Abstract
Background
Assessing the likelihood for Legionella sp. in community-acquired pneumonia is important because of differences in treatment
regimens. Currently used antigen tests and culture have limited sensitivity with important
time delays, making empirical broad-spectrum coverage necessary. Therefore, a score
with 6 variables recently has been proposed. We sought to validate these parameters
in an independent cohort.
Methods
We analyzed adult patients with community-acquired pneumonia from a large multinational
database (Community Acquired Pneumonia Organization) who were treated between 2001
and 2012 with more than 4 of the 6 prespecified clinical variables available. Association
and discrimination were assessed using logistic regression analysis and area under
the curve (AUC).
Results
Of 1939 included patients, the infectious cause was known in 594 (28.9%), including
Streptococcus pneumoniae in 264 (13.6%) and Legionella sp. in 37 (1.9%). The proposed clinical predictors fever, cough, hyponatremia, lactate
dehydrogenase, C-reactive protein, and platelet count were all associated or tended
to be associated with Legionella cause. A logistic regression analysis including all these predictors showed excellent
discrimination with an AUC of 0.91 (95% confidence interval, 0.87-0.94). The original
dichotomized score showed good discrimination (AUC, 0.73; 95% confidence interval,
0.65-0.81) and a high negative predictive value of 99% for patients with less than
2 parameters present.
Conclusions
With the use of a large independent patient sample from an international database,
this analysis validates previously proposed clinical variables to accurately rule
out Legionella sp., which may help to optimize initial empiric therapy.
Keywords
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Article info
Publication history
Published online: May 06, 2014
Footnotes
SH, FH, and LG are equally contributing first authors.
Funding: PS was supported by a research grant from the Swiss Foundation for Grants in Biology and Medicine (Schweizerische Stiftung für medizinisch-biologische Stipendien, SSMBS, PASMP3-127684/1). Part of the data came from an initial trial supported by Grant SNF 3200BO-116177/1 from the Swiss National Science Foundation. No commercial sponsor had any involvement in the design and conduct of this study; the collection, management, analysis, and interpretation of the data; or the preparation, decision to submit, review, or approval of the manuscript.
Conflict of Interest: BM and PS received support from B.R.A.H.M.S. (Thermo Fisher Scientific) to attend meetings and fulfill speaking engagements. BM has served as a consultant for BRAHMS/Therofisher and Biomerieux and received research support. All other authors declare that they have no competing interests.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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- Clinical Diagnosis of Legionnaire's Disease: Six Characteristic Clinical PredictorsThe American Journal of MedicineVol. 128Issue 7
