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Naehrig S, Schulte-Hubbert B, Hafkemeyer S, Hammermann J, Dumke M, Sieber S. Chronic inhaled antibiotic therapy in people with cystic fibrosis with Pseudomonas aeruginosa infection in Germany. Pulm Pharmacol Ther 2023; 80:102214. [PMID: 37003541 DOI: 10.1016/j.pupt.2023.102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/16/2023] [Accepted: 03/26/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Several clinical guidelines recommend chronic inhaled therapy for pwCF (people with cystic fibrosis) and chronic Pseudomonas aeruginosa infection of the lungs. METHODS To demonstrate what kind of therapy regimens are used in Germany, we retrospectively analysed chronic inhaled antibiotic therapy within the cohort of the German CF Registry in 2020. For comparison we also analysed the use of inhaled antibiotics in pwCF with intermittent Pseudomonas or without Pseudomonas infection. RESULTS A total of 1960 pwCF had chronic P. aeruginosa infection and were retrospectively evaluated. Almost 90% (n = 1751) received at least one inhaled antibiotic. The most commonly used inhaled antibiotic was colistin solution for inhalation (55.2%), followed by aztreonam solution for inhalation (32.6%) and tobramycin solution for Inhalation (30%). Almost 56% of adults and 44% of children alternated two antibiotics for inhalation. In children, alternating colistin + tobramycin was the most often used regimen. In adults, only 23% used colistin + tobramycin; there was a wide range of treatment regimens among adults using two inhaled antibiotics alternately. 2456 pwCF had no Pseudomonas infection, but almost 24% had a chronic inhaled antibiotic therapy, while 56% of 361 pwCF and intermittent chronic Pseudomonas infection had a chronic inhaled antibiotic therapy. CONCLUSION In all three groups the most commonly used inhaled antibiotic was colistin solution for inhalation. Almost 56% of adults and 44% of children with chronic Pseudomonas infection alternated two antibiotics for inhalation. It will be interesting to see how the introduction of the highly effective modulator elexacaftor/tezacaftor/ivacaftor will change the use of inhaled antibiotics.
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Affiliation(s)
- S Naehrig
- University Hospital of the Ludwig Maximilians University Munich (LMU), Department of Internal Medicine V, Cystic Fibrosis Center for Adults, Munich, Germany.
| | - B Schulte-Hubbert
- Division of Pulmonology, Medical Department I, Cystic Fibrosis Center, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - S Hafkemeyer
- Mukoviszidose Institut gGmbH (MI), Bonn, Germany
| | - J Hammermann
- Children's Hospital, Cystic Fibrosis Center, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - M Dumke
- STAT-UP Statistical Consulting & Services, Munich, Germany
| | - S Sieber
- STAT-UP Statistical Consulting & Services, Munich, Germany
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Langner S, Koschel D, Kleymann J, Tausche K, Karl S, Frenzen F, Heberling M, Schulte-Hubbert B, Halank M, Kolditz M. [Complications after Indwelling Pleural Catheter Implant for Symptomatic Recurrent Benign and Malignant Pleural Effusions]. Pneumologie 2020; 74:864-870. [PMID: 32663890 DOI: 10.1055/a-1201-3682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Implant of indwelling pleural catheters (IPC) represents an established therapy method in addition to pleurodesis for symptomatic recurrent benign and malignant pleural effusions (BPE and MPE).There are only few studies on IPC safety during follow-up, especially with regard to infection and pneumothorax rates.The aim of our investigation was to determine the complication frequency after IPC implant and its predictive factors in patients with BPE vs. MPE. METHODS Retrospective analysis of all IPC implantations in the pneumology department at the University Hospital Dresden during 2015 - 2018. RESULTS An IPC was implanted in 86 patients (43 m/f each; age 66.9 ± 13.3 years) with symptomatic BPE and MPE. BPE and MPE was present in 12.8 % (11/86) and 87.2 % (75/86) of the patients, respectively.A predominantly small and asymptomatic pneumothorax was detectable as an immediate complication in 43/86 (50 %) of patients; 34/43 (79 %) of patients did not require any specific therapy. For 9/43 patients, IPC suction was required for a median period of three days; 8/43 patients had a large pneumothorax with partial or complete regression after a median period of two days.Catheter infection developed in 15.1 % (13/86) of the total group and 36.4 % (4/11) of the BPE vs. 12 % (9/75) of the MPE after a median period of 87 (BPE/MPE 116/87) days. This was more common in BPE (p = 0.035), large pneumothorax (4/8 patients; p = 0.015) and longer catheter dwell times (124 ± 112 vs. 71 ± 112 days; p = 0.07). CONCLUSION Small pneumothoraxes are frequent after IPC implantation, but usually do not require specific therapy. IPC infection was detected in 15.1 % of all patients after a median period of 87 days. This was more common in patients with BPE, longer catheter dwell times and large pneumothorax.
