Management-based risk prediction in community-acquired pneumonia by scores and biomarkers

European Respiratory Journal

Volumn 41, Issue 4, 2013, Pages 974-984

  Kolditz, Martin ^a   Ewig, Santiago ^b,c   Höffken, Gert ^a  

^a UNIVERSITY HOSPITAL CARL GUSTAV CARUS   (Germany)

^b Thoraxzentrum Ruhrgebiet   (Germany)

^c Augusta Kranken Anstalt   (Germany)

Author keywords

Acute respiratory failure; Biomarkers; Community acquired pneumonia; Early intervention; Risk group; Sepsis

Indexed keywords

AMINO TERMINAL PRO BRAIN NATRIURETIC PEPTIDE; ANTIBIOTIC AGENT; ATRIAL NATRIURETIC FACTOR DERIVATIVE; BIOLOGICAL MARKER; C REACTIVE PROTEIN; COPEPTIN; D DIMER; HYDROCORTISONE; INTERLEUKIN 6; MIDREGIONAL PROADRENOMEDULLIN; MIDREGIONAL PROATRIAL NATRIURETIC PEPTIDE; PREPROENDOTHELIN 1; PROADRENOMEDULLIN; PROCALCITONIN; TUMOR NECROSIS FACTOR ALPHA; UNCLASSIFIED DRUG;

AMBULATORY CARE; ANTIBIOTIC THERAPY; ARTIFICIAL VENTILATION; BLOOD GAS ANALYSIS; BREATHING RATE; CARDIOVASCULAR RESPONSE; CLINICAL ASSESSMENT; CLINICAL EFFECTIVENESS; COMMUNITY ACQUIRED PNEUMONIA; COMORBIDITY; DISEASE ASSOCIATION; DISEASE COURSE; ELDERLY CARE; FLUID RESUSCITATION; FUNCTIONAL STATUS; HIGH RISK PATIENT; HOSPITAL ADMISSION; HOSPITAL CARE; HUMAN; INFECTION RISK; INTENSIVE CARE UNIT; LOW RISK POPULATION; MORTALITY; NURSING HOME PATIENT; OXYGENATION; PATIENT IDENTIFICATION; PATIENT MONITORING; PRACTICE GUIDELINE; PRIORITY JOURNAL; PROGNOSIS; RESPIRATORY FAILURE; RESPIRATORY FUNCTION; REVIEW; RISK ASSESSMENT; RISK MANAGEMENT; SCORING SYSTEM; SEPSIS; SEPSIS RELATED ORGAN DYSFUNCTION; SEPTIC SHOCK; STRESS; THROMBOCYTE; TREATMENT CONTRAINDICATION; TREATMENT PLANNING; URINE VOLUME; VITAL SIGN;

AGED; BIOLOGICAL MARKERS; CLINICAL TRIALS AS TOPIC; COMMUNITY-ACQUIRED INFECTIONS; COMORBIDITY; HOSPITALS; HUMANS; INFLAMMATION; NURSING HOMES; PNEUMONIA; PROGNOSIS; RISK; SEPSIS; TREATMENT OUTCOME;

EID: 84875836835     PISSN: 09031936     EISSN: 13993003     Source Type: Journal    
DOI: 10.1183/09031936.00104412     Document Type: Review

References (103)

1. Bauer TT, Ewig S, Marre R, et al. CRB-65 predicts death from community-acquired pneumonia. J Intern Med 2006; 260: 93-101.
2. Ewig S, Birkner N, Strauss R, et al. New perspectives on community-acquired pneumonia in 388,406 patients. Results from a nationwide mandatory performance measurement programme in healthcare quality. Thorax 2009; 64: 1062-1069.
3. Ewig S, Torres A. Community-acquired pneumonia as an emergency: time for an aggressive intervention to lower mortality. Eur Respir J 2011; 38: 253-260.
4. Carr GE, Yuen TC, McConville JF, et al. Early cardiac arrest in patients hospitalized with pneumonia: a report from the American Heart Association's Get With the Guidelines-Resuscitation Program. Chest 2012; 141: 1528-1536.
5. Aliberti S, Amir A, Peyrani P, et al. Incidence, etiology, timing, and risk factors for clinical failure in hospitalized patients with community-acquired pneumonia. Chest 2008; 134: 955-962.
6. Phua J, Ngerng WJ, Lim TK. The impact of a delay in intensive care unit admission for community-acquired pneumonia. Eur Respir J 2010; 36: 826-833.
7. Renaud B, Santin A, Coma E, et al. Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. Crit Care Med 2009; 37: 2867-2874.
8. Restrepo MI, Mortensen EM, Rello J, et al. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest 2010; 137: 552-557.
9. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008; 36: 296-327.
10. Kumar A, Roberts D, Wood KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589-1596.
11. Puskarich MA, Trzeciak S, Shapiro NI, et al. Association between timing of antibiotic administration and mortality from septic shock in patients treated with a quantitative resuscitation protocol. Crit Care Med 2011; 39: 2066-2071.
12. Ewig S, Klapdor B, Pletz MW, et al. Nursing-home-acquired pneumonia in Germany: an 8-year prospective multicentre study. Thorax 2012; 67: 132-138.
13. Fine MJ, Auble TE, Yealy DM, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997; 336: 243-250.
14. Corrales-Medina VF, Musher DM, Wells GA, et al. Cardiac complications in patients with community-acquired pneumonia: incidence, timing, risk factors, and association with short-term mortality. Circulation 2012; 125: 773-781.
15. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003; 58: 377-382.
16. Ewig S, Welte T. CRB-65 for the assessment of pneumonia severity: who could ask for more? Thorax 2008; 63: 665-666.
17. Woodhead M, Blasi F, Ewig S, et al. Guidelines for the management of adult lower respiratory tract infections-full version. Clin Microbiol Infect 2011; 17: Suppl. 6, E1-E59.
18. Loke YK, Kwok CS, Niruban A, et al. Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis. Thorax 2010; 65: 884-890.
19. Chalmers JD, Singanayagam A, Akram AR, et al. Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax 2010; 65: 878-883.
20. Ewig S, Ruiz M, Mensa J, et al. Severe community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 1998; 158: 1102-1108.
21. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis 2007; 44: Suppl. 2, S27-S72.
22. Chalmers JD, Mandal P, Singanayagam A, et al. Severity assessment tools to guide ICU admission in communityacquired pneumonia: systematic review and meta-analysis. Intensive Care Med 2011; 37: 1409-1420.
23. Chalmers JD, Taylor JK, Mandal P, et al. Validation of the Infectious Diseases Society of America/American Thoratic Society minor criteria for intensive care unit admission in community-acquired pneumonia patients without major criteria or contraindications to intensive care unit care. Clin Infect Dis 2011; 53: 503-511.
24. Charles PG, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis 2008; 47: 375-384.
25. Espana PP, Capelastegui A, Gorordo I, et al. Development and validation of a clinical prediction rule for severe communityacquired pneumonia. Am J Respir Crit Care Med 2006; 174: 1249-1256.
26. Yandiola PP, Capelastegui A, Quintana J, et al. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 2009; 135: 1572-1579.
27. Buising KL, Thursky KA, Black JF, et al. Identifying severe community-acquired pneumonia in the emergency department: a simple clinical prediction tool. Emerg Med Australas 2007; 19: 418-426.
28. Renaud B, Labarere J, Coma E, et al. Risk stratification of early admission to the intensive care unit of patients with no major criteria of severe community-acquired pneumonia: development of an international prediction rule. Crit Care 2009; 13: R54.
29. Ewig S, Woodