Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design, Patients Enrolled and Definitions
2.2. Measurements at Admission
2.3. Outcomes
2.4. Statistical Analysis
3. Results
3.1. General, Clinical, and Microbiological Characteristics
3.2. Systemic Inflammatory Response
3.3. Pleural Complications
3.4. Other Outcomes
4. Discussion
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variables | Non-Smokers | Former Smokers | Current Smokers | COPD | p Value |
Number of patients | 626 | 351 | 273 | 251 | |
Age, years | 77 [21] | 75 [16] | 53 [24] **,§§ | 75 [11] ## | <0.001 |
Male, % | 30 | 87 ** | 72 **,§§ | 92 **,## | <0.001 |
PSI, classes IV+V, % | 63 | 70 * | 42 **,§§ | 71 *,## | <0.001 |
History of alcohol, % | 4 | 26 ** | 38 **,§ | 28 **,# | <0.001 |
FEV1, % predicted | 48 [22] | ||||
Chronic heart failure, % | 24 | 30 * | 8 **,§§ | 25 ## | <0.001 |
Chronic liver disease, % | 3 | 3 | 6 | 5 | 0.086 |
Chronic renal failure, % | 5 | 11 * | 4 § | 7 | 0.002 |
Neurological disease, % | 33 | 23 * | 16 ** | 23 * | <0.001 |
Diabetes mellitus, % | 20 | 25 | 13 *,§§ | 23 # | 0.003 |
Malignancy, % | 4 | 9 * | 3 § | 13 **,## | <0.001 |
Pneumonia during previous year, % | 17 | 22 | 13 § | 42 **,§§,## | <0.001 |
Previous antibiotic in the last month, % | 30 | 31 | 25 | 37 | 0.090 |
Previous ICS therapy, % | 12 | 20 * | 4 *,§§ | 65 **,§§,## | <0.001 |
Previous OCS therapy, % | 4 | 6 | 3 | 12 **,§,## | <0.001 |
Previous use of H2 antagonists, % | 16 | 16 | 8 *,§ | 15 # | 0.011 |
Antipneumococcal vaccination | <0.001 | ||||
No | 81 | 75 | 93 *,§§ | 70 **,§,## | |
<5 years, % | 3 | 5 | 0.5 | 0.6 | |
≥5 years, % | 16 | 20 | 6.5 | 29.4 | |
Influenza vaccination | <0.001 | ||||
No | 40 | 37 | 71 **,§§ | 26 *,## | |
<6 months, % | 39 | 44 | 16 | 49 | |
≥6 months, % | 21 | 19 | 13 | 25 |
Variables | Non-Smokers | Former Smokers | Current Smokers | COPD | p Value |
Temperature ≥ 39 °C, % | 13 | 10 | 17 | 12 | 0.093 |
Chills, % | 54 | 60 | 59 | 58 | 0.225 |
Cough, % | 79 | 81 | 83 | 84 | 0.364 |
Pleuritic pain, % | 40 | 40 | 55 **,§§ | 43 # | <0.001 |
Confusion, % | 28 | 23 | 21 | 20 | 0.067 |
Respiratory rate ≥ 30 bpm, % | 28 | 28 | 30 | 38 *,§ | 0.044 |
SBP ≤ 90 mmHg, % | 6 | 5 | 6 | 4 | 0.778 |
Heart rate ≥ 120 bpm, % | 13 | 14 | 24 **,§ | 17 # | <0.001 |
Multilobar involvement (≥2 lobes), % | 27 | 30 | 36 * | 19 *,§,## | <0.001 |
Pulmonary atelectasis, % | 2 | 2 | 6 *,§ | 3 | 0.006 |
Parapneumonic pleural effusion, % | 17 | 15 | 20 | 10 * # | 0.015 |
Pulmonary empyema, % | 5 | 3 | 11 **,§ | 1 # | <0.001 |
pH | 7.46 [0.07] | 7.46 [0.06] | 7.46 [0.08] | 7.44 [0.07] **,§§,# | <0.001 |
PaCO2, mmHg | 35.3 [8.4] | 33.8 [6.7] | 32.9 [7.2] | 37.8 [11.5] **,§§,## | <0.001 |
PaO2/FiO2 | 280.9 [76.2] | 276.2 [81.1] | 280.9 [90.5] | 265.8 [79.9] * | 0.023 |
Leucocytes, 103/L | 12.7 [8.6] | 12.35 [7.9] | 13.5 [8] | 13.4 [7.7] | 0.142 |
Neutrophils, % | 83 [11] | 83 [11] | 82 [10] | 83 [9.5] | 0.932 |
Hematocrit, % | 39 [6] | 40 [6] * | 41 [7] * | 42 [7] **,§,# | <0.001 |
Platelets, 103/L | 237 [112] | 221 [117] | 241 [119] | 239 [128] | 0.056 |
