Search

Study objective: Interleukin (IL)-18 is a proinflammatory cytokine, originally termed interferon (IFN)-γ-inducing factor, which promotes T-helper type 1 (Th1) cytokine responses. We recently reported that serum IL-18 levels were elevated [...]

Study objectives: This study was undertaken to evaluate the laboratory abnormalities observed in patients with bacterial pneumonia as predictors of the severity of illness. Design: Retrospective analysis. Setting: Tertiary care hospital. Patients and participants: We studied 302 consecutive patients who were admitted to the Long Island Jewish Medical Center from January through December 1993 and treated for bacterial pneumonia. The patients were subdivided into two groups based on their serum phosphorus level either on hospital admission or 4 days before the onset of pneumonia, if this was acquired in-hospital. Hypophosphatemia (group 1) was defined as serum phosphorus level of [is less than or equal to] 2.4 mg/dL and normophosphatemia [is greater than] 2.4 mg/dL (group 2). Three hundred randomly selected hospitalized patients treated for conditions other than pneumonia comprised the control group (group 3). Measurements: Groups 1 and 2 were compared with respect to laboratory data, mortality rate, and duration of hospitalization. The laboratory data of patients in group 3 were compared with those treated for bacterial pneumonia (groups 1 and 2). Stepwise multivariate logistic regression analysis was employed to identify the variables that best predicted the onset of pneumonia. Results: In groups 1 and 2, a greater (p [is less than] 0.0001) number of patients (135 of 302 patients with pneumonia, 44.7%) developed hypophosphatemia compared with patients in group 3 (31 of 300 control subjects, 10.3%). Patients with pneumonia (groups 1 and 2) had higher levels (p [is less than] 0.01) of bicarbonate compared with control subjects. Moreover, patients with pneumonia demonstrated lower levels (p [is less than] 0.01) of calcium, phosphorus, albumin, cholesterol, and alanine aminotransferase compared with control patients (group 3). Among patients with pneumonia, those with hypophosphatemia (group 1) had significantly lower levels (p [is less than] 0.05) of potassium, calcium, and albumin compared to those subjects with normophosphatemia (group 2). Furthermore, hypophosphatemic subjects manifested higher levels of glucose (p [is less than] 0.01) and creatine phosphokinase (p [is less than] 0.05) compared to their normophosphatemic counterparts. In addition, hypophosphatemic patients experienced a longer duration of hospital stay (hypophosphatemia, 24.6 ± 2.0 days, vs normophosphatemia, 14.1 ± 1.0, p [is less than] 0.001) and higher (p [is less than] 0.001) mortality compared to normophosphatemic subjects. The incidence of nosocomial pneumonia was higher (p [is less than] 0.0001) in hypophosphatemic patients compared to those with normophosphatemia. Conclusion: We conclude that hypophosphatemia, hypocalcemia, hypokalemia, and hypoalbuminemia may be predictors of the severity of illness in patients admitted to the hospital with bacterial pneumonia. (CHEST 1997; 111:595-600) Key words: bacterial pneumonia; hypophosphatemia; laboratory abnormalities, Pneumonia is the most common life-threatening infectious disease.[1] Pleuropulmonary infection remains the fifth most common cause of mortality in the United States, accounting for an estimated 55,000 deaths annually.[2] Pneumonia [...]

Two patients with acute pulmonary coccidioidomycosis presenting as acute bacterial pneumonia and sepsis are described. One patient died despite appropriate antifungal therapy, whereas the diagnosis in the other patient was only established after postmortem examination. In both cases, coccidioidomycosis had disseminated beyond the lungs. Factors leading to overwhelming coccidioidomycosis are discussed, and the relation of the sepsis syndrome to coccidioidomycosis is reviewed.

The term bronchiolitis obliterans was used by Lange[1] in 1901. There have been scattered reports of this disorder until the 1980s when a proliferation of publications began to appear regarding [...]

Idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP) or cryptogenic organizing pneumonitis (COP) is a specific clinicopathologic syndrome of unknown etiology. Since the histopathologic lesions present in this syndrome can be [...]

It has been shown that patients with COPD require as long as 20 min for equilibration oxygen tension to occur after changing the fraction of inspired oxygen ([FIo.sub.2]). To date, [...]

Purpose: To evaluate the prevalence of microorganisms causing CAP and the usefulness of a clinical practice guideline in their routine management. Methods: All patients with diagnosis of CAP seen during [...]

To study the role of T cells in bronchiolitis obliterans organizing pneumonia (BOOP) and chronic eosinophilic pneumonia (CEP) and to examine the influence of differing racial background, T-cell subsets in [...]