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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP-
dc.contributor.authorPRINA, Elena-
dc.contributor.authorFERRER, Miquel-
dc.contributor.authorRANZANI, Otavio T.-
dc.contributor.authorPOLVERINO, Eva-
dc.contributor.authorCILLONIZ, Catia-
dc.contributor.authorMORENO, Encarnacion-
dc.contributor.authorMENSA, Josep-
dc.contributor.authorMONTULL, Beatriz-
dc.contributor.authorMENENDEZ, Rosario-
dc.contributor.authorCOSENTINI, Roberto-
dc.contributor.authorTORRES, Antoni-
dc.identifier.citationCHEST, v.143, n.3, p.767-775, 2013-
dc.description.abstractBackground: Thrombocytosis, often considered a marker of normal inflammatory reaction of infections, has been recently associated with increased mortality in hospitalized patients with community-acquired pneumonia (CAP). We assessed the characteristics and outcomes of patients with CAP and thrombocytosis (platelet count >= 4 x 10(5)/mm(3)) compared with thrombocytopenia (platelet count <10(5)/mm(3)) and normal platelet count. Methods: We prospectively analyzed 2,423 consecutive, hospitalized patients with CAP. We excluded patients with immunosuppression, neoplasm, active TB, or hematologic disease. Results: Fifty-three patients (2%) presented with thrombocytopenia, 204 (8%) with thrombocytosis, and 2,166 (90%) had normal platelet counts. Patients with thrombocytosis were younger (P < .001); those with thrombocytopenia more frequently had chronic heart and liver disease (P < .001. for both). Patients with thrombocytosis presented more frequently with respiratory complications, such as complicated pleural effusion and empyema (P < .001), whereas those with thrombocytopenia presented more often with severe sepsis (P < .001), septic shock (P = .009), need for invasive mechanical ventilation (P < .001), and ICU admission (P = .011). Patients with thrombocytosis and patients with thrombocytopenia had longer hospital stays (P = .004), and higher 30-day mortality (P = .001) and readmission rates (P = .011) than those with normal platelet counts. Multivariate analysis confirmed a significant association between thrombocytosis and 30-day mortality (OR, 2.720; 95% CI, 1.589-4.657; P < .001). Adding thrombocytosis to the confusion, respiratory rate, and BP plus age >= 65 years score slightly improved the accuracy to predict mortality (area under the receiver operating characteristic curve increased from 0.634 to 0.654, P = .049). Conclusions: Thrombocytosis in patients with CAP is associated with poor outcome, complicated pleural effusion, and empyema. The presence of thrombocytosis in CAP should encourage ruling out respiratory complication and could be considered for severity evaluation. CHEST 2013; 143(3):767-775-
dc.description.sponsorshipCentro de Investigacion Biomedica en Red-Enfermedades Respiratorias-Instituto de Salud Carlos III [CibeRes CB06/06/0028, 2009 SGR 911]-
dc.description.sponsorshipPII de infecciones respiratorias of SEPAR-
dc.subject.otherparapneumonic effusion-
dc.subject.otherantimicrobial therapy-
dc.subject.otherplatelet count-
dc.subject.othersevere sepsis-
dc.subject.otherseptic shock-
dc.titleThrombocytosis Is a Marker of Poor Outcome in Community-Acquired Pneumonia-
dc.rights.holderCopyright AMER COLL CHEST PHYSICIANS-
dc.subject.wosCritical Care Medicine-
dc.subject.wosRespiratory System-
dc.type.categoryoriginal article-
dc.type.versionpublishedVersion-, Elena:Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, E-08007 Barcelona, Spain; Osped Maggiore Policlin, Dept Emergency Med, Carattere Sci Fdn Ca Granda, Milan, Italy-, Miquel:Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, E-08007 Barcelona, Spain; Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain-, Eva:Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, E-08007 Barcelona, Spain; Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain-, Catia:Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, E-08007 Barcelona, Spain; Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain-, Encarnacion:Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, E-08007 Barcelona, Spain; Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain-, Josep:Hosp Clin Barcelona, IDIBAPS, Serv Enfermedades Infecciosas, E-08036 Barcelona, Spain-, Beatriz:Hosp Univ La Fe, Serv Neumol, Valencia, Spain-, Rosario:Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain; Hosp Univ La Fe, Serv Neumol, Valencia, Spain-, Roberto:Osped Maggiore Policlin, Dept Emergency Med, Carattere Sci Fdn Ca Granda, Milan, Italy-, Antoni:Univ Barcelona, IDIBAPS, Hosp Clin, Serv Pneumol,Inst Torax, E-08007 Barcelona, Spain; Ctr Invest Biomed Red Enfermedades Resp, Barcelona, Spain-
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hcfmusp.remissive.sponsorshipInstituto de Salud Carlos III-
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Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - LIM/09
LIM/09 - Laboratório de Pneumologia

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ODS/03 - Saúde e bem-estar

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