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Affiliation(s)
- S Langner
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - D Koschel
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden.,Fachkrankenhaus Coswig, Abteilung Innere Medizin und Pneumologie, Lungenzentrum, Coswig
| | - J Kleymann
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - K Tausche
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - S Karl
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - F Frenzen
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - M Heberling
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - B Schulte-Hubbert
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - M Halank
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
| | - M Kolditz
- Bereich Pneumologie, Medizinische Klinik I, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden
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Schwarz C, Schulte-Hubbert B, Bend J, Abele-Horn M, Baumann I, Bremer W, Brunsmann F, Dieninghoff D, Eickmeier O, Ellemunter H, Fischer R, Grosse-Onnebrink J, Hammermann J, Hebestreit H, Hogardt M, Hügel C, Hug M, Illing S, Jung A, Kahl B, Koitschev A, Mahlberg R, Mainz JG, Mattner F, Mehl A, Möller A, Muche-Borowski C, Nüßlein T, Puderbach M, Renner S, Rietschel E, Ringshausen FC, Schmidt S, Sedlacek L, Sitter H, Smaczny C, Tümmler B, Vonberg R, Wielpütz MO, Wilkens H, Wollschläger B, Zerlik J, Düesberg U, van Koningsbruggen-Rietschel S. [CF Lung Disease - a German S3 Guideline: Module 2: Diagnostics and Treatment in Chronic Infection with Pseudomonas aeruginosa]. Pneumologie 2018; 72:347-392. [PMID: 29758578 DOI: 10.1055/s-0044-100191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Cystic Fibrosis (CF) is the most common autosomal-recessive genetic disease affecting approximately 8000 people in Germany. The disease is caused by mutations in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene leading to dysfunction of CFTR, a transmembrane chloride channel. This defect causes insufficient hydration of the epithelial lining fluid which leads to chronic inflammation of the airways. Recurrent infections of the airways as well as pulmonary exacerbations aggravate chronic inflammation, lead to pulmonary fibrosis and tissue destruction up to global respiratory insufficiency, which is responsible for the mortality in over 90 % of patients. The main aim of pulmonary treatment in CF is to reduce pulmonary inflammation and chronic infection. Pseudomonas aeruginosa (Pa) is the most relevant pathogen in the course of CF lung disease. Colonization and chronic infection are leading to additional loss of pulmonary function. There are many possibilities to treat Pa-infection. This is a S3-clinical guideline which implements a definition for chronic Pa-infection and demonstrates evidence-based diagnostic methods and medical treatment for Pa-infection in order to give guidance for individual treatment options.
