community-acquired bacteraemic pneumococcal pneumonia. Eur Respir J 2006; 28 (4) 816-823
    CrossrefPubMedGoogle Scholar
  • 62 Almirall J, Bolíbar I, Toran P , et al; Community-Acquired Pneumonia Maresme Study Group. Contribution of C-reactive protein to the diagnosis and assessment of severity of community-acquired pneumonia. Chest 2004; 125 (4) 1335-1342
    CrossrefPubMedGoogle Scholar
  • 63 Hohenthal U, Hurme S, Helenius H , et al. Utility of C-reactive protein in assessing the disease severity and complications of community-acquired pneumonia. Clin Microbiol Infect 2009; 15 (11) 1026-1032
    CrossrefPubMedGoogle Scholar
  • 64 Menéndez R, Martínez R, Reyes S , et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009; 64 (7) 587-591
    CrossrefPubMedGoogle Scholar
  • 65 Lee JH, Kim J, Kim K , et al. Albumin and C-reactive protein have prognostic significance in patients with community-acquired pneumonia. J Crit Care 2011; 26 (3) 287-294
    CrossrefPubMedGoogle Scholar
  • 66 Müller B, Harbarth S, Stolz D , et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneumonia. BMC Infect Dis 2007; 7: 10
    CrossrefPubMedGoogle Scholar
  • 67 Müller B, Morgenthaler N, Stolz D , et al. Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections. Eur J Clin Invest 2007; 37 (2) 145-152
    CrossrefPubMedGoogle Scholar
  • 68 Christ-Crain M, Stolz D, Jutla S , et al. Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia. Am J Respir Crit Care Med 2007; 176 (9) 913-920
    CrossrefPubMedGoogle Scholar
  • 69 Müller B, Süess E, Schuetz P , et al. Circulating levels of pro-atrial natriuretic peptide in lower respiratory tract infections. J Intern Med 2006; 260 (6) 568-576
    CrossrefPubMedGoogle Scholar
  • 70 Krüger S, Papassotiriou J, Marre R , et al; CAPNETZ Study Group. Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med 2007; 33 (12) 2069-2078
    CrossrefPubMedGoogle Scholar
  • 71 Christ-Crain M, Morgenthaler NG, Stolz D , et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care 2006; 10 (3) R96-R103
    CrossrefPubMedGoogle Scholar
  • 72 Masiá M, Gutiérrez F, Shum C , et al. Usefulness of procalcitonin levels in community-acquired pneumonia according to the patients outcome research team pneumonia severity index. Chest 2005; 128 (4) 2223-2229
    CrossrefPubMedGoogle Scholar
  • 73 Krüger S, Ewig S, Marre R , et al; CAPNETZ Study Group. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31 (2) 349-355
    CrossrefPubMedGoogle Scholar
  • 74 Huang DT, Weissfeld LA, Kellum JA , et al; GenIMS Investigators. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med 2008; 52 (1) 48-58 , e2
    CrossrefPubMedGoogle Scholar
  • 75 Querol-Ribelles JM, Tenias JM, Grau E , et al. Plasma d-dimer levels correlate with outcomes in patients with community-acquired pneumonia. Chest 2004; 126 (4) 1087-1092
    CrossrefPubMedGoogle Scholar
  • 76 Chalmers JD, Singanayagam A, Scally C, Hill AT. Admission D-dimer can identify low-risk patients with community-acquired pneumonia. Ann Emerg Med 2009; 53 (5) 633-638
    CrossrefPubMedGoogle Scholar
  • 77 Mueller C, Laule-Kilian K, Scholer A, Perruchoud AP. B-type natriuretic peptide for risk stratification in community-acquired pneumonia. J Intern Med 2005; 258 (4) 391-393
    CrossrefPubMedGoogle Scholar
  • 78 Christ-Crain M, Breidthardt T, Stolz D , et al. Use of B-type natriuretic peptide in the risk stratification of community-acquired pneumonia. J Intern Med 2008; 264 (2) 166-176
    CrossrefPubMedGoogle Scholar
  • 79 Gotoh S, Nishimura N, Takahashi O , et al. Adrenal function in patients with community-acquired pneumonia. Eur Respir J 2008; 31 (6) 1268-1273
    CrossrefPubMedGoogle Scholar
