Giuseppe
Emeritus
Nonsteroidal Antiinflammatory Drugs May Affect the Presentation and Course of Community-Acquired Pneumonia (CHEST, abstract, edited)
[Source: Chest, full page: <cite cite="http://chestjournal.chestpubs.org/content/139/2/387.short?rss=1">Nonsteroidal Antiinflammatory Drugs May Affect the Presentation and Course of Community-Acquired Pneumonia ? CHEST</cite>. Abstract, edited.]
Nonsteroidal Antiinflammatory Drugs May Affect the Presentation and Course of Community-Acquired Pneumonia
1. Guillaume Voiriot, MD, 2. Sandra Dury, MD, 3. Antoine Parrot, MD, 4. Charles Mayaud, MD and 5. Muriel Fartoukh, MD
Author Affiliations
1. From the Service de Pneumologie et R?animation (Drs Voiriot, Dury, Parrot, Mayaud, and Fartoukh), H?pital Tenon, Assistance Publique-H?pitaux de Paris; and Universit? Pierre et Marie Curie (Dr Mayaud), Paris, France.
1. Correspondence to: Muriel Fartoukh, MD, H?pital Tenon, Assistance Publique-H?pitaux de Paris, 04 rue de la Chine, 75020 Paris, France; e-mail: muriel.fartoukh@tnn.aphp.fr
Abstract
Background:
Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used as antipyretics and analgesics and may affect the host response to acute infection. We investigated the potential influence of NSAIDs on the presentation and short-term outcomes of nonimmunocompromised inpatients with community-acquired pneumonia (CAP) admitted to the ICU.
Methods:
All consecutive patients with CAP admitted to the ICU or step-down unit of a university hospital during a 4-year period were prospectively included, except when receiving long-term NSAIDs or steroids. Drug exposures, presentation, and hospital course were recorded.
Results:
Of the 90 patients included, 32 (36%) had taken NSAIDs prior to hospital referral. Compared with nonexposed patients, they were younger and had fewer comorbidities but similar severity of disease at presentation, despite a longer duration of symptoms before referral. However, they more often developed pleuropulmonary complications, such as pleural empyema and lung cavitation (37.5% vs 7%; P = .0009), and had a trend to more-invasive disease, with a higher frequency of pleural empyema (25% vs 5%, P = .014) and bacteremia, especially in those not having received concomitant antibiotics (69% vs 27%, P = .009). Nevertheless, the patients in the NSAID group had no more severe systemic inflammation or remote organ dysfunction. In multivariable analyses, NSAID exposure was independently associated with the occurrence of pleuropulmonary complications (OR, 8.1; 95% CI, 2.3-28).
Conclusions:
Our findings suggest that NSAID exposure at the early stage of CAP is associated with a more complicated course but a blunted systemic response, which may be associated with a delayed diagnosis and a protracted course.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
#Abbreviations: CAP community-acquired pneumonia - LRTI lower respiratory tract infection - NSAID nonsteroidal antiinflammatory drug - PSI Pneumonia Severity Index - SAPS Simplified Acute Physiologic Score - SOFA Sepsis-related Organ Failure Assessment
* Received January 19, 2010.
* Accepted June 28, 2010.
* ? 2011 American College of Chest Physicians
-
------
[Source: Chest, full page: <cite cite="http://chestjournal.chestpubs.org/content/139/2/387.short?rss=1">Nonsteroidal Antiinflammatory Drugs May Affect the Presentation and Course of Community-Acquired Pneumonia ? CHEST</cite>. Abstract, edited.]
Nonsteroidal Antiinflammatory Drugs May Affect the Presentation and Course of Community-Acquired Pneumonia
1. Guillaume Voiriot, MD, 2. Sandra Dury, MD, 3. Antoine Parrot, MD, 4. Charles Mayaud, MD and 5. Muriel Fartoukh, MD
Author Affiliations
1. From the Service de Pneumologie et R?animation (Drs Voiriot, Dury, Parrot, Mayaud, and Fartoukh), H?pital Tenon, Assistance Publique-H?pitaux de Paris; and Universit? Pierre et Marie Curie (Dr Mayaud), Paris, France.
1. Correspondence to: Muriel Fartoukh, MD, H?pital Tenon, Assistance Publique-H?pitaux de Paris, 04 rue de la Chine, 75020 Paris, France; e-mail: muriel.fartoukh@tnn.aphp.fr
Abstract
Background:
Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used as antipyretics and analgesics and may affect the host response to acute infection. We investigated the potential influence of NSAIDs on the presentation and short-term outcomes of nonimmunocompromised inpatients with community-acquired pneumonia (CAP) admitted to the ICU.
Methods:
All consecutive patients with CAP admitted to the ICU or step-down unit of a university hospital during a 4-year period were prospectively included, except when receiving long-term NSAIDs or steroids. Drug exposures, presentation, and hospital course were recorded.
Results:
Of the 90 patients included, 32 (36%) had taken NSAIDs prior to hospital referral. Compared with nonexposed patients, they were younger and had fewer comorbidities but similar severity of disease at presentation, despite a longer duration of symptoms before referral. However, they more often developed pleuropulmonary complications, such as pleural empyema and lung cavitation (37.5% vs 7%; P = .0009), and had a trend to more-invasive disease, with a higher frequency of pleural empyema (25% vs 5%, P = .014) and bacteremia, especially in those not having received concomitant antibiotics (69% vs 27%, P = .009). Nevertheless, the patients in the NSAID group had no more severe systemic inflammation or remote organ dysfunction. In multivariable analyses, NSAID exposure was independently associated with the occurrence of pleuropulmonary complications (OR, 8.1; 95% CI, 2.3-28).
Conclusions:
Our findings suggest that NSAID exposure at the early stage of CAP is associated with a more complicated course but a blunted systemic response, which may be associated with a delayed diagnosis and a protracted course.
Footnotes
* Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).
#Abbreviations: CAP community-acquired pneumonia - LRTI lower respiratory tract infection - NSAID nonsteroidal antiinflammatory drug - PSI Pneumonia Severity Index - SAPS Simplified Acute Physiologic Score - SOFA Sepsis-related Organ Failure Assessment
* Received January 19, 2010.
* Accepted June 28, 2010.
* ? 2011 American College of Chest Physicians
-
------