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Affiliation(s)
- C Schwarz
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Christiane Herzog Zentrum, Berlin
| | - B Schulte-Hubbert
- Medizinische Klinik und Poliklinik I, Pneumologie, Universitätsklinikum Dresden
| | - J Bend
- Mukoviszidose Institut, Bonn
| | - M Abele-Horn
- Universität Würzburg, Institut für Hygiene und Mikrobiologie
| | - I Baumann
- Universität Heidelberg, Hals-Nasen-Ohrenklinik, Heidelberg
| | | | - F Brunsmann
- Charité Universitätsmedizin Berlin, Deutschland (Patientenvertreter)
| | - D Dieninghoff
- Kliniken der Stadt Köln, Lungenklinik, Lehrstuhl der Universität Witten Herdecke
| | - O Eickmeier
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Christiane Herzog CF-Zentrum, Frankfurt
| | - H Ellemunter
- Tirolkliniken GmbH, Department für Kinderheilkunde Pädiatrie III, Innsbruck, Österreich
| | - R Fischer
- Zentrum für erwachsene Mukoviszidose-Patienten München-West
| | - J Grosse-Onnebrink
- Universitätsklinikum Münster UKM; Klinik für Kinder- und Jugendmedizin; Allgemeine Pädiatrie Mukoviszidose-Ambulanz, Münster
| | - J Hammermann
- Universitäts-Mukoviszidose-Zentrum "Christiane Herzog", Dresden
| | | | - M Hogardt
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Frankfurt
| | - C Hügel
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Inneren Medizin, Frankfurt, Deutschland
| | - M Hug
- Universitätsklinikum Freiburg, Apotheke des Klinikums Freiburg
| | - S Illing
- Olgahospital - Kinderklinik - CF-Zentrum/Jugendliche/Erwachsene Stuttgart
| | - A Jung
- Kinderspital Zürich, Abteilung Pneumologie, Zürich, Schweiz
| | - B Kahl
- Universitätsklinikum Münster UKM, Institut für Medizinische Mikrobiologie, Münster
| | - A Koitschev
- Klinikum Stuttgart - Standort Olgahospital, Klinik für Hals-Nasen-Ohrenkrankheiten, Stuttgart
| | - R Mahlberg
- Klinikum Mutterhaus der Borromäerinnen, Abteilung Innere Medizin, Trier
| | - J G Mainz
- Universitätsklinikum Jena, Mukoviszidosezentrum/Pädiatrische Pneumologie, Jena
| | - F Mattner
- Kliniken der Stadt Köln, Institut für Hygiene, Köln
| | - A Mehl
- Charité - Universitätsmedizin Berlin, Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Christiane Herzog Zentrum, Berlin
| | - A Möller
- Pneumologie und CF Ambulanz der Universitäts-Kinderklinik Zürich, Schweiz
| | - C Muche-Borowski
- Philipps-Universität Marburg, AWMF-Institut für Medizinisches Wissensmanagement, Marburg und Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Allgemeinmedizin, Hamburg
| | - T Nüßlein
- Gemeinschaftsklinikum Mittelrhein, Klinik für Kinder- und Jugendmedizin Koblenz und Mayen
| | - M Puderbach
- Hufeland Klinikum, Abteilung für Diagnostische und Interventionelle Radiologie, Bad Langensalza
| | - S Renner
- Allgemeines Universitätskrankenhaus, Klinik für Kinder- und Jugendheilkunde, CF Ambulanz, Wien, Österreich
| | - E Rietschel
- Mukoviszidose-Zentrum Köln, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universität zu Köln
| | - F C Ringshausen
- Medizinische Hochschule Hannover, Klinik für Pneumologie und Deutsches Zentrum für Lungenforschung (DZL), Hannover
| | - S Schmidt
- Ernst-Moritz-Arndt Universität Greifswald, Zentrum für Kinder- und Jugendmedizin; Mukoviszidose Zentrum Mecklenburg/Vorpommern, Greifswald
| | - L Sedlacek
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover
| | - H Sitter
- Philipps-Universität Marburg, Institut für theoretische Medizin, Marburg
| | - C Smaczny
- Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Zentrum der Inneren Medizin, Frankfurt, Deutschland
| | - B Tümmler
- Medizinische Hochschule Hannover, Klinische Forschergruppe OE 6710, Klinik für Pädiatrische Pneumologie und Neonatologie
| | - R Vonberg
- Medizinische Hochschule Hannover, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Hannover
| | - M O Wielpütz
- Diagnostische und Interventionelle Radiologie Universitätsklinikum Heidelberg, Heidelberg
| | - H Wilkens
- Universitätsklinikum des Saarlandes, Medizinische Klinik V, Pneumologie, Allergologie und Beatmungsmedizin, Homburg
| | - B Wollschläger
- Martin-Luther-Universität Halle, Universitätsklinik und Poliklinik für Innere Medizin I/Pneumologie, Halle
| | - J Zerlik
- Altonaer Kinderkrankenhaus gGmbH, Abteilung Physiotherapie, Hamburg
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Kutschan U, Frenzen F, Meiswinkel N, Schulte-Hubbert B, Ewig S, Kolditz M. Admission lactate predicts poor prognosis independently of the CRB-/CURB-65-scores in community-acquired pnumonia. Pneumologie 2018. [DOI: 10.1055/s-0037-1619136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- U Kutschan
- Medizinische Klinik I, Bereich Pneumologie, Universitätsklinikum Dresden
| | - F Frenzen