Glucose, mg/dL | 127 [56] | 125 [54] | 120 [52] | 123 [60] | 0.682 |
Creatinine, mg/dL | 1 [0.5] | 1.2 [0.7] * | 1 [0.5] | 1 [0.4] | 0.028 |
Sodium, mEq/L | 135 [6] | 135 [6] | 134 [7.4] *,§ | 136 [5] # | 0.001 |
Potassium, mEq/L | 4 [0.9] | 4.1 [0.7] | 3.9 [0.6] § | 4.1 [0.7] *,## | <0.001 |
Variables | Non-Smokers | Former Smokers | Current Smokers | COPD | p Value |
---|---|---|---|---|---|
Patients with etiological diagnosis, n (%) | 255 (41) | 141 (40) | 153 (56) **,§§ | 111 (44) # | <0.001 |
Streptococcus pneumoniae, n (%) | 116 (45.4) | 70 (50) | 72 (47.1) | 55 (49.5) | 0.832 |
Streptococcus viridans, n (%) | 6 (2.3) | 3 (2.1) | 3 (2) | 4 (3.6) | 0.837 |
Staphylococcus aureusa, n (%) | 19 (7.4) | 8 (5.7) | 7 (4.6) | 3 (2.7) | 0.293 |
Staphylococcus spp., n (%) | 5 (2) | 5 (3.5) | 3 (2) | 3 (2.7) | 0.763 |
Haemophilus influenzae, n (%) | 9 (3.5) | 2 (1.4) | 3 (2) | 3 (2.7) | 0.590 |
Haemophilus parainfluenzae, n (%) | 1 (0.4) | 1 (0.7) | 1 (0.6) | 0 (0) | 0.943 |
Moraxella catarrhalis, n (%) | 0 (0) | 1 (0.7) | 1 (0.6) | 2 (1.8) | 0.554 |
Legionella pneumophila, n (%) | 14 (5.5) | 17 (12.1) * | 23 (15) * | 4 (3.6) §,# | <0.001 |
Other atypical pathogens b, n (%) | 5 (2) | 2 (1.4) | 1 (0.6) | 1 (0.9) | 0.698 |
Pseudomonas aeruginosa, n (%) | 12 (4.7) | 3 (2.1) | 3 (2) | 13 (11.7) *,§,# | <0.001 |
Klebsiella pneumoniae, n (%) | 4 (1.6) | 1 (0.7) | 0 (0) | 0 (0) | 0.786 |
Moraxella catarrhalis, n (%) | 0 (0) | 1 (0.7) | 1 (0.6) | 2 (1.8) | 0.554 |
Escherichia coli, n (%) | 5 (2) | 2 (1.4) | 2 (1.31) | 2 (1.8) | 0.956 |
Respiratory virus c, n (%) | 25 (9.8) | 15 (10.6) | 16 (10.5) | 7 (6.3) | 0.634 |
Polymicrobial pneumonia, n (%) | 20 (7.8) | 18 (12.8) | 20 (13.1) | 15 (13.5) | 0.220 |
Variables | Categories | Non-Smokers | Former Smokers | Current Smokers | COPD | p Value |
---|---|---|---|---|---|---|
Age | <65 years | n = 169 | n = 78 | n = 199 | n = 43 | 0.131 |
CRP value, mg/L | 183.9 [205.5] | 187.4 [246.2] | 230 [216] | 192.7 [246] | ||
≥65 years | n = 457 | n = 273 | n = 74 | n = 208 | 0.001 | |
CRP value, mg/L | 173 [193.1] | 179 [181.5] | 208.4 [190] | 135.2 [170.3] ## | ||
Chronic heart failure | No | n = 476 | n = 244 | n = 250 | n = 189 | <0.001 |
CRP value, mg/L | 187.1 [194.5] | 185.4 [194.1] | 224.2 [199.3] * | 172 [178] §,## | ||
Yes | n = 148 | n = 107 | n = 21 | n = 62 | 0.278 | |
CRP value, mg/L | 131.3 [193.4] | 153 [190.8] | 237.9 [251.1] | 112.2 [193.6] | ||
Previous ICS therapy | No | n = 547 | n = 279 | n = 255 | n = 86 | 0.001 |
CRP value, mg/L | 179 [192.7] | 181 [195] | 226.2 [198.1] * | 156.4 [176.7] # | ||
Yes | n = 73 | n = 69 | n = 12 | n = 162 | 0.607 | |
CRP value, mg/L | 130 [210.3] | 174 [183.6] | 189.2 [183.8] | 140.7 [190.5] | ||
Previous oral corticosteroid therapy | No | n = 491 | n = 267 | n = 205 | n = 217 | <0.001 |
CRP value, mg/L | 184.2 [196.2] | 187.5 [200] | 239 [173.8] **,§ | 152 [183] §,## | ||
Yes | n = 20 | n = 18 | n = 6 | n = 29 | 0.101 | |
CRP value, mg/L | 104.6 [180] | 100 [103.9] | 201.7 [170.3] | 172.7 [206.3] |