  • 80 Kolditz M, Halank M, Schulte-Hubbert B, Höffken G. Adrenal function is related to prognosis in moderate community-acquired pneumonia. Eur Respir J 2010; 36 (3) 615-621
    CrossrefPubMedGoogle Scholar
  • 81 Robertson GL, Mahr EA, Athar S, Sinha T. Development and clinical application of a new method for the radioimmunoassay of arginine vasopressin in human plasma. J Clin Invest 1973; 52 (9) 2340-2352
    CrossrefPubMedGoogle Scholar
  • 82 Preibisz JJ, Sealey JE, Laragh JH, Cody RJ, Weksler BB. Plasma and platelet vasopressin in essential hypertension and congestive heart failure. Hypertension 1983; 5 (2 Pt 2) I129-I138
    CrossrefPubMedGoogle Scholar
  • 83 Kluge M, Riedl S, Erhart-Hofmann B, Hartmann J, Waldhauser F. Improved extraction procedure and RIA for determination of arginine8-vasopressin in plasma: role of premeasurement sample treatment and reference values in children. Clin Chem 1999; 45 (1) 98-103
    PubMedGoogle Scholar
  • 84 Hirata Y, Mitaka C, Sato K , et al. Increased circulating adrenomedullin, a novel vasodilatory peptide, in sepsis. J Clin Endocrinol Metab 1996; 81 (4) 1449-1453
    CrossrefPubMedGoogle Scholar
  • 85 Eto T. A review of the biological properties and clinical implications of adrenomedullin and proadrenomedullin N-terminal 20 peptide (PAMP), hypotensive and vasodilating peptides. Peptides 2001; 22 (11) 1693-1711
    CrossrefPubMedGoogle Scholar
  • 86 Jougasaki M, Burnett Jr JC. Adrenomedullin: potential in physiology and pathophysiology. Life Sci 2000; 66 (10) 855-872
    CrossrefPubMedGoogle Scholar
  • 87 Kato J, Tsuruda T, Kitamura K, Eto T. Adrenomedullin: a possible autocrine or paracrine hormone in the cardiac ventricles. Hypertens Res 2003; 26 (Suppl) S113-S119
    CrossrefPubMedGoogle Scholar
  • 88 Struck J, Tao C, Morgenthaler NG, Bergmann A. Identification of an Adrenomedullin precursor fragment in plasma of sepsis patients. Peptides 2004; 25 (8) 1369-1372
    CrossrefPubMedGoogle Scholar
  • 89 Huang DT, Angus DC, Pugh NA et al. Proadrenomedullin in Emergency Department patients with community-acquired pneumonia. Ann Emerg Med 2008; 52 (Suppl. 04) S41
    PubMedGoogle Scholar
  • 90 Schuetz P, Wolbers M, Christ-Crain M , et al; ProHOSP Study Group. Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections. Crit Care 2010; 14 (3) R106
    CrossrefPubMedGoogle Scholar
  • 91 Prat C, Lacoma A, Dominguez J , et al. Midregional pro-atrial natriuretic peptide as a prognostic marker in pneumonia. J Infect 2007; 55 (5) 400-407
    CrossrefPubMedGoogle Scholar
  • 92 Masiá M, Papassotiriou J, Morgenthaler NG, Hernández I, Shum C, Gutiérrez F. Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia. Clin Chem 2007; 53 (12) 2193-2201
    CrossrefPubMedGoogle Scholar
  • 93 Claessens YE, Mathevon T, Kierzek G , et al. Accuracy of C-reactive protein, procalcitonin, and mid-regional pro-atrial natriuretic peptide to guide site of care of community-acquired pneumonia. Intensive Care Med 2010; 36 (5) 799-809
    CrossrefPubMedGoogle Scholar
  • 94 Krüger S, Ewig S, Kunde J, Hartmann O, Suttorp N, Welte T ; CAPNETZ Study Group. Pro-atrial natriuretic peptide and pro-vasopressin for predicting short-term and long-term survival in community-acquired pneumonia: results from the German Competence Network CAPNETZ. Thorax 2010; 65 (3) 208-214
    CrossrefPubMedGoogle Scholar
  • 95 Vazquez M, Jockers K, Christ-Crain M, Zimmerli W, Müller B, Schuetz P. MR-pro-atrial natriuretic peptide (MR-proANP) predicts short- and long-term outcomes in respiratory tract infections: a prospective validation study. Int J Cardiol 2010; 156 (1) 16-23
    PubMedGoogle Scholar
  • 96 Prat C, Lacoma A, Dominguez J , et al. Midregional pro-atrial natriuretic peptide as a prognostic marker in pneumonia. J Infect 2007; 55 (5) 400-407
