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3. Limited prognostic accuracy of the CRB-65 and qSOFA in patients presenting with pneumonia and immunosuppression

Author

B Schulte-Hubbert, Martin Kolditz, Sophie Frantz, Dirk Koschel, and Michael Halank

Subjects
medicine.medical_specialty, Organ Dysfunction Scores, medicine.medical_treatment, Population, 030204 cardiovascular system & hematology, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Internal Medicine, medicine, Humans, In patient, Hospital Mortality, 030212 general & internal medicine, education, Retrospective Studies, Immunosuppression Therapy, Mechanical ventilation, education.field_of_study, business.industry, Retrospective cohort study, Immunosuppression, Pneumonia, Emergency department, Prognosis, medicine.disease, ROC Curve, business
Abstract

Scores for risk prediction used in immunocompetent patients with sepsis or pneumonia are poorly evaluated in immunocompromised patients. Therefore, we evaluated the prognostic value of the qSOFA- and CRB-65-criteria in immunocompromised patients presenting with pneumonia.Retrospective cohort study including consecutive patients hospitalized with pneumonia and immunosuppression without treatment restrictions. The qSOFA and CRB-65 criteria were documented in the emergency department. Outcome was defined as need of mechanical ventilation (MV) or vasopressor support (VS) and/or hospital-mortality.41 of 198 (21%) patients reached the outcome and 10% died. Both, the CRB-65 and qSOFA- were independently associated with the outcome (all p0.01), but age was not predictive. ROC curve analysis showed moderate predictive potential for both scores (CRB-65: AUC 0.63 and qSOFA: 0.69). With scores of 0, the negative predictive values were below 90% (CRB-65: 9/60 and qSOFA: 12/105 missed patients). With scores1, the positive predictive values were 36% (CRB-65) and 58% (qSOFA), respectively.Both, the qSOFA and the CRB-65 only showed moderate prognostic value, and negative predictive values were inadequate to exclude organ failure or death in patients with immunosuppression. In this population, age was not a predictive parameter. Patients with1 positive vital sign criterion measured by both scores should be assessed for organ failure.

Published
2020
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4. Komplikationen nach pleuralem getunnelten Dauerkatheter bei symptomatischen rezidivierenden benignen und malignen Pleuraergüssen

Author

F Frenzen, M. Heberling, S. Langner, Martin Kolditz, B Schulte-Hubbert, Michael Halank, J. Kleymann, S. Karl, Dirk Koschel, and K. Tausche

Subjects
Pulmonary and Respiratory Medicine, Gynecology, medicine.medical_specialty, business.industry, Pleural effusion, medicine.medical_treatment, Treatment outcome, Follow up studies, Medicine, business, medicine.disease, Pleurodesis
Abstract

Zusammenfassung Einleitung Die Implantation eines pleuralen getunnelten Dauerkatheters (indwelling pleural catheter = IPC) stellt bei symptomatischen rezidivierenden benignen und malignen Pleuraergüssen (BPE und MPE) neben einer Pleurodese eine weitere etablierte Therapiemethode dar.Zur Sicherheit des IPC, insbesondere zu Pneumothorax und Katheterinfektionen, existierten wenige Studien.Ziel unserer Untersuchung war, die Komplikationshäufigkeit nach IPC-Anlage und deren prädiktive Faktoren bei Patienten mit BPE vs. MPE zu ermitteln. Methoden Retrospektive Analyse aller IPC-Implantationen im Bereich Pneumologie am Universitätsklinikum Dresden im Zeitraum von 2015 – 2018. Ergebnisse Bei 86 Patienten (je 43 m/f; Alter 66,9 ± 13,3 Jahre) wurde bei symptomatischem BPE und MPE ein IPC implantiert. Ein BPE bzw. MPE bestand bei 12,8 % (11/86) bzw. 87,2 % (75/86) der Erkrankten.Als Sofortkomplikation nach IPC-Anlage war bei 43/86 (50 %) Patienten ein meist kleiner, asymptomatischer Pneumothorax nachweisbar. 34/43 (79 %) Patienten bedurften diesbezüglich keiner spezifischen Therapie. Bei 9/43 war ein IPC-Sog im Median über 3 Tage erforderlich. 8/43 Patienten wiesen einen großen Pneumothorax mit partieller/kompletter Regredienz im Median nach 2 Tagen auf.Bei 15,1 % (13/86) der Gesamtgruppe und 36,4 % (4/11) der BPE vs. 12 % (9/75) der MPE kam es im Median nach 87 (BPE/MPE 116/87) Tagen zu einer Katheterinfektion. Diese war bei BPE (p = 0,035), großem Pneumothorax (4/8 Patienten; p = 0,015) und längerer Katheterverweildauer (124 ± 112 vs. 71 ± 112 Tage; p = 0,07) häufiger. Schlussfolgerung Kleine Pneumothoraces sind häufig nach IPC-Implantation, bedürfen aber meist keiner spezifischen Therapie. Bei 15,1 % aller Patienten war im Median nach 87 Tagen eine Katheterinfektion nachweisbar. Diese trat häufiger bei BPE, längerer Katheterverweildauer und großen Pneumothoraces auf.

Published
2020
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5. Rate and Predictors of Bacteremia in Afebrile Community-Acquired Pneumonia

Author

N. Klopp, J. Freise, J. Naim, A. Vestergaard-Jensen, H. Buschmann, T. Bauer, M. Wallner, J. Drijkoningen, M. Dreher, A. Mikolajewska, Jan Rupp, Gernot Rohde, Mathias W. Pletz, Santiago Ewig, Martin Witzenrath, S. Langner, M. Witzenrath, Heinz Burgmann, D. Wehde, T. Welte, W. Knüppel, D. Thiemig, P. Ravn, D. Stolz, Christina Forstner, D. Krieger, K. Dalhoff, M. Panning, F. Herth, D. Drömann, J. Rupp, W. Kröner, M. Nawrocki, C. Kroegel, D. Braeken, G. Baunbaek-Knudsen, I. Hering, B. Schulte-Hubbert, S. Schmager, Tobias Welte, Benjamin T. Schleenvoigt, T. Illig, W. Albrich, G. Barten, Martin Kolditz, M. Kreuter, M. Prediger, R. Hörster, O. Arenas Toro, T. Schaberg, G. Rohde, C. Cornelissen, B. Hauptmeier, M. Witte, Norbert Suttorp, P. Creutz, W. Pankow, Vladimir Patchev, M. W. Pletz, S. Hummler, J. Winning, and J. Frosinski

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, biology, medicine.diagnostic_test, business.industry, Mortality rate, Urinary system, C-reactive protein, Critical Care and Intensive Care Medicine, Logistic regression, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Community-acquired pneumonia, Bacteremia, Internal medicine, medicine, biology.protein, Blood culture, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, business, Cohort study
Abstract