- Med. Klinik und Poliklinik, Universitätsklinikum Carl Gustav Carus Dresden
| | | | - B Schulte-Hubbert
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden; Universitätsmukoviszidosecentrum 'Christian Herzog' (UMC)
| | - S Ewig
- Department of Respiratory and Infectious Diseases, Thoraxzentrum Ruhrgebiet, Evk Herne
| | - M Kolditz
- Medizinische Klinik I, Bereich Pneumologie, Universitätsklinikum Dresden
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5
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Frenzen FS, Kutschan U, Meiswinkel N, Schulte-Hubbert B, Ewig S, Kolditz M. Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia. Clin Microbiol Infect 2017; 24:306.e1-306.e6. [PMID: 28710027 DOI: 10.1016/j.cmi.2017.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/06/2017] [Accepted: 07/04/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Community-acquired pneumonia (CAP) is associated with a high risk of respiratory failure or septic organ dysfunction. Lactate is an established early marker of prognosis and sepsis severity, but few data exist in patients with CAP. METHODS We performed a retrospective cohort study of consecutive adult CAP patients without treatment restrictions or direct intensive care unit admission. Lactate was measured as a point-of-care test within the capillary admission blood gas analysis, and its prognostic value was compared to the CRB/CURB-65 criteria by multivariate and receiver operating characteristic (ROC) curve analysis. The primary endpoint was the combination of need for mechanical ventilation, vasopressors, intensive care unit admission or hospital mortality. RESULTS Of 303 included patients, 75 (25%) met the primary endpoint. After ROC analysis, lactate predicted the primary endpoint (area under the curve 0.67) with an optimal cutoff of >1.8 mmol/L. Of the 76 patients with lactate above this threshold, 35 (46%) met the primary endpoint. After multivariate analysis, the predictive value of lactate was independent of the CRB/CURB-65 scores. The addition of lactate >1.8 mmol/L to the CRB/CURB-65 scores resulted in significantly improved area under the curves (0.69 to 0.74, p 0.005 and 0.71 to 0.75, p 0.008 respectively). Fourteen (42%) of 33 and 11 (39%) of 28 patients meeting the endpoint despite presenting with 0 or 1 CRB/CURB-65 criteria had lactate >1.8 mmol/L. CONCLUSIONS Admission lactate levels significantly improved the prognostic value of the CRB/CURB-65 scores in CAP patients. Lactate may therefore be considered a rapid, cheap and broadly available additional criterion for the assessment of risk in patients with CAP.
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Affiliation(s)
- F S Frenzen
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - U Kutschan
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - N Meiswinkel
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - B Schulte-Hubbert
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Bochum, Germany
| | - M Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Hammermann J, Ulbrich K, Schulte-Hubbert B. 18 The first date with patients detected by newborn screening – what do we see? J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kolditz M, Halank M, Schulte-Hubbert B, Bergmann S, Albrecht S, Höffken G. Copeptin als Parameter zur Vorhersage einer kurzfristigen Hochrisikoprognose bei Patienten mit ambulant erworbener Pneumonie. Pneumologie 2014. [DOI: 10.1055/s-0033-1364126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Schulte-Hubbert B, Ulbrich K, Hammermann J. Schwangerschaft und Cystische Fibrose aus pneumologischer Sicht. Pneumologie 2014. [DOI: 10.1055/s-0034-1367975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kolditz M, Halank M, Schulte-Hubbert B, Bergmann S, Albrecht S, Höffken G. Copeptin als Parameter zur Vorhersage einer kurzfristigen Hochrisikoprognose bei Patienten mit ambulant erworbener Pneumonie. Pneumologie 2013. [DOI: 10.1055/s-0033-1345066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wetzko K, Blechschmidt M, Hölig K, Poppe-Thiede K, Ganepola S, Fischbach R, Ordemann R, Laniado M, Schulte-Hubbert B, Schuler M, Cotta L, Braumann D, Ehninger G, Kroschinsky F. Pulmonary adverse events in unrelated donors of peripheral blood stem cells. Transfus Med 2012; 23:69-71. [PMID: 23167281 DOI: 10.1111/tme.12001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K Wetzko
- Medical Department I, Dresden University Hospital, Dresden, Germany
| | - M Blechschmidt
- Medical Department I, Dresden University Hospital, Dresden, Germany
| | - K Hölig
- Medical Department I, Dresden University Hospital, Dresden, Germany
| | - K Poppe-Thiede
- Cellex GmbH, Stem Cell Collection Center, Dresden, Germany
