Community-acquired pneumonia (CAP) is the most common cause of death among infectious diseases. During the management of pneumonia, it is often uncertain when the disease may turn into severe form. The first definition of severe CAP was provided by the ATS Guidelines. Definition was built up around simple clinical and radiographic criteria reflecting the actual illness. The assessment of disease severity is valuable for clinicians caring for patients with severe CAP. The Pneumonia Severity Index (PSI) and CURB-65 (Confusion, Urea nitrogen, Respiratory rate, Blood pressure, age ≥65 years) are usually employed to predict the prognosis of CAP. However, the accuracy of PSI and CURB-65 for predicting outcomes has been challenged. New biomarkers may be useful for improving the outcome prediction in PSI classes I-V and high-risk CURB-65 score categories. Patients with severe form of the disease have benefit from admission to the intensive care unit. We must recognize the right moment for admission. Elevated concentrations of cytokines and markers reflect the complex changes in the immune response to microorganisms, and are associated with alterations of the neuroendocrine and vascular systems. Physicians must understand the problems associated with the pathogenesis of severe pneumonia and to apply the basic principles to guide the effective management. A lot of biomarker tests demonstrate independent prognostic factors for either 30-day or in-hospital mortality, including procalcitonin, triggering receptor expressed on myeloid cells-1 (TREM-1), proadrenomedullin, CRP, pro-atrial natriuretic peptide and pro-vasopressin. Further study of these remarkable plasma proteins is necessary, aiming to treat CAP more efficiently.
Bouchon A, Dietrich J, Colonna M. Cutting edge: in flammatory responses can be triggered by TREM-1, a novel receptor expressed on neutrophils and mono cytes. Journal of Immunology. 2000;164(10).
2.
Harbarth S, Holeckova K, Froidevaux C, Pittet D, Ricou B, Grau GE, et al. Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am J.
3.
Luyt CE, Guerin V, Combes A, Trouillet JL, Ayed SB, Bernard M, et al. Procalcitonin kinetics as a prognostic marker of ventilator associated pneu monia. Am J Respir Crit Care Med. 2005;171:48–53.
4.
Masia M, Gutiarrez F, Shum C, Padilla S, Navarro JC, Flores E, et al. Usefulness of procalcitonin le vels in community-acquired pneumonia according to the patients outcome research team pneumonia se verity index. Chest. 2005;128(4):2223–9.
5.
Mira JP, Max A, Burgel PR. The role of biomarkers in community-acquired pneumonia: predicting mortality and response to adjunctive therapy. Crit Care. 2008;12(6).
6.
S K, S E, R M, J P, K R, Baum H, et al. Procalcitonin predicts patients at low risk of death from CAP across all CRB-65 classes. Eur Respir J. 2008;31:349–55.
7.
Abraham E. Coagulation abnormalities in acute lung injury and sepsis. Am J Respir Cell Mol Biol. 2000;22(4):401–4.
8.
Dhainaut JF, Yan SB, Joyce DE, Pettila V, Basson B, Brandt JT, et al. Treatment effects of drotrecogin alfa (activated) in patients with severe se psis with or without overt disseminated intravascular coagulation. J Thromb Haemost. 2004;2:1924–33.
9.
Querol-Ribelles JM, Tenias JM, Grau E, Querol-Borras JM, Climent JL, Gomez E, et al. Plasma D-dimer levels correlate with outcomes in patients with co mmunity - acquired pneumonia. Chest. 2004;126:1087–92.
10.
Shilon Y, Shitrit ABG, Rudensky B, Am Y, M M, Sulkes J, et al. A rapid quantitative D dimer assay at admission correlates with the severity of community acquired pneumonia. Blood Coagul Fibrinolysis. 2003;14:745–8.
11.
Jensen JU, Heslet L, Jensen TH, Espersen K, P S, Tvede M. Procalcitonin increase in early identification of critically ill patients at high risk of mortality. Crit Care Med. 2006;34:2596–602.
12.
Gibot S, Cravoisy A. Soluble form of the triggering re ceptor expressed on myeloid cells-1 as a marker of microbial infection. Clin Med Res. 2004;2:181–7.
13.
Muller B, Gencay MM, Gibot S, Stolz D, Hunziker L, Tamm M, et al. 35:990–3.
14.
Tejera A, Santolaria F, Diez ML, Alemán-Valls MR, González-Reimers E, Martínez-Riera A, et al. Prognosis of community acquired pneumonia (CAP): value of triggering receptor expressed on myeloid cells-1 (TREM-1) and other mediators of the infla mmatory response. Cytokine. 2007;38(3):117–23.
15.
Christ-Crain M, Morgenthaler NG, Stolz D, Muller C, Bingisser R, Harbarth S, et al. Pro-adrenomedullin to predict se verity and outcome in community-acquired pneumo nia. Crit Care. 2006;10:R96.
16.
Morgenthaler NG, Struck J, Jochberger S, Dünser MW. Copeptin: clinical use of a new biomarker. Trends Endocrinol Metab. 2008;19(2):43–9.
17.
Prat C, Lacoma A, Dominguez J. Midregional pro-atrial natriuretic peptide as a prognostic marker in pneumonia. J Infection. 2007;55(5):400–7.
18.