Background Although blood cultures (BCs) are the "gold standard" for detecting bacteremia, the utility of BCs in patients with community-acquired pneumonia (CAP) is controversial. This study describes the proportion of patients with CAP and afebrile bacteremia and identifies the clinical characteristics predicting the necessity for BCs in patients who are afebrile. Methods Bacteremia rates were determined in 4,349 patients with CAP enrolled in the multinational cohort study The Competence Network of Community-Acquired Pneumonia (CAPNETZ) and stratified by presence of fever at first patient contact. Independent predictors of bacteremia in patients who were afebrile were determined using logistic regression analysis. Results Bacteremic pneumonia was present in 190 of 2,116 patients who were febrile (8.9%), 101 of 2,149 patients who were afebrile (4.7%), and one of 23 patients with hypothermia (4.3%). Bacteremia rates increased with the CURB-65 score from 3.5% in patients with CURB-65 score of 0 to 17.1% in patients with CURB-65 score of 4. Patients with afebrile bacteremia exhibited the highest 28-day mortality rate (9.9%). Positive pneumococcal urinary antigen test (adjusted OR [AOR], 4.6; 95% CI, 2.6-8.2), C-reactive protein level > 200 mg/L (AOR, 3.1; 95% CI, 1.9-5.2), and BUN level ≥ 30 mg/dL (AOR, 3.1; 95% CI, 1.9-5.3) were independent positive predictors, and antibiotic pretreatment (AOR, 0.3; 95% CI, 0.1-0.6) was an independent negative predictor of bacteremia in patients who were afebrile. Conclusions A relevant proportion of patients with bacteremic CAP was afebrile. These patients had an increased mortality rate compared with patients with febrile bacteremia or nonbacteremic pneumonia. Therefore, the relevance of fever as an indicator for BC necessity merits reconsideration.

Published
2020
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6. Prognostic value of blood pressure drops during the first 24 h after hospital admission for risk stratification of community-acquired pneumonia: a retrospective cohort study

Author

B Schulte-Hubbert, N Meiswinkel, Martin Kolditz, and U Kutschan

Subjects
0301 basic medicine, Microbiology (medical), Mechanical ventilation, medicine.medical_specialty, Multivariate analysis, business.industry, medicine.medical_treatment, 030106 microbiology, Diastole, Retrospective cohort study, General Medicine, medicine.disease, 03 medical and health sciences, 0302 clinical medicine, Infectious Diseases, Blood pressure, Community-acquired pneumonia, Internal medicine, Cohort, Clinical endpoint, Medicine, 030212 general & internal medicine, business
Abstract

Current risk stratification in community-acquired pneumonia (CAP) does not incorporate the dynamic nature of CAP evolution. Study aim was to evaluate the predictive value of early blood pressure (BP) drop and its consideration within the CRB-65 score. We performed a retrospective cohort study including consecutive adult hospitalized CAP patients 2013–2014 without documented treatment limitations or direct ICU admission. The CRB-65 score was calculated initially and re-calculated including any BP below the threshold (BP drop) within the first 24 h (CRB-65[BP24]). The primary endpoint was need for mechanical ventilation or vasopressors (MVVS) occurring after 24 h. Prognostic values were evaluated by uni- and multivariate and ROC curve analyses. 28/294 patients (9.5%) met the primary endpoint. Only 3 (11%) of them showed an initial BP of

Published
2020
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8. [Complications after Indwelling Pleural Catheter Implant for Symptomatic Recurrent Benign and Malignant Pleural Effusions]

Author

S, Langner, D, Koschel, J, Kleymann, K, Tausche, S, Karl, F, Frenzen, M, Heberling, B, Schulte-Hubbert, M, Halank, and M, Kolditz

Subjects
Male, Pleural Effusion, Catheters, Indwelling, Treatment Outcome, Drainage, Humans, Female, Middle Aged, Pleurodesis, Aged, Follow-Up Studies, Pleural Effusion, Malignant, Retrospective Studies
Abstract

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. Retrospective analysis of all IPC implantations in the pneumology department at the University Hospital Dresden during 2015 - 2018. 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). 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. Die Implantation eines pleuralen getunnelten Dauerkatheters (indwelling pleural catheter = IPC) stellt bei symptomatischen rezidivierenden benignen und malignen Pleuraergüssen (BPE und MPE) neben einer Pleurodese eine weitere etablierte Therapiemethode dar.Zur Sicherheit des IPC, insbesondere zu Pneumothorax und Katheterinfektionen, existierten wenige Studien.Ziel unserer Untersuchung war, die Komplikationshäufigkeit nach IPC-Anlage und deren prädiktive Faktoren bei Patienten mit BPE vs. MPE zu ermitteln. Retrospektive Analyse aller IPC-Implantationen im Bereich Pneumologie am Universitätsklinikum Dresden im Zeitraum von 2015 – 2018. Bei 86 Patienten (je 43 m/f; Alter 66,9 ± 13,3 Jahre) wurde bei symptomatischem BPE und MPE ein IPC implantiert. Ein BPE bzw. MPE bestand bei 12,8 % (11/86) bzw. 87,2 % (75/86) der Erkrankten.Als Sofortkomplikation nach IPC-Anlage war bei 43/86 (50 %) Patienten ein meist kleiner, asymptomatischer Pneumothorax nachweisbar. 34/43 (79 %) Patienten bedurften diesbezüglich keiner spezifischen Therapie. Bei 9/43 war ein IPC-Sog im Median über 3 Tage erforderlich. 8/43 Patienten wiesen einen großen Pneumothorax mit partieller/kompletter Regredienz im Median nach 2 Tagen auf.Bei 15,1 % (13/86) der Gesamtgruppe und 36,4 % (4/11) der BPE vs. 12 % (9/75) der MPE kam es im Median nach 87 (BPE/MPE 116/87) Tagen zu einer Katheterinfektion. Diese war bei BPE (p = 0,035), großem Pneumothorax (4/8 Patienten; p = 0,015) und längerer Katheterverweildauer (124 ± 112 vs. 71 ± 112 Tage; p = 0,07) häufiger. Kleine Pneumothoraces sind häufig nach IPC-Implantation, bedürfen aber meist keiner spezifischen Therapie. Bei 15,1 % aller Patienten war im Median nach 87 Tagen eine Katheterinfektion nachweisbar. Diese trat häufiger bei BPE, längerer Katheterverweildauer und großen Pneumothoraces auf.

Published
2020

11. S3-Leitlinie: Lungenerkrankung bei Mukoviszidose – Modul 2: Diagnostik und Therapie bei der chronischen Infektion mit Pseudomonas aeruginosa

Author

Ernst Rietschel, B. Schulte-Hubbert, R. Mahlberg, Carsten Schwarz, U. Düesberg, Michael Puderbach, F. Mattner, Christian Hügel, S. van Koningsbruggen-Rietschel, M. O. Wielpütz, C. Muche-Borowski, Ralf-Peter Vonberg, A. Möller, Helmut Ellemunter, Michael Hogardt, A. Koitschev, S. Illing, Jutta Hammermann, T. Nüßlein, S. Schmidt, D. Dieninghoff, H. Hebestreit, W. Bremer, Felix C. Ringshausen, Martin J. Hug, F. Brunsmann, Burkhard Tümmler, Helmut Sitter, Ingo Baumann, L. Sedlacek, B. Kahl, M. Abele-Horn, J. Grosse-Onnebrink, Rainald Fischer, J. Bend, H. Wilkens, A. Mehl, Andreas Jung, S. Renner, J. Zerlik, Olaf Eickmeier, B Wollschläger, Jochen G. Mainz, and Christina Smaczny

Subjects
Pulmonary and Respiratory Medicine, Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, 030228 respiratory system, business.industry, Medicine, 030212 general & internal medicine, business
Abstract

