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Pneumonia in multiple injured patients: a prospective controlled trial on early prediction using clinical and
J Andermahr1, A Greb, T Hensler
1Clinic of Trauma-, Hand- and Reconstructive Surgery, University of Cologne, Köln, Germany. JAndermahr@t-online.de
Objective And Design:
In a prospective trial 266 multiple injured patients were included to evaluate clinical risk factors and immune parameters related to pneumonia.
Methods:
Clinical and humoral parameters were assessed and multivariate analysis performed.
Results:
The multivariate analysis (odds ratio with 95% confidence interval (CI)) revealed male gender (3.65), traumatic brain injury (TBI) (2.52), thorax trauma (AIS(thorax) > or = 3) (2.05), antibiotic prophylaxis (1.30), injury severity score (ISS) (1.03 per ISS point) and the age (1.02 per year) as risk factors for pneumonia. The main pathogens were Acinetobacter Baumannii (40%) and Staphylococcus aureus (25%). A tendency towards higher Procalcitonin (PCT) and Interleukin (IL)-6 levels two days after trauma was observed for pneumonia patients.
Conclusion:
The immune parameters (PCT, IL-6, IL-10, soluble tumor necrosis factor p-55 and p-75) could not confirm the diagnosis of pneumonia earlier than the clinical parameters.