    CrossrefPubMedGoogle Scholar
  • 97 Uchida T, Shirasawa M, Ware LB , et al. Receptor for advanced glycation end-products is a marker of type I cell injury in acute lung injury. Am J Respir Crit Care Med 2006; 173 (9) 1008-1015
    CrossrefPubMedGoogle Scholar
  • 98 Angus DC, Yang L, Kong L , et al; GenIMS Investigators. Circulating high-mobility group box 1 (HMGB1) concentrations are elevated in both uncomplicated pneumonia and pneumonia with severe sepsis. Crit Care Med 2007; 35 (4) 1061-1067
    CrossrefPubMedGoogle Scholar
  • 99 Gibot S, Cravoisy A, Levy B, Bene MC, Faure G, Bollaert PE. Soluble triggering receptor expressed on myeloid cells and the diagnosis of pneumonia. N Engl J Med 2004; 350 (5) 451-458
    CrossrefPubMedGoogle Scholar
  • 100 Feldman C, Kallenbach JM, Levy H, Thorburn JR, Hurwitz MD, Koornhof HJ. Comparison of bacteraemic community-acquired lobar pneumonia due to Streptococcus pneumoniae and Klebsiella pneumoniae in an intensive care unit. Respiration 1991; 58 (5–6) 265-270
    CrossrefPubMedGoogle Scholar
  • 101 Brogly N, Devos P, Boussekey N, Georges H, Chiche A, Leroy O. Impact of thrombocytopenia on outcome of patients admitted to ICU for severe community-acquired pneumonia. J Infect 2007; 55 (2) 136-140
    CrossrefPubMedGoogle Scholar
  • 102 Mirsaeidi M, Peyrani P, Aliberti S , et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest 2010; 137 (2) 416-420
    CrossrefPubMedGoogle Scholar
  • 103 Landsman JB. Bacteriaemia and prognosis in lobar pneumonia: the results of quantitative blood culture in pneumococcus pneumonia. Glasg Med J 1952; 33 (2) 33-45
    PubMedGoogle Scholar
  • 104 Christie IM. Bacteraemia in lobar pneumonia. Lancet 1933; 2: 804-805
    PubMedGoogle Scholar
  • 105 Carrol ED, Guiver M, Nkhoma S , et al; IPD Study Group. High pneumococcal DNA loads are associated with mortality in Malawian children with invasive pneumococcal disease. Pediatr Infect Dis J 2007; 26 (5) 416-422
    PubMedGoogle Scholar
  • 106 Peters RP, van Agtmael MA, Gierveld S , et al. Quantitative detection of Staphylococcus aureus and Enterococcus faecalis DNA in blood to diagnose bacteremia in patients in the intensive care unit. J Clin Microbiol 2007; 45 (11) 3641-3646
    CrossrefPubMedGoogle Scholar
  • 107 Ho YC, Chang SC, Lin SR, Wang WK. High levels of mecA DNA detected by a quantitative real-time PCR assay are associated with mortality in patients with methicillin-resistant Staphylococcus aureus bacteremia. J Clin Microbiol 2009; 47 (5) 1443-1451
    CrossrefPubMedGoogle Scholar
  • 108 Peters RP, de Boer RF, Schuurman T , et al. Streptococcus pneumoniae DNA load in blood as a marker of infection in patients with community-acquired pneumonia. J Clin Microbiol 2009; 47 (10) 3308-3312
    CrossrefPubMedGoogle Scholar
  • 109 Chuang YC, Chang SC, Wang WK. High and increasing Oxa-51 DNA load predict mortality in Acinetobacter baumannii bacteremia: implication for pathogenesis and evaluation of therapy. PLoS ONE 2010; 5 (11) e14133
    CrossrefPubMedGoogle Scholar
  • 110 Muñoz-Almagro C, Gala S, Selva L, Jordan I, Tarragó D, Pallares R. DNA bacterial load in children and adolescents with pneumococcal pneumonia and empyema. Eur J Clin Microbiol Infect Dis 2011; 30 (3) 327-335
    CrossrefPubMedGoogle Scholar
  • 111 Kim DM, Jung SI, Jang HC , et al. Vibrio vulnificus DNA load and mortality. J Clin Microbiol 2011; 49 (1) 413-415
    CrossrefPubMedGoogle Scholar
  • 112 Rello J, Lisboa T, Lujan M , et al; DNA-Neumococo Study Group. Severity of pneumococcal pneumonia associated with genomic bacterial load. Chest 2009; 136 (3) 832-840
    CrossrefPubMedGoogle Scholar