ZusammenfassungMukoviszidose (Cystic Fibrosis, CF) ist die häufigste, autosomal-rezessiv vererbte Multisystemerkrankung. In Deutschland sind ca. 8000 Menschen betroffen. Die Erkrankung wird durch Mutationen im Cystic Fibrosis Transmembrane Conductance Regulator (CFTR-) Gen verursacht; diese führen zu einer Fehlfunktion des Chloridkanals CFTR. Dadurch kommt es in den Atemwegen zu einer unzureichenden Hydrierung des epithelialen Flüssigkeitsfilms und somit zu einer chronischen Inflammation. Rezidivierende Infektionen der Atemwege sowie pulmonale Exazerbationen der Lunge führen im Verlauf zu zunehmender Inflammation, pulmonaler Fibrose und fortschreitender Lungendestruktion bis hin zur respiratorischen Globalinsuffizienz, die für über 90 % der Mortalität verantwortlich ist. Das Ziel der medikamentösen Therapie ist die pulmonale Inflammation und v. a. die Infektion der Atemwege zu reduzieren. Der Kolonisation und chronischen Infektion mit Pseudomonas aeruginosa (Pa) kommt die größte Bedeutung zu. Diese führt zu weiterem Verlust an Lungenfunktion. Für die medikamentöse Therapie der chronischen Pa-Infektion stehen viele unterschiedliche Therapieoptionen zur Verfügung.Mit dieser S3-Leitlinie wird eine einheitliche Definition für die chronische Pa-Infektion implementiert sowie eine evidenzbasierte Diagnostik und Therapie dargelegt, um eine Orientierung bei der individuellen Therapieentscheidung zu geben.

Published
2018
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12. [CF Lung Disease - a German S3 Guideline: Module 2: Diagnostics and Treatment in Chronic Infection with Pseudomonas aeruginosa]

Author

C, Schwarz, B, Schulte-Hubbert, J, Bend, M, Abele-Horn, I, Baumann, W, Bremer, F, Brunsmann, D, Dieninghoff, O, Eickmeier, H, Ellemunter, R, Fischer, J, Grosse-Onnebrink, J, Hammermann, H, Hebestreit, M, Hogardt, C, Hügel, M, Hug, S, Illing, A, Jung, B, Kahl, A, Koitschev, R, Mahlberg, J G, Mainz, F, Mattner, A, Mehl, A, Möller, C, Muche-Borowski, T, Nüßlein, M, Puderbach, S, Renner, E, Rietschel, F C, Ringshausen, S, Schmidt, L, Sedlacek, H, Sitter, C, Smaczny, B, Tümmler, R, Vonberg, M O, Wielpütz, H, Wilkens, B, Wollschläger, J, Zerlik, U, Düesberg, and S, van Koningsbruggen-Rietschel

Subjects
Cystic Fibrosis, Germany, Practice Guidelines as Topic, Pseudomonas aeruginosa, Cystic Fibrosis Transmembrane Conductance Regulator, Humans, Pseudomonas Infections
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.Mukoviszidose (Cystic Fibrosis, CF) ist die häufigste, autosomal-rezessiv vererbte Multisystemerkrankung. In Deutschland sind ca. 8000 Menschen betroffen. Die Erkrankung wird durch Mutationen im Cystic Fibrosis Transmembrane Conductance Regulator (CFTR-) Gen verursacht; diese führen zu einer Fehlfunktion des Chloridkanals CFTR. Dadurch kommt es in den Atemwegen zu einer unzureichenden Hydrierung des epithelialen Flüssigkeitsfilms und somit zu einer chronischen Inflammation. Rezidivierende Infektionen der Atemwege sowie pulmonale Exazerbationen der Lunge führen im Verlauf zu zunehmender Inflammation, pulmonaler Fibrose und fortschreitender Lungendestruktion bis hin zur respiratorischen Globalinsuffizienz, die für über 90 % der Mortalität verantwortlich ist. Das Ziel der medikamentösen Therapie ist die pulmonale Inflammation und v. a. die Infektion der Atemwege zu reduzieren. Der Kolonisation und chronischen Infektion mit

Published
2018

13. S3-Leitlinie 'Lungenerkrankung bei Mukoviszidose'

Author

Ingo Baumann, F.-M. Müller, J. Bend, A. Möller, Doris Staab, Carsten Schwarz, W. Bremer, Ernst Rietschel, R.-P. Vonberg, Burkhard Tümmler, R. Mahlberg, R. Bruns, Christina Smaczny, J. Riedler, B. Schulte-Hubbert, M. Abele-Horn, H. Hebestreit, R. Fischer, M. Kohlhäufl, F. Brunsmann, L. Sedlacek, S. Illing, J. Zerlik, Helmut Sitter, M. Puderbach, J. Bargon, Jochen G. Mainz, T. O. Hirche, Assen Koitschev, Michael Hogardt, Isidor Huttegger, Manfred Ballmann, S. Pfeiffer-Auler, C. Geidel, and Tof Wagner

Subjects
Gynecology, medicine.medical_specialty, business.industry, Pediatrics, Perinatology and Child Health, medicine, Surgery, business, Disease control
Abstract

Mukoviszidose (zystische Fibrose, CF) ist eine der haufigsten autosomal-rezessiv vererbten Erkrankungen der kaukasischen Bevolkerung. Der genetische Defekt im CFTR-Gen fuhrt zu einer Verringerung des Chloridionentransports an der Zellmembran. Die resultierende Dehydrierung des epithelialen Flussigkeitsfilms bedingt ihrerseits eine Reduktion der Sekret-Clearance. Die Folge ist eine Multiorganerkrankung. Die pulmonale Manifestation mit chronischen Infektionen und der Inflammation ist hierbei die dominierende Todesursache. Akute und chronische Infektion mit Pseudomonas aeruginosa (PA) konnen zu einem Abfall in der Lungenfunktion fuhren und sich direkt negativ auf die Uberlebenswahrscheinlichkeit auswirken. Die Entwicklung der ersten klinischen S3-Leitlinie fur die Mukoviszidose hat das Ziel, die Diagnostik und Therapie bei einem ersten Nachweis von PA in Deutschland, Osterreich und der Schweiz zu vereinheitlichen und zu optimieren. Zugleich sollen Impulse fur weitere Forschungsaktivitaten und Leitlinienentwicklungen gegeben werden. Auf der Grundlage eines Cochrane-Reviews wurde eine systematische Literaturrecherche im Zeitraum von 1995 bis November 2011 (Update September 2014) durchgefuhrt. Von den 286 resultierenden Originalarbeiten wurden 6 randomisierte klinische Studien und 8 weitere Eradikationsstudien niedrigerer Evidenz als relevant identifiziert und ausgewertet. Experten aus 13 wissenschaftlich-medizinischen Fachgesellschaften und Verbanden pruften anhand dieser Originalarbeiten und unter Zuhilfenahme von nationalen und internationalen Leitlinien und Konsensuspapieren die Evidenz als Grundlage fur die Formulierung von 36 Empfehlungen in einem nominalen Gruppenprozess. Die Auswertung der Eradikationsstudien zeigt, dass eine fruhe antibiotische Eradikationstherapie fur Patienten mit CF effektiv ist. Welches Therapieregime am erfolgversprechendsten ist, kann aufgrund von zu wenigen Daten aus vergleichenden Untersuchungen nicht entschieden werden. Nach Auswertung aller Hinweise konnten jedoch die folgenden Kernempfehlungen getroffen werden: Die fruhe Eradikation sollte mittels Tobramycin inhalativ fur 4 Wochen oder mittels Ciprofloxacin p.o., kombiniert mit Colistin inhalativ uber 3 Wochen, durchgefuhrt werden. Fur den Fall, dass eine Inhalation nicht moglich ist, sollte eine i.v.-Kombinationstherapie als Moglichkeit in Betracht gezogen werden. Falls eine Therapie mit inhalativen und oralen Antibiotika nicht zur Eradikation fuhrt, sollte eine Kombinationstherapie aus i.v.-Antibiotika und inhalativem Colistin durchgefuhrt werden. Bei einer pulmonalen Exazerbation und erstem Nachweis von PA wird eine sequenzielle Kombination aus i.v.- und inhalativem Antibiotikum empfohlen. Die fruhe Eradikationstherapie von PA bei Mukoviszidose ist effektiv und kann nach der vorliegenden Leitlinie durchgefuhrt werden. Es konnte in den vorliegenden Studien keine Uberlegenheit eines Therapieregimes gezeigt werden. Weitere vergleichende sowie Studien zur Beteiligung der oberen Atemwege sollten in Zukunft durchgefuhrt werden.