| | | | - R Fischbach
- Department of Radiology, ASKLEPIOS Hospital Altona, Hamburg, Germany
| | - R Ordemann
- Medical Department I, Dresden University Hospital, Dresden, Germany
| | - M Laniado
- Department for Radiology, Dresden University Hospital, Dresden, Germany
| | | | - M Schuler
- Medical Department I, Dresden University Hospital, Dresden, Germany
| | - L Cotta
- German Bone Marrow Donor Center (DKMS), Tübingen, Germany
| | | | - G Ehninger
- Medical Department I, Dresden University Hospital, Dresden, Germany
| | - F Kroschinsky
- Medical Department I, Dresden University Hospital, Dresden, Germany
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Kolditz M, Halank M, Schulte-Hubbert B, Bergmann S, Albrecht S, Höffken G. Copeptin predicts clinical deterioration and persistent instability in community-acquired pneumonia. Respir Med 2012; 106:1320-8. [DOI: 10.1016/j.rmed.2012.06.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/30/2012] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
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12
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Kolditz M, Halank M, Schulte-Hubbert B, Höffken G. Procalcitonin unterstützt die Differenzierung zwischen kryptogen organisierender Pneumonie bzw. BOOP und infektiöser Pneumonie. Pneumologie 2012. [DOI: 10.1055/s-0032-1302533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kolditz M, Halank M, Schulte-Hubbert B, Höffken G. Procalcitonin unterstützt die Differenzierung zwischen kryptogen organisierender Pneumonie bzw. BOOP und infektiöser Pneumonie. Pneumologie 2011. [DOI: 10.1055/s-0031-1296118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hennigs J, Baumann HJ, Heyckendorf J, Schulte-Hubbert B, Halank M, Klose H. Fibrinogen-Plasmakonzentrationen bei pulmonaler Hypertonie. Pneumologie 2011. [DOI: 10.1055/s-0031-1272213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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15
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Kolditz M, Halank M, Schulte-Hubbert B, Höffken G. Die Nebennierenrindenfunktion ist assoziiert mit der Prognose von Patienten mit moderater ambulant erworbener Pneumonie (CAP). Pneumologie 2010. [DOI: 10.1055/s-2010-1268888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
The aim of our study was to prospectively examine adrenal function, including cosyntropin stimulation, and its prognostic value in patients with moderate community-acquired pneumonia (CAP). 59 consecutive adult patients hospitalised on normal wards because of CAP were enrolled. A cosyntropin stimulation test was performed and serum concentrations of C-reactive protein, procalcitonin, interleukin-6, tumour necrosis factor-α, ACTH, cortisol, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone-sulfate (DHEAS) were measured. Predefined outcome parameters were clinical instability after 72 h, mortality and combined intensive care unit (ICU) admission or mortality. Critical illness-related corticosteroid insufficiency (CIRCI) occurred in six patients (10.3%). Cortisol, age-corrected DHEA, ACTH and the DHEA/DHEAS ratio were elevated in patients remaining unstable after 72 h. In multivariate analysis, cortisol (p = 0.03), ACTH (p = 0.04) and the pneumonia severity index (PSI) score (p = 0.005) independently predicted clinical instability after 72 h, and only cortisol predicted mortality (p = 0.04) and combined ICU-admission or mortality (p = 0.006). The predictive value of serum cortisol after receiver operating characteristic curve analysis equalled that of the PSI score. Patients with serum cortisol >734 nmol·L(-1) had a high probability for mortality (OR 38.3; p = 0.002). CIRCI is rare in patients with moderate CAP. Adrenal function is related to the prognosis of CAP. The diagnostic accuracy of serum cortisol equals that of the PSI score. Serum cortisol should be evaluated within clinical prediction scores on larger studies.
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Affiliation(s)
- M Kolditz
- Dept of Pulmonology, Medical Clinic 1, University Hospital Carl Gustav Carus, Fetscherstr 74, 01307 Dresden, Germany.
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de Roux A, Roth A, Schulte-Hubbert B, Mauch H, Lode H. Pulmonale Infektionen durch Nocardien bei 11 HIV-negativen Erwachsenen. Pneumologie 2004. [DOI: 10.1055/s-2004-819696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schulte-Hubbert B, de Roux A, Roth A, Lode H. Disseminierte Nocardia-paucivorans-Infektion unter dem Bild des metastasierten Bronchialkarzinoms. Pneumologie 2004. [DOI: 10.1055/s-2004-819715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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