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Open Access Highly Accessed Research article

Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department

Rico Fiumefreddo1, Roya Zaborsky1, Jeannine Haeuptle1, Mirjam Christ-Crain1, Andrej Trampuz2, Ingrid Steffen3, Reno Frei2, Beat Müller4* and Philipp Schuetz1

Author Affiliations

1 Department of Internal Medicine, University Hospital Basel, Basel, Switzerland

2 Departement of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland

3 Institute of Medical Microbiology, University of Basel, Basel, Switzerland

4 Department of Internal Medicine, Kantonsspital Aarau, Tellstrasse, CH-5001 Aarau, Switzerland

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BMC Pulmonary Medicine 2009, 9:4  doi:10.1186/1471-2466-9-4

Published: 19 January 2009

Abstract

Background

Legionella species cause severe forms of pneumonia with high mortality and complication rates. Accurate clinical predictors to assess the likelihood of Legionella community-acquired pneumonia (CAP) in patients presenting to the emergency department are lacking.

Methods

We retrospectively compared clinical and laboratory data of 82 consecutive patients with Legionella CAP with 368 consecutive patients with non-Legionella CAP included in two studies at the same institution.

Results

In multivariate logistic regression analysis we identified six parameters, namely high body temperature (OR 1.67, p < 0.0001), absence of sputum production (OR 3.67, p < 0.0001), low serum sodium concentrations (OR 0.89, p = 0.011), high levels of lactate dehydrogenase (OR 1.003, p = 0.007) and C-reactive protein (OR 1.006, p < 0.0001) and low platelet counts (OR 0.991, p < 0.0001), as independent predictors of Legionella CAP. Using optimal cut off values of these six parameters, we calculated a diagnostic score for Legionella CAP. The median score was significantly higher in Legionella CAP as compared to patients without Legionella (4 (IQR 3–4) vs 2 (IQR 1–2), p < 0.0001) with a respective odds ratio of 3.34 (95%CI 2.57–4.33, p < 0.0001). Receiver operating characteristics showed a high diagnostic accuracy of this diagnostic score (AUC 0.86 (95%CI 0.81–0.90), which was better as compared to each parameter alone. Of the 191 patients (42%) with a score of 0 or 1 point, only 3% had Legionella pneumonia. Conversely, of the 73 patients (16%) with ≥4 points, 66% of patients had Legionella CAP.

Conclusion

Six clinical and laboratory parameters embedded in a simple diagnostic score accurately identified patients with Legionella CAP. If validated in future studies, this score might aid in the management of suspected Legionella CAP.