Published
2015
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14. The glycemic gap and 90-day mortality in community-acquired pneumonia- A prospective cohort study

Author

Andreas Vestergaard Jensen, Gertrud Baunbæk Egelund, Stine Bang Andersen, Pelle Trier Petersen, Thomas Benfield, Martin Witzenrath, Gernot Rohde, Pernille Ravn, Daniel Faurholt-Jepsen, M. Dreher, C. Cornelissen, W. Knüppel, D. Stolz, N. Suttorp, P. Creutz, T. Bauer, T. Sabha, W. Pankow, D. Thiemig, A. Lies, B. Hauptmeier, D. Wehde, M. Prediger, S. Schmager, M. Kolditz, B. Schulte-Hubbert, S. Langner, G. Höffken, S. Ewig, G. Barten, M. Abrahamczik, J. Naim, W. Kröner, T. Welte, T. Illig, N. Klopp, C. Kroegel, M. Pletz, J. Happe, J. Frosinski, J. Winning, A. Moeser, K. Dalhoff, K. Dageförde, K. Franzen, F. Hyzy, H. Schmieg, P. Parschke, P. Thiemann, J. Ahrens, T. Hardel, J. Drijkoningen, D. Braeken, H. Buschmann, R. Kröning, T. Schaberg, I. Hering, H. Schütte, C. Kropf-Sanchen, T. Illmann, M. Wallner, O. Burghuber, and G. Rainer

Subjects
Adult, Blood Glucose, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Time Factors, endocrine system diseases, Future risk, Comorbidity, macromolecular substances, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Community-acquired pneumonia, Predictive Value of Tests, Germany, Diabetes mellitus, Internal medicine, Humans, Medicine, In patient, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Proportional Hazards Models, Glycemic, business.industry, Proportional hazards model, nutritional and metabolic diseases, Pneumonia, Middle Aged, Prognosis, medicine.disease, Community-Acquired Infections, 030228 respiratory system, Quartile, Austria, Hyperglycemia, Biomarker (medicine), Female, business
Abstract

Background: In patients without diabetes (DM) hyperglycemia is associated with high mortality from community-acquired pneumonia(CAP). Hyperglycemia, however, is a common condition among patients with DM and preexisting hyperglycemia should be accounted for in studies of a possible association between hyperglycemia and mortality in patients with DM. Aim: To investigate the association between the glycemic gap (the difference between admission hyperglycemia and the estimated average glucose (EAG)) and 90-day mortality. Methods: A prospective cohort study. EAG was derived from hemoglobin A1c. The absolute-glycemic gap was defined as; “admittance blood glucose - EAG“. The proportional glycemic-gap was defined as; “((admittance blood glucose/EAG)*100)-100”. The association between the absolute-glycemic gap and the proportional-glycemic gap and 90-day mortality was assessed with Cox proportional hazard model. We categorized the proportional-glycemic gap according to quartiles. Results: 1933 adults were included. The absolute-glycemic-gap was not associated with an increased risk for 90-day mortality, HR 1.02 (95% CI 0.93-1.11). Compared to the 2nd quartile, the 1st and 4th proportional-glycemic gap quartile was associated with a higher risk with HR 2.7 (95% CI 1.11-6.65) and HR 2.5 (95% CI 1.05-5.69), respectively. No interaction between DM and the proportional-glycemic gap or the absolute-glycemic gap was found (p=0.82 and p=0.25, respectively). Conclusion: Patients with the lowest and highest proportional-glycemic gap had the highest risk for 90-day mortality and it was not modified by DM. The proportional-glycemic gap might be incorporated into future risk assessment tools for CAP.

Published
2017
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15. Copeptin predicts clinical deterioration and persistent instability in community-acquired pneumonia

Author

B Schulte-Hubbert, Michael Halank, S Albrecht, Martin Kolditz, Gert Höffken, and S Bergmann

Subjects
Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Community-acquired pneumonia, Kaplan-Meier Estimate, Risk Assessment, Procalcitonin, Copeptin, Internal medicine, medicine, Pneumonia, Bacterial, Humans, Prospective Studies, Intensive care medicine, Prospective cohort study, ICU-admission, Risk stratification, Aged, Aged, 80 and over, business.industry, Glycopeptides, Biomarker, Middle Aged, medicine.disease, Prognosis, Icu admission, Community-Acquired Infections, Pneumonia, ROC Curve, Disease Progression, Biomarker (medicine), Female, Risk assessment, business, Biomarkers
Abstract

Summary Rationale Optimal risk prediction of early clinical deterioration in community-acquired pneumonia (CAP) remains unresolved. We prospectively examined the predictive value of the new biomarkers copeptin and proadrenomedullin (MR-proADM) in comparison to clinical scores and inflammatory markers to predict early high risk prognosis in CAP. Methods 51 consecutive hospitalised adult patients were enrolled. We measured CRB-65- and PSI-scores, the ATS/IDSA 2007 minor criteria to predict ICU-admission and the biomarkers CRP, procalcitonin, copeptin and MR-proADM on admission. Predefined outcome parameters were combined mortality or ICU-admission after 7 days and clinical instability after 72 h. Results Copeptin was the only biomarker significantly elevated in patients with either adverse short term outcome ( p = 0.003). According to ROC-curve analysis, copeptin predicted ICU admission or death within 7 days (AUC 0.81, cut-off 35 pmol/l: sensitivity 78%, specificity 79%) and persistent clinical instability after 72 h (AUC 0.74). In Kaplan-Meier-analysis patients with high copeptin showed lower ICU-free survival within 7 days ( p = 0.001). The diagnostic accuracy of copeptin was superior to the CRB-65 score and comparable to the PSI-score and the ATS/IDSA minor criteria. If copeptin was included as additional minor criterion for combined 7-day mortality or ICU-admission, the diagnostic accuracy of the minor criteria was significantly improved ( p = 0.045). Conclusion Copeptin predicts early deterioration and persistent clinical instability in hospitalised CAP and improves the predictive properties of existing clinical scores. It should be evaluated within a biomarker guided strategy for early identification of high risk CAP patients who most likely benefit from early intensified management strategies.

