Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department
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 [greater than or equal to]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.
Author: Rico Fiumefreddo, Roya Zaborsky, Jeannine Haeuptle, Mirjam Christ-Crain, Andrej Trampuz, Ingrid Steffen, Reno Frei, Beat Mueller and Philipp Schuetz
Credits/Source: BMC Pulmonary Medicine 2009, 9:4
Published on: 2009-01-19
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
make sure to read our disclaimer prior to contacting 7thSpace Interactive. To contact our editors, visit our online helpdesk. If you wish submit your own press release, click here.
Social Bookmarking
RETWEET This! | Digg this! | Post to del.icio.us | Post to Furl | Add to Netscape | Add to Yahoo! | Rojo
|
|