Krüger S, Papassotiriou J, Marre R, Richter K, C S, Baum H, et al. Pro-atrial natriuretic peptide and pro-vaso pressin to predict severity and prognosis in commu nity-acquired pneumonia. Intensive Care Medicine. 2007;33(12):2069–78.
19.
Masiá M, Papassotiriou J, Morgenthaler NG, I H, Shum C, Gutiérrez F. Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopre ssin may predict prognosis in community-acquired pneumonia. Clin Chem. 2007;53(12):2193–20.
20.
Krüger S, Ewig S, Kunde J, Hartmann O, Suttorp N, Welte T. Respiratory infection Pro-atrial natriuretic peptide and pro-vasopressin for predicting short-term and long-term survival in community-acquired pne umonia: results from the German Competence Net work CAPNETZ. Thorax. 2010;65:208–14.
21.
Borovac N. Dijagnostički i prognostički značaj C-reaktivnog protein, transferina i serumskog gvožđa kod bolesnika sa vanbolnički stečenom pneu monijom. Magistarski rad Medicinski fakultet Niš. 2008;
22.
Rello J, Rodriguez A. Severity of illness assessment for managing community-acquired pneumonia. Inten sive Care Med. 2007;33:2043–4.
23.
Group BTSG. Guidelines for the Management of Community Acquired Pneu monia in Adults-Update 2009. Thorax. 2009;64(III):1–55.
24.
Gordon GS, Throop D, Berberian L, Niederman M, Bass J, Alemayehu D. Validation of the therapeutic recommendations of the American Thoracic Society (ATS) guidelines for community acquired pneumonia in hospitalized patients. Chest. 1996;110(55).
25.
Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, et al. Severe co mmunity-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med. 1998;158(1102):08.
26.
Fine MJ, Auble TE, Yealy DM. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;36:243–50.
27.
Lim WS, Eerden MM, Laing R, Boersma WG, N, Town GI, et al. Defining community acquired pneumonia severity on presenta tion to hospital: an international derivation and vali dation study. Thorax. 2003;58:377–82.
28.
Bozza FA, Salluh JI, Japiassu AM, Soares M, Assis EF, Gomes RN, et al. Cytokine profiles as markers of disease severity in sepsis: a multiplex analysis. Crit Care. 2007;11:R49.
29.
Nastasijević-Borovac D, Pejčić T, Rađenović Petković T, Cekić M, Dimić S, Radović M. Korelacija između nekih parametara inflamacije kod bolesnika sa van bolnički stečenom pneumonijom. Majski pulmološki dani Zbornik radova sa recenzijom, Banja Luka. 2006:121–6.
30.
Kellum JA, Kong L, Fink MP, Weissfeld LA, Yealy DM, Pinsky MR, et al. Understanding the inflamatory cytokine response in pneumonia and sepsis: results of the Genetic and Inflammatory Markers of Sepsis (GenIMS) study. Arch Intern Med. 2007;167:1655–63.
31.
Pneumonia NMSS. Definition of Severity. In: Lung Biology in He alth and Disease-Severe Pneumonia. p. 2005 2-18.
32.
D NB, T RP. Parametri rane inflamacije i neke biohemijske analize u pacijenata sa pneumonijom. U: Pejčić T.(ured) Sa vremeni aspekti i lečenje pneumonija. Zbornik radova sa recenzijom Medicinski fakultet Niš. 2006:123–34.
33.
Castro-Guardiola A, Armengou-Arxe A, Viejo-Rodriguez A, Penarroja-Matutano G, Garcia BF. Differential diagnosis between community-acquired pneumonia and non-pneumonia diseases of the chest in the emergency ward. Eur J Intern Med. 2000;11:334–9.
34.
Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in co mmunity-acquired pneumonia. Am J Med. 2008;121:219–25.
35.
Brunkhorst FM, Al-Nawas B, Krummenauer F, Forycki ZF, Shah PM. Procalcitonin, C-reactive protein and APACHE II score for risk evaluation in patients with severe pneumonia. Clin Microbiol Infect. 2002;8(93).
36.
Kang YA, Kwon SY, Yoon HI, Lee JH, Lee ST. Role of C-Reactive Protein and Procalcitonin in Differentiation of Tuberculosis from Bacterial Community Acquired Pneumonia. Korean J Intern Med. 2009;24(4):42.
37.
Nastasijević-Borovac D, Rađenović-Petković T, Pejčić T, Rančić M, Đorđević VB. Inverse correlation of CRP and serum iron in patients with simple community acquired pneumonia (CAP. Acta Fac Med Naiss. 2007;24(3):107–12.
38.
Menendez R, Cavalcanti M, Reyes S, Mensa J, Martinez R, Marcos MA, et al. Markers of treatment failure in hospitalized community acquired pneumonia. Thorax. 2008;63:447–52.
39.
Joyce CD, Fiscus RR, Wang X, Dries DJ, Morris RC, Prinz RA. Calcitonin generelated peptide levels are elevated in patients with sepsis. Surgery. 1990;108:1097–110.
40.
Muller B, Harbarth S, Stolz D, Bingisser R, Mueller C, Leuppi J, et al. Diagnostic and prognostic accuracy of clinical and laboratory parameters in community-acquired pneu monia. BMC Infect Dis. 2007;7(10).
The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.