Published
2012
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18. Admission lactate predicts poor prognosis independently of the CRB-/CURB-65-scores in community-acquired pnumonia

Author

Frederik S. Frenzen, Martin Kolditz, N Meiswinkel, Santiago Ewig, B Schulte-Hubbert, and U Kutschan

Subjects
Male, medicine.medical_treatment, Severity of Illness Index, law.invention, 0302 clinical medicine, Community-acquired pneumonia, law, Clinical endpoint, 030212 general & internal medicine, Aged, 80 and over, Area under the curve, General Medicine, Middle Aged, Prognosis, Intensive care unit, Community-Acquired Infections, Infectious Diseases, Female, medicine.symptom, Adult, Microbiology (medical), Pulmonary and Respiratory Medicine, Poor prognosis, medicine.medical_specialty, Adolescent, Point-of-care testing, Sepsis, Young Adult, 03 medical and health sciences, Predictive Value of Tests, Internal medicine, medicine, Humans, Lactic Acid, Intensive care medicine, Aged, Retrospective Studies, Mechanical ventilation, Receiver operating characteristic, Diagnostic Tests, Routine, business.industry, Organ dysfunction, Retrospective cohort study, Pneumonia, medicine.disease, Respiration, Artificial, Survival Analysis, CURB-65, ROC Curve, 030228 respiratory system, business
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.

Published
2018
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19. Adrenal function is related to prognosis in moderate community-acquired pneumonia

Author

Gert Höffken, M Halank, B Schulte-Hubbert, and Martin Kolditz

Subjects
Adult, Pulmonary and Respiratory Medicine, endocrine system, medicine.medical_specialty, Hydrocortisone, medicine.drug_class, Pneumonia severity index, Comorbidity, Gastroenterology, Procalcitonin, law.invention, Community-acquired pneumonia, law, Internal medicine, Cosyntropin, Adrenal Glands, Humans, Medicine, Aged, Aged, 80 and over, biology, business.industry, C-reactive protein, Pneumonia, Middle Aged, Prognosis, medicine.disease, Intensive care unit, Community-Acquired Infections, Treatment Outcome, Endocrinology, Multivariate Analysis, biology.protein, Corticosteroid, business, hormones, hormone substitutes, and hormone antagonists, medicine.drug
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.

Published
2010
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20. Pulmonary adverse events in unrelated donors of peripheral blood stem cells

Author

B. Schulte-Hubbert, Matthias Blechschmidt, Frank Kroschinsky, S. Ganepola, Kristina Hölig, G. Ehninger, Katrin Wetzko, Michael Laniado, Markus K. Schuler, D. Braumann, Rainer Ordemann, K. Poppe-Thiede, R. Fischbach, and L. Cotta

Subjects
medicine.medical_specialty, biology, business.industry, MEDLINE, Hematology, medicine.disease_cause, medicine.disease, Peripheral Blood Stem Cells, biology.organism_classification, Lenograstim, Pneumonia, Internal medicine, medicine, Influenza A virus, Young adult, Adverse effect, Intensive care medicine, business, Enterococcus faecium
Published
2012
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21. Schwangerschaft und Cystische Fibrose aus pneumologischer Sicht

Author

K. Ulbrich, B. Schulte-Hubbert, and J Hammermann

Subjects
Pulmonary and Respiratory Medicine
Abstract

Das durchschnittliche Lebensalter von Patienten mit Cystischer Fibrose hat in den letzten Jahren deutlich zugenommen und liegt aktuell bei uber 40 Jahren. Die stabileren klinischen Verlaufe und das hohere Lebensalter bedingen in der CF-Betreuung vermehrt Aspekte der Lebens- und Familienplanung. Wir mochten exemplarisch uber die Erfahrung mit einigen Schwangerschaften an unserem Universitatsmukoviszidosezentrum fur Kinder und Erwachsene berichten. Die Schwerpunkte sollen dabei auf dem lungenfunktionellen Verlauf, den infektiologischen Besonderheiten und der perioperativen Betreuung liegen. Die forcierte 1-Sekundenkapazitat (FEV1) lag bei 6 Schwangeren im ersten Trimenon zwischen 47% und 64% des Solls. Im letzten Trimenon der Schwangerschaft wurden FEV1-Werte zwischen 18% und 63% bestimmt. Im Sputum der Patientinnen wurden mulitresistente Pseudomonas aeruginosa und MRSA, Bukhholderia cepacia complex, zweimal Pseudomonas aeruginosa sowie Mund- und Rachflora nachgewiesen. Es erfolgten resistenzgerechte Antibiotikatherapien insbesondere vor und wahrend des geplanten Geburtstermins und eine intensive Atem- und Physiotherapie. Die Antibiotika wurden unter dem Gesichtspunkt einer resistenzgerechten und minimal embryotoxischen Therapie ausgesucht. In der ersten Phase der Schwangerschaft wurde versucht, auf systemische Antibiotikatherapien weitestgehend zu verzichten. Inhalative Antibiotikatherapien mit Colistin und Aztreonamlysin wurden unverandert fortgesetzt. Von sechs Schwangeren konnten zwei spontan entbinden, dreimalig erfolgte die primare Sectio caesarea und einmalig die sekundare Sectio ceasarea bei Beckenendlage. Alle Kinder waren zum Zeitpunkt der Geburt wohlauf und wiesen keine Fehlbildungen auf. Die weitere Betreuung von Mutter und Kind erfolgte bei funf von sechs Patientinnen in unserer Klinik, bei einer Mutter auf Wunsch wohnortnah.

Published
2014
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22. Neutrophil elastase-mediated increase in airway temperature during inflammation

Author

Baroukh M. Assael, Susanne Häußler, Annika Schmidt, Jutta Hammermann, Monika Schniederjans, Gerd Döring, Rosi Bissinger, Joachim Seelig, Garrit Koller, D. Worlitzsch, Keith C. Meyer, Kenneth D. Bruce, Soeren Damkiaer, Otto Holst, Giorgio Piacentini, John J. LiPuma, Laurette Malleret, Azzaq Belaaouaj, Antonio Molinaro, Ciro D'Orazio, B Schulte-Hubbert, Martino Facchinelli, Schmidt, Annika, Belaaouaj, Azzaq, Bissinger, Rosi, Koller, Garrit, Malleret, Laurette, D'Orazio, Ciro, Facchinelli, Martino, Schulte-Hubbert, Bernhard, Molinaro, Antonio, Holst, Otto, Hammermann, Jutta, Schniederjans, Monika, Meyer, Keith C., Damkiaer, Soeren, Piacentini, Giorgio, Assael, Baroukh, Bruce, Kenneth, Häußler, Susanne, Lipuma, John J., Seelig, Joachim, Worlitzsch, Dieter, Döring, Gerd, Institute of Medical Microbiology and Hygiene (IMHR), Universität Regensburg (UR), Pathogénie des Staphylocoques – Staphylococcal Pathogenesis (StaPath), Centre International de Recherche en Infectiologie (CIRI), École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure de Lyon (ENS de Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet - Saint-Étienne (UJM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), King‘s College London, Department of Pediatrics, Università degli studi di Verona = University of Verona (UNIVR), Ospedale Civile Maggiore, Verona CF center-Università degli studi di Verona = University of Verona (UNIVR), Medical Clinic and Policlinic I, University Hospital Carl Gustav Carus Dresden, Department of Chemical Sciences, University of Naples Federico II = Università degli studi di Napoli Federico II, Research Center Borstel, Leibniz Center for Medicine and Biosciences, University Clinic Carl Gustav Carus, Dresden, Helmholtz Centre for Infection Research (HZI), University of Wisconsin School of Medicine and Public Health, Danmarks Tekniske Universitet = Technical University of Denmark (DTU), University of Michigan Medical School [Ann Arbor], University of Michigan [Ann Arbor], University of Michigan System-University of Michigan System, Departement of Biophysical Chemistry, University of Basel (Unibas), Institute of Biochemistry and Biotechnology, Martin-Luther-University Halle-Wittenberg, Centre International de Recherche en Infectiologie - UMR (CIRI), Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Centre National de la Recherche Scientifique (CNRS), University of Verona (UNIVR), Verona CF center-University of Verona (UNIVR), University of Naples Federico II, Technical University of Denmark [Lyngby] (DTU), Biozentrum Universitaet Basel, École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-École normale supérieure - Lyon (ENS Lyon)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and University of Verona (UNIVR)-Verona CF center

