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

被引：77

作者：

Fiumefreddo R. ^{[1
]}

Zaborsky R. ^{[1
]}

Haeuptle J. ^{[1
]}

Christ-Crain M. ^{[1
]}

Trampuz A. ^{[2
]}

Steffen I. ^{[3
]}

Frei R. ^{[2
]}

Müller B. ^{[4
]}

Schuetz P. ^{[1
]}

机构：

[1] Department of Internal Medicine, University Hospital Basel, Basel

[2] Departement of Infectious Diseases, Hospital Epidemiology, University Hospital Basel, Basel

[3] Institute of Medical Microbiology, University of Basel, Basel

[4] Department of Internal Medicine, Kantonsspital Aarau, CH-5001 Aarau, Tellstrasse

来源：

BMC Pulmonary Medicine | / 9卷 / 1期

关键词：

Empirical Antibiotic Therapy; Sputum Production; Pneumonia Severity Index; Urinary Antigen; Urinary Antigen Testing;

D O I：

10.1186/1471-2466-9-4

中图分类号：

学科分类号：

摘要：

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 sixparameters, 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 ≥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. © 2009 Fiumefreddo et al; licensee BioMed Central Ltd.

引用

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