Neumonía adquirida en la comunidad en un hospital terciario español: ¿cómo se comporta en pacientes provenientes de residencia? / Community acquired pneumonia in a Spanish tertiary hospital: how does it work in patients from residence?

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Characteristics of community-acquired pneumonia in patients with chronic obstructive pulmonary disease.

STUDY OBJECTIVES: Community-acquired pneumonia is a frequent event in the course of chronic obstructive pulmonary disease (COPD). The aim of the present study was to provide information on clinical and microbiological characteristics and outcome of community-acquired pneumonia in these patients, in a comparative study with the non-COPD population. DESIGN: Prospective study of cases. SETTING: A university hospital in Lleida, Spain. PATIENTS: During a 6 year-period, we prospectively studied the clinical and radiological manifestations, microbiological data and outcome of all patients with community-acquired pneumonia. A comparative analysis of characteristics of pneumonia between 132 patients with a definitive diagnosis of COPD and 575 patients who did not have this underlying disease was performed. MEASUREMENTS AND RESULTS: COPD was associated with an older and predominantly male population. These patients frequently had concomitant comorbidities such as diabetes mellitus or chronic heart failure. Clinical presentation was more severe, manifested by septic shock, tachypnea, lower values of pH, pO(2) and oxygen saturation, and greater values of pCO(2). Purulent expectoration was also more frequent in this subset of patients. Admission was usually required for patients with COPD, and length of hospitalization was significantly increased; however, difference in the mortality rate was not observed. Although the spectrum of responsible microorganisms was very similar, the incidence of Pseudomonas aeruginosa and other Gram-negative bacilli was increased in COPD, particularly among patients with advanced situation and/or oral corticosteroid treatment. CONCLUSIONS: Community-acquired pneumonia in patients with COPD was associated with epidemiological and clinical particularities mainly related to the underlying disease but showed only minor differences in outcome parameters. Gram-negative bacilli and P. aeruginosa are potential pathogens that need to be considered.

[Reappraisal of the standard method (Light's criteria) for identifying pleural exudates]. / Revaluación del método estándar (criterios de Light) para identificar exudados pleurales.

BACKGROUND AND OBJECTIVES: Light's criteria remain the best method for separating pleural exudates from transudates. We assessed their operating characteristics, as well as those resulting from omitting the pleural fluid to serum lactate dehydrogenase (LDH) ratio from the original criteria (abbreviated Light criteria), in a large series of patients. We also searched for the best combination of pleural fluid parameters, including protein, LDH and cholesterol that identify exudates. PATIENTS AND METHOD: We conducted a retrospective study of 1,490 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis. There were 1,192 exudates and 298 transudates. Sensitivity, specificity, area under ROC curve, and odds ratio for both individual and combined pleural fluid parameters were calculated. RESULTS: Light's criteria yielded 97.5% sensitivity and 80% specificity. Both abbreviated Light criteria (sensitivity: 95.4%; specificity: 83.3%) and the combined use in an "or" rule of pleural fluid protein and LDH (sensitivity: 95.4%; specificity: 80,2%) had similar discriminative properties than standard criteria. CONCLUSIONS: Diagnostic separation of pleural effusions into exudates or transudates can be done effectively thorough the abbreviated Light criteria when the serum LDH value is not available. On the other hand, if venipuncture wants to be avoided (an unusual circumstance) the combination of pleural fluid protein and LDH represents an alternative to Light's criteria.

Revaluación del método estándar (criterios de Light) para identificar exudados pleurales / Reappraisal of the standard method (Light's criteria) for identifying pleural exudates

Fundamento y objetivos: Los criterios de Light se consideran el mejor método para diferenciar los exudados de los trasudados pleurales. Nos proponemos evaluar sus características operativas, así como las que resultan de eliminar el cociente de lactatodeshidrogenasa (LDH) entre líquido pleural y suero de los criterios originales (criterios de Light abreviados), en una serie amplia de pacientes. Asimismo buscamos la mejor combinación de parámetros bioquímicos del líquido pleural (entre ellas proteínas, LDH y colesterol), capaz de identificar exudados. Pacientes y método: Se analizó retrospectivamente a 1.490 pacientes consecutivos con derrame pleural a quienes se había realizado una toracentesis. El diagnóstico final fue de exudado en 1.192 y de trasudado en 298. Se calcularon la sensibilidad, especificidad, área bajo la curva de eficacia diagnóstica y odds ratio tanto de parámetros individuales como combinados del líquido pleural. Resultados: La sensibilidad y especificidad de los criterios de Light fueron del 97,5 y el 80%, respectivamente. Tanto los criterios de Light abreviados (sensibilidad del 95,4% y especificidad del 83,3%) como la combinación, con una regla en «o», de las proteínas y LDH del líquido pleural (sensibilidad del 95,4% y especificidad del 80,2%) tuvieron la misma capacidad discriminatoria que los criterios estándar. Conclusiones: La identificación de los exudados pleurales se puede realizar con los criterios de Light abreviados cuando no se dispone del valor de la LDH sérica. Por otro lado, si la extracción sanguínea no es posible (circunstancia infrecuente), la combinación de proteínas y LDH pleurales serviría también como criterio diagnóstico alternativo a los criterios clásicos de Light

Background and objectives: Light's criteria remain the best method for separating pleural exudates from transudates. We assessed their operating characteristics, as well as those resulting from omitting the pleural fluid to serum lactate dehydrogenase (LDH) ratio from the original criteria (abbreviated Light criteria), in a large series of patients. We also searched for the best combination of pleural fluid parameters, including protein, LDH and cholesterol that identify exudates. Patients and method: We conducted a retrospective study of 1,490 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis. There were 1,192 exudates and 298 transudates. Sensitivity, specificity, area under ROC curve, and odds ratio for both individual and combined pleural fluid parameters were calculated. Results: Light's criteria yielded 97.5% sensitivity and 80% specificity. Both abbreviated Light criteria (sensitivity: 95.4%; specificity: 83.3%) and the combined use in an «or» rule of pleural fluid protein and LDH (sensitivity: 95.4%; specificity: 80,2%) had similar discriminative properties than standard criteria. Conclusions: Diagnostic separation of pleural effusions into exudates or transudates can be done effectively thorough the abbreviated Light criteria when the serum LDH value is not available. On the other hand, if venipuncture wants to be avoided (an unusual circumstance) the combination of pleural fluid protein and LDH represents an alternative to Light's criteria