Journal of the Chinese Medical Association
Volume 70, Issue 8 , Pages 318-323, August 2007

Risk Factor Analysis of Acute Respiratory Distress Syndrome Among Hospitalized Patients with Chlamydophila pneumoniae Pneumonia

  • Kuan-Ting Liu

      Affiliations

    • Chest Department, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Taipei City Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Kuang-Yao Yang

      Affiliations

    • Chest Department, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Kuang-Yao Yang, Chest Department, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
    • ,
  • Yu-Chin Lee

      Affiliations

    • Chest Department, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Reury-Perng Perng

      Affiliations

    • Chest Department, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Taipei City Hospital, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Received 12 January 2007; accepted 13 July 2007.

Article Outline

Background

Chlamydophila pneumoniae (C. pneumoniae) pneumonia-associated acute respiratory distress syndrome (ARDS) is rare and has been seldom reported, but the outcome is usually fatal. This study was designed to identify the risk factors for hospitalized C. pneumoniae patients developing ARDS and to describe the outcomes.

Methods

A retrospective study was performed to evaluate hospitalized patients over 18 years old diagnosed with C. pneumoniae pneumonia in a tertiary medical center.

Results

Eleven patients who fulfilled the diagnostic criteria were included in this study. ARDS developed in 6 of 11 patients and mostly within 7 days of admission. Five of 6 patients needed to be transferred to the intensive care unit, and all of these patients died. The patients who developed ARDS had higher initial Acute Physiology and Chronic Health Evaluation II scores and CURB-65 (confusion, urea, respiratory rate, blood pressure, age) scores. The risk factors for developing ARDS included age ≥ 75 years, comorbid disease such as congestive heart failure, diabetes or liver cirrhosis, APACHE II score ≥ 12, CURB-65 score ≥ 2, white blood cell count > 12,000/mm3 or < 4,000/mm3, serum creatinine ≥ 1.4 mg/dL, and bilateral or multilobar involvement.

Conclusion

C. pneumoniae associated with ARDS has a higher mortality, and several risk factors, such as older age, underlying comorbidity and bilateral or multilobar involvement, should be identified earlier.

Key words:  acute respiratory distress syndrome , Chlamydophila pneumoniae , mortality , pneumonia , risk factors

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. File TM , Tan JS . Chlamydia pneumoniae pneumonia . Semin Respir Crit Care Med . 2000;21:285–294
  2. Almirall J, Morato I, Riera F, Verdaguer A, Priu R, Coll P, et al  Incidence of community-acquired pneumonia and Chlamydia pneumoniae infection: a prospective multicen-tre study . Eur Respir J . 1993;6:14–18
  3. Falguera M , Nogues A , Ruiz-Gonzalez A . Community-acquired Chlamydia pneumoniae pneumonia . Thorax . 1996;51:967
  4. Cosentini R, Blasi F, Raccanelli R, Rossi S, Arosio C, Tarsia P, et al  Severe community-acquired pneumonia: a possible role for Chlamydia pneumoniae . Respiration . 1996;63:61–65
  5. Wu JS , Lin JC , Chang FY . Chlamydia pneumoniae infection in community-acquired pneumonia in Taiwan . J Microbiol Immunol Infect . 2000;33:34–38
  6. Ikeda K , Mita M , Yamaki T , Maehara K , Maruyama Y . A 22-year-old woman with fulminant Chlamydia pneumoniae pneumonia . Fukushima J Med Sci . 2002;48:57–62
  7. Yanagi S , Ashitani J , Arimura Y , Sano A , Kato S . A case of severe Chlamydia pneumoniae pneumonia requiring mechanical ventilation and complicated with disseminated intravascular coagulation . Nihon Kokyuki Gakkai Zasshi . 2003;41:840–845 [In Japanese]
  8. Okamoto T, Niwakawa M, Yasuoka T, Shimizu K, Okuda K, Fukunaga T, et al  Severe case of Chlamydia pneu-moniae pneumonia . Nippon Naika Gakkai Zasshi . 2003;92:2025–2028 [In Japanese]
  9. Balis E , Boufas A , Iliopoulos I , Legakis NJ , Zerva L . Severe community-acquired pneumonia with acute hypoxemic respiratory failure due to primary infection with Chlamydia pneu-moniae in a previously healthy adult . Clin Infect Dis . 2003;36:e155–e157
  10. Miyashita N, Fukano H, Okimoto N, Hara H, Yoshida K, Niki Y, et al. Clinical presentation of community-acquired Chlamydia pneumoniae pneumonia in adults . Chest . 2002;121:1776–1781
  11. Kauppinen MT , Herva E , Kujala P , Leinonen M , Saikku P , Syrjala H . The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland . J Infect Dis . 1995;172:1330–1335
  12. File TM , Plouffe JF , Breiman RF , Skelton SK . Clinical characteristics of Chlamydia pneumoniae infection as the sole cause of community-acquired pneumonia . Clin Infect Dis . 1999;29:426–428
  13. Dowell SF, Peeling RW, Boman J, Carlone GM, Fields BS, Guarner J, et al  Standardizing Chlamydia pneumoniae assays: recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada) . Clin Infect Dis . 2001;33:492–503
  14. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al  Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study . Thorax . 2003;58:377–382
  15. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al  The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination . Am J Respir Crit Care Med . 1994;149:818–824
  16. Kuo CC , Jackson LA , Campbell LA , Grayston JT . Chlamydia pneumoniae (TWAR) . Clin Microbiol Rev . 1995;8:451–461
  17. Ciarrocchi G , De Benedetto F , Fogliani V , Magliano E , Del Prete R , Miragliotta G . Serological study on Chlamydophila pneumoniae in patients with community-acquired pneumonia . New Microbiol . 2004;27:335–343
  18. Kauppinen M , Saikku P . Pneumonia due to Chlamydia pneu-moniae: prevalence, clinical features, diagnosis, and treatment . Clin Infect Dis . 1995;21:244–252
  19. Capelastegui A, Espana PP, Quintana JM, Areitio I, Gorordo I, Egurrola M, et al. Validation of a predictive rule for the management of community-acquired pneumonia . Eur Respir J . 2006;27:151–157

PII: S1726-4901(08)70012-1

doi:10.1016/S1726-4901(08)70012-1

Journal of the Chinese Medical Association
Volume 70, Issue 8 , Pages 318-323, August 2007

Article Tools