Subjects
Male, Hot Temperature, Cystic Fibrosis, Inbred C57BL, medicine.disease_cause, Cystic fibrosis, Body Temperature, Neutrophil elastase, Mice, 0302 clinical medicine, Medicine, Respiratory Tract Infection, Child, Pathogen, Respiratory Tract Infections, 0303 health sciences, biology, Temperature, 3. Good health, [SDV.MP.VIR]Life Sciences [q-bio]/Microbiology and Parasitology/Virology, Pseudomonas aeruginosa, Inflammation, [SDV.IMM]Life Sciences [q-bio]/Immunology, Female, medicine.symptom, Case-Control Studie, Human, Pulmonary and Respiratory Medicine, Adolescent, Microbiology, Pseudomonas Infection, 03 medical and health sciences, Animals, Humans, Pseudomonas Infections, Pediatrics, Perinatology, and Child Health, Cystic Fibrosi, 030304 developmental biology, Innate immune system, business.industry, Animal, medicine.disease, [SDV.MP.BAC]Life Sciences [q-bio]/Microbiology and Parasitology/Bacteriology, Mice, Inbred C57BL, Chronic infection, Disease Models, Animal, 030228 respiratory system, Case-Control Studies, Disease Models, Immunology, Pediatrics, Perinatology and Child Health, biology.protein, business, Airway, Leukocyte Elastase
Abstract

International audience; BACKGROUND: How elevated temperature is generated during airway infections represents a hitherto unresolved physiological question. We hypothesized that innate immune defence mechanisms would increase luminal airway temperature during pulmonary infection. METHODS: We determined the temperature in the exhaled air of cystic fibrosis (CF) patients. To further test our hypothesis, a pouch inflammatory model using neutrophil elastase-deficient mice was employed. Next, the impact of temperature changes on the dominant CF pathogen Pseudomonas aeruginosa growth was tested by plating method and RNAseq. RESULTS: Here we show a temperature of ~38°C in neutrophil-dominated mucus plugs of chronically infected CF patients and implicate neutrophil elastase:α1-proteinase inhibitor complex formation as a relevant mechanism for the local temperature rise. Gene expression of the main pathogen in CF, P. aeruginosa, under anaerobic conditions at 38°C vs 30°C revealed increased virulence traits and characteristic cell wall changes. CONCLUSION: Neutrophil elastase mediates increase in airway temperature, which may contribute to P. aeruginosa selection during the course of chronic infection in CF.

Published
2014
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24. Fibrinogen Plasma Concentrations Are Increased In Chronic Thromboembolic Pulmonary Hypertension And Associated With Impaired Hemodynamics

Author

Nicole Lüneburg, Hans Klose, Karsten Sydow, B Schulte-Hubbert, Jan K. Hennigs, Hans Jörg Baumann, and Michael Halank

Subjects
medicine.medical_specialty, business.industry, Internal medicine, Plasma concentration, medicine, Cardiology, Hemodynamics, Chronic thromboembolic pulmonary hypertension, Fibrinogen, business, medicine.drug
Published
2012
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31. Every CFTR variant counts - Target-capture based next-generation-sequencing for molecular diagnosis in the German CF Registry.

Author

Ahting S, Nährlich L, Held I, Henn C, Krill A, Landwehr K, Meister J, Nährig S, Nolde A, Remke K, Ruppel R, Sauer-Heilborn A, Schebek M, Schopper G, Schulte-Hubbert B, Schwarz C, Smaczny C, Wege S, and Hentschel J

Subjects
Humans, Germany, Genetic Testing methods, Female, Male, Genotype, Mutation, Cystic Fibrosis genetics, Cystic Fibrosis diagnosis, Cystic Fibrosis Transmembrane Conductance Regulator genetics, Registries, High-Throughput Nucleotide Sequencing methods
Abstract

Background: In times of genotype guided therapy options, a total of 3.2 % of people with CF (pwCF) in the German CF Registry[1] only have one or no CFTR-variant detected after genetic analysis. Additionally, genetic data in the Registry can be documented as free text and can therefore be prone to error. In order to allow the greatest possible amount of pwCF access to modern therapies, we conducted a re-evaluation of free text entries and established a custom-whole-CFTR-locus NGS-approach for all pwCF who remained without genetic confirmation afterwards., Methods: To this end, we assembled 731 free text variants of 655 pwCF in the German CF Registry. All variants were evaluated using ClinVar, HGMD and CFTR1/2, corrected in the Registries' database and uploaded to ClinVar. PwCF whose diagnosis remained uncertain as well as additional pwCF or pwCFTR-RD that were assembled through a nationwide call for testing of unclear cases were offered genetic analysis. Samples were analysed using a target-capture based NGS-custom-design-panel covering the entire CFTR-locus., Results: Evaluation of free text variants led to the discovery of 43 variants not formerly reported in the context of CF. The Registries' dropdown list was extended by 497 variants and over 500 pwCF were provided with their most up-to-date genotype. Samples of 47 pwCF/pwCFTR-RD were sequenced via NGS with an overall success rate of 61.7 %, resulting in implementation of entire CFTR-genotyping into routine diagnostics., Conclusion: Entire CFTR-genotyping can greatly increase the genetic diagnostic rate of pwCF/pwCFTR-RD and should be considered after inconspicuous CFTR screening panels in CFTR-diagnostics., Competing Interests: Declaration of Competing Interest The following authors declare a conflict of interest in preparing this article: SN has received grants from the CTN-ECFS, DZL and a Speaker’s fee from Vertex pharmaceuticals. LN has received institutional fees from the German Center for Lung Research, Vertex Pharmaceuticals and the Mukoviszidose Institute. He participated in the Trial Steering Committee for CF STORM and is the Medical lead of the German CF-registry and the Pharmacovigilance study manager of the ECFSPR. CS has received a Speaker’s fee from Vertex, TFF Pharma, Chiesi and Viatris and is an ECFS Board Member.All other author’s declare no conflicts of interest., (Copyright © 2023 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Published
2024
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32. [CF Lung Disease - a German S3 Guideline: Pseudomonas aeruginosa].

Author

Schwarz C, Bend J, Hebestreit H, Hogardt M, Hügel C, Illing S, Mainz JG, Rietschel E, Schmidt S, Schulte-Hubbert B, Sitter H, Wielpütz MO, Hammermann J, Baumann I, Brunsmann F, Dieninghoff D, Eber E, Ellemunter H, Eschenhagen P, Evers C, Gruber S, Koitschev A, Ley-Zaporozhan J, Düesberg U, Mentzel HJ, Nüßlein T, Ringshausen FC, Sedlacek L, Smaczny C, Sommerburg O, Sutharsan S, Vonberg RP, Weber AK, and Zerlik J

Abstract

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Published
2024
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33. Chronic inhaled antibiotic therapy in people with cystic fibrosis with Pseudomonas aeruginosa infection in Germany.