Variables | Non-Smokers | Former Smokers | Current Smokers | COPD | p Value |
---|---|---|---|---|---|
Pleural complications, % | 13 | 13 | 21 *,§ | 8 * §,## | <0.001 |
Length of hospital stay, days | 8 [5] | 8 [6] | 8 [8] | 8 [6] | 0.099 |
NIMV, % | 3 | 7 * | 4 | 8 * | 0.033 |
IMV, % | 4 | 5 | 10 *,§ | 4 # | 0.007 |
ICU admission, % | 7 | 10 | 15 ** | 8 # | 0.004 |
In-hospital mortality, % | 6 | 4 | 3 | 3 | 0.107 |
30-days mortality, % | 7 | 6 | 3 | 4 | 0.056 |
Variables | Univariate | Multivariate | Multivariate Adjusted * | ||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | OR | 95% CI | p Value | |
Non-smokers | 1 | 1 | 1 | ||||||
Former smokers | 1.009 | 0.68 to 1.49 | 0.966 | 1.42 | 0.71 to 2.85 | 0.324 | 1.44 | 0.68 to 3.05 | 0.344 |
Current smokers | 1.75 | 1.20 to 2.55 | 0.004 | 2.51 | 1.36 to 4.64 | 0.003 | 2.52 | 1.29 to 4.95 | 0.007 |
COPD | 0.54 | 0.32 to 0.93 | 0.026 | 0.55 | 0.18 to 1.75 | 0.315 | 0.52 | 0.15 to 1.78 | 0.299 |
Age, ≥65 y | 0.53 | 0.39 to 0.72 | <0.001 | ||||||
Neurological disease, yes | 0.67 | 0.43 to 1.03 | 0.071 | ||||||
Pneumonia during previous year, yes | 0.69 | 0.46 to 1.03 | 0.069 | ||||||
Previous ICS therapy, yes | 0.38 | 0.24 to 0.62 | <0.001 | ||||||
Influenza vaccination, No | 1 | ||||||||
<6 months | 0.44 | 0.28 to 0.68 | <0.001 | ||||||
≥6 months | 0.67 | 0.41 to 1.10 | 0.106 | ||||||
CRP, ≥150 mg/L | 1.50 | 1.10 to 2.06 | 0.012 | 2.46 | 1.25 to 4.81 | 0.009 | 2.58 | 1.30 to 5.10 | 0.007 |
Temperature, ≥39 °C | 0.47 | 0.26 to 0.82 | 0.008 | ||||||
Heart rate, ≥120 bpm | 1.61 | 1.11 to 2.35 | 0.013 | ||||||
Pleuritic pain, yes | 3.71 | 2.67 to 5.15 | <0.001 | 4.88 | 2.72 to 8.75 | <0.001 | 5.13 | 2.78 to 9.46 | <0.001 |
Positivity for S. pneumoniae | 1.50 | 1.09 to 2.05 | 0.012 | ||||||
Platelets, +1 103/L | 1.002 | 1.000 to 1.003 | 0.026 | 1.003 | 1.001 to 1.006 | 0.006 | 1.003 | 1.001 to 1.006 | 0.004 |
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Crisafulli, E.; Cillóniz, C.; Liapikou, A.; Ferrari, M.; Busti, F.; Girelli, D.; Torres, A. Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease. J. Clin. Med. 2020, 9, 2884. https://doi.org/10.3390/jcm9092884
Crisafulli E, Cillóniz C, Liapikou A, Ferrari M, Busti F, Girelli D, Torres A. Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease. Journal of Clinical Medicine. 2020; 9(9):2884. https://doi.org/10.3390/jcm9092884
Chicago/Turabian StyleCrisafulli, Ernesto, Catia Cillóniz, Adamantia Liapikou, Marcello Ferrari, Fabiana Busti, Domenico Girelli, and Antoni Torres. 2020. "Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease" Journal of Clinical Medicine 9, no. 9: 2884. https://doi.org/10.3390/jcm9092884
APA StyleCrisafulli, E., Cillóniz, C., Liapikou, A., Ferrari, M., Busti, F., Girelli, D., & Torres, A. (2020). Systemic Inflammatory Response and Outcomes in Community-Acquired Pneumonia Patients Categorized According to the Smoking Habit or Presence of Chronic Obstructive Pulmonary Disease. Journal of Clinical Medicine, 9(9), 2884. https://doi.org/10.3390/jcm9092884