Author

Naehrig S, Schulte-Hubbert B, Hafkemeyer S, Hammermann J, Dumke M, Sieber S, and Naehrlich L

Subjects
Adult, Child, Humans, Anti-Bacterial Agents, Retrospective Studies, Colistin therapeutic use, Pseudomonas aeruginosa, Tobramycin, Administration, Inhalation, Germany, Pseudomonas Infections drug therapy, Cystic Fibrosis complications, Cystic Fibrosis drug therapy
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., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Published
2023
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34. [Complications after Indwelling Pleural Catheter Implant for Symptomatic Recurrent Benign and Malignant Pleural Effusions].

Author

Langner S, Koschel D, Kleymann J, Tausche K, Karl S, Frenzen F, Heberling M, Schulte-Hubbert B, Halank M, and Kolditz M

Subjects
Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pleural Effusion, Malignant pathology, Pleurodesis, Retrospective Studies, Treatment Outcome, Catheters, Indwelling adverse effects, Drainage instrumentation, Pleural Effusion surgery, Pleural Effusion, Malignant therapy
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., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Published
2020
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35. Limited prognostic accuracy of the CRB-65 and qSOFA in patients presenting with pneumonia and immunosuppression.

Author

Frantz S, Schulte-Hubbert B, Halank M, Koschel D, and Kolditz M

Subjects
Hospital Mortality, Humans, Immunosuppression Therapy, Organ Dysfunction Scores, Prognosis, ROC Curve, Retrospective Studies, Pneumonia, Sepsis
Abstract

Background: Scores for risk prediction used in immunocompetent patients with sepsis or pneumonia are poorly evaluated in immunocompromised patients. Therefore, we evaluated the prognostic value of the qSOFA- and CRB-65-criteria in immunocompromised patients presenting with pneumonia., Methods: Retrospective cohort study including consecutive patients hospitalized with pneumonia and immunosuppression without treatment restrictions. The qSOFA and CRB-65 criteria were documented in the emergency department. Outcome was defined as need of mechanical ventilation (MV) or vasopressor support (VS) and/or hospital-mortality., Results: 41 of 198 (21%) patients reached the outcome and 10% died. Both, the CRB-65 and qSOFA- were independently associated with the outcome (all p<0.01), but age was not predictive. ROC curve analysis showed moderate predictive potential for both scores (CRB-65: AUC 0.63 and qSOFA: 0.69). With scores of 0, the negative predictive values were below 90% (CRB-65: 9/60 and qSOFA: 12/105 missed patients). With scores > 1, the positive predictive values were 36% (CRB-65) and 58% (qSOFA), respectively., Conclusions: Both, the qSOFA and the CRB-65 only showed moderate prognostic value, and negative predictive values were inadequate to exclude organ failure or death in patients with immunosuppression. In this population, age was not a predictive parameter. Patients with > 1 positive vital sign criterion measured by both scores should be assessed for organ failure., (Copyright © 2020 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Published
2020
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36. Prognostic value of blood pressure drops during the first 24 h after hospital admission for risk stratification of community-acquired pneumonia: a retrospective cohort study.

Author

Schulte-Hubbert B, Meiswinkel N, Kutschan U, and Kolditz M

Subjects
Aged, Cohort Studies, Community-Acquired Infections mortality, Humans, Kaplan-Meier Estimate, Pneumonia mortality, Pneumonia pathology, Predictive Value of Tests, Retrospective Studies, Risk Factors, Time Factors, Blood Pressure, Community-Acquired Infections diagnosis, Hospitalization statistics & numerical data, Pneumonia diagnosis
Abstract

Objectives: Current risk stratification in community-acquired pneumonia (CAP) does not incorporate the dynamic nature of CAP evolution. Study aim was to evaluate the predictive value of early blood pressure (BP) drop and its consideration within the CRB-65 score., Methods: We performed a retrospective cohort study including consecutive adult hospitalized CAP patients 2013-2014 without documented treatment limitations or direct ICU admission. The CRB-65 score was calculated initially and re-calculated including any BP below the threshold (BP drop) within the first 24 h (CRB-65[BP24]). The primary endpoint was need for mechanical ventilation or vasopressors (MVVS) occurring after 24 h. Prognostic values were evaluated by uni- and multivariate and ROC curve analyses., Results: 28/294 patients (9.5%) met the primary endpoint. Only 3 (11%) of them showed an initial BP of < 90 mmHg systolic or ≤ 60 mmHg diastolic, but 21 (75%) developed a BP drop within the first 24 h. 24/178 (13%) with and only 4/116 (3%) without any low BP during the first 24 h needed MVVS (p = 0.004). After multivariate analysis, the predictive value of BP drop was independent of other score parameters and biomarkers (all p < 0.01). In ROC analysis, the new CRB-65(BP24) showed a better prediction than the CRB-65 score (AUC 0.69 vs. 0.62, p = 0.04). 7/13 patients (54%) with MVVS despite an admission CRB-65 of 0 or 1 showed a BP drop., Conclusions: In the evaluated cohort, BP drop within the first 24 h was significantly associated with more need for MVVS in CAP, and its consideration improved the prognostic value of the CRB-65 score.

Published
2020
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37. [CF Lung Disease - a German S3 Guideline: Module 2: Diagnostics and Treatment in Chronic Infection with Pseudomonas aeruginosa].

Author

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, and van Koningsbruggen-Rietschel S

Subjects
Cystic Fibrosis complications, Cystic Fibrosis microbiology, Cystic Fibrosis Transmembrane Conductance Regulator metabolism, Germany, Humans, Pseudomonas Infections diagnosis, Cystic Fibrosis diagnosis, Cystic Fibrosis therapy, Cystic Fibrosis Transmembrane Conductance Regulator genetics, Practice Guidelines as Topic, Pseudomonas aeruginosa isolation & purification
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., Competing Interests: Eine Übersicht der Interessenkonflikte findet sich im Internet unter http://awmf.org; AWMF-Registriernummer 020-018., (© Georg Thieme Verlag KG Stuttgart · New York.)

Published
2018
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38. Admission lactate predicts poor prognosis independently of the CRB/CURB-65 scores in community-acquired pneumonia.

Author

Frenzen FS, Kutschan U, Meiswinkel N, Schulte-Hubbert B, Ewig S, and Kolditz M

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, ROC Curve, Respiration, Artificial statistics & numerical data, Retrospective Studies, Severity of Illness Index, Survival Analysis, Young Adult, Community-Acquired Infections diagnosis, Community-Acquired Infections pathology, Diagnostic Tests, Routine, Lactic Acid blood, Pneumonia diagnosis, Pneumonia pathology
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., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Published
2018
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39. Neutrophil elastase-mediated increase in airway temperature during inflammation.

Author

Schmidt A, Belaaouaj A, Bissinger R, Koller G, Malleret L, D'Orazio C, Facchinelli M, Schulte-Hubbert B, Molinaro A, Holst O, Hammermann J, Schniederjans M, Meyer KC, Damkiaer S, Piacentini G, Assael B, Bruce K, Häußler S, LiPuma JJ, Seelig J, Worlitzsch D, and Döring G

Subjects
Adolescent, Animals, Case-Control Studies, Child, Cystic Fibrosis complications, Disease Models, Animal, Female, Hot Temperature, Humans, Male, Mice, Mice, Inbred C57BL, Pseudomonas Infections enzymology, Pseudomonas Infections microbiology, Pseudomonas Infections pathology, Pseudomonas aeruginosa, Respiratory Tract Infections microbiology, Respiratory Tract Infections pathology, Body Temperature, Cystic Fibrosis enzymology, Leukocyte Elastase physiology, Respiratory Tract Infections enzymology
Abstract

Background: How elevated temperature is generated during airway infections represents a hitherto unresolved physiological question. We hypothesized that innate immune defence mechanisms would increase luminal airway temperature during pulmonary infection., Methods: We determined the temperature in the exhaled air of cystic fibrosis (CF) patients. To further test our hypothesis, a pouch inflammatory model using neutrophil elastase-deficient mice was employed. Next, the impact of temperature changes on the dominant CF pathogen Pseudomonas aeruginosa growth was tested by plating method and RNAseq., Results: Here we show a temperature of ~38°C in neutrophil-dominated mucus plugs of chronically infected CF patients and implicate neutrophil elastase:α1-proteinase inhibitor complex formation as a relevant mechanism for the local temperature rise. Gene expression of the main pathogen in CF, P. aeruginosa, under anaerobic conditions at 38°C vs 30°C revealed increased virulence traits and characteristic cell wall changes., Conclusion: Neutrophil elastase mediates increase in airway temperature, which may contribute to P. aeruginosa selection during the course of chronic infection in CF., (Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Published
2014
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40. Fibrinogen plasma concentration is an independent marker of haemodynamic impairment in chronic thromboembolic pulmonary hypertension.

Author

Hennigs JK, Baumann HJ, Lüneburg N, Quast G, Harbaum L, Heyckendorf J, Sydow K, Schulte-Hubbert B, Halank M, and Klose H

Subjects
Aged, Biomarkers, Chronic Disease, Female, Follow-Up Studies, Humans, Hypertension, Pulmonary diagnosis, Hypertension, Pulmonary etiology, Male, Middle Aged, Prognosis, ROC Curve, Retrospective Studies, Risk Factors, Fibrinogen, Hemodynamics, Hypertension, Pulmonary blood, Hypertension, Pulmonary physiopathology
Abstract

Fibrinogen has a crucial role in both inflammation and coagulation, two processes pivotal for the pathogenesis of pulmonary hypertension. We therefore aimed to investigate whether fibrinogen plasma concentrations a) are elevated in pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) and b) may serve as a novel biomarker for haemodynamic impairment. In a dual-centre, retrospective analysis including 112 patients with PAH (n = 52), CTEPH (n = 49) and a control cohort of patients with suspected PAH ruled out by right heart catheterisation (n = 11), we found fibrinogen plasma concentrations to be increased in patients with PAH (4.1 ± 1.4 g/l) and CTEPH (4.3 ± 1.2 g/l) compared to control patients (3.4 ± 0.5 g/l, p = 0.0035 and p = 0.0004, respectively). In CTEPH patients but not in PAH patients fibrinogen was associated with haemodynamics (p < 0.036) and functional parameters (p < 0.041). Furthermore, fibrinogen was linked to disease severity (WHO functional class, p = 0.017) and independently predicted haemodynamic impairment specifically in CTEPH (p < 0.016). Therefore, fibrinogen seems to represent an important factor in CTEPH pathophysiology and may have the potential to guide clinical diagnosis and therapy.

Published
2014
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41. Pulmonary adverse events in unrelated donors of peripheral blood stem cells.

Author

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, and Kroschinsky F

Subjects
Acute Kidney Injury chemically induced, Acute Lung Injury etiology, Adult, Bronchitis complications, Enterococcus faecium, Female, Gram-Positive Bacterial Infections complications, Gram-Positive Bacterial Infections microbiology, Granulocyte Colony-Stimulating Factor pharmacology, Humans, Influenza A Virus, H1N1 Subtype isolation & purification, Influenza B virus isolation & purification, Influenza, Human complications, Influenza, Human virology, Lenograstim, Lung Diseases, Interstitial drug therapy, Male, Otitis Media complications, Otitis Media microbiology, Pleural Effusion etiology, Pneumonia, Viral complications, Pneumonia, Viral virology, Prednisone therapeutic use, Recombinant Proteins adverse effects, Recombinant Proteins pharmacology, Young Adult, Acute Lung Injury chemically induced, Granulocyte Colony-Stimulating Factor adverse effects, Hematopoietic Stem Cell Mobilization adverse effects, Lung Diseases, Interstitial etiology, Peripheral Blood Stem Cell Transplantation, Unrelated Donors
Published
2013
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42. Copeptin predicts clinical deterioration and persistent instability in community-acquired pneumonia.

Author

Kolditz M, Halank M, Schulte-Hubbert B, Bergmann S, Albrecht S, and Höffken G

Subjects
Aged, Aged, 80 and over, Biomarkers metabolism, Community-Acquired Infections mortality, Disease Progression, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Pneumonia, Bacterial mortality, Prognosis, Prospective Studies, ROC Curve, Risk Assessment, Community-Acquired Infections diagnosis, Glycopeptides metabolism, Pneumonia, Bacterial diagnosis
Abstract

Rationale: Optimal risk prediction of early clinical deterioration in community-acquired pneumonia (CAP) remains unresolved. We prospectively examined the predictive value of the new biomarkers copeptin and proadrenomedullin (MR-proADM) in comparison to clinical scores and inflammatory markers to predict early high risk prognosis in CAP., Methods: 51 consecutive hospitalised adult patients were enrolled. We measured CRB-65- and PSI-scores, the ATS/IDSA 2007 minor criteria to predict ICU-admission and the biomarkers CRP, procalcitonin, copeptin and MR-proADM on admission. Predefined outcome parameters were combined mortality or ICU-admission after 7 days and clinical instability after 72 h., Results: Copeptin was the only biomarker significantly elevated in patients with either adverse short term outcome (p = 0.003). According to ROC-curve analysis, copeptin predicted ICU admission or death within 7 days (AUC 0.81, cut-off 35 pmol/l: sensitivity 78%, specificity 79%) and persistent clinical instability after 72 h (AUC 0.74). In Kaplan-Meier-analysis patients with high copeptin showed lower ICU-free survival within 7 days (p = 0.001). The diagnostic accuracy of copeptin was superior to the CRB-65 score and comparable to the PSI-score and the ATS/IDSA minor criteria. If copeptin was included as additional minor criterion for combined 7-day mortality or ICU-admission, the diagnostic accuracy of the minor criteria was significantly improved (p = 0.045)., Conclusion: Copeptin predicts early deterioration and persistent clinical instability in hospitalised CAP and improves the predictive properties of existing clinical scores. It should be evaluated within a biomarker guided strategy for early identification of high risk CAP patients who most likely benefit from early intensified management strategies., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Published
2012
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44. Adrenal function is related to prognosis in moderate community-acquired pneumonia.

Author

Kolditz M, Halank M, Schulte-Hubbert B, and Höffken G

Subjects
Adult, Aged, Aged, 80 and over, Community-Acquired Infections, Comorbidity, Humans, Hydrocortisone metabolism, Middle Aged, Multivariate Analysis, Prognosis, Treatment Outcome, Adrenal Glands physiology, Pneumonia diagnosis, Pneumonia physiopathology
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.

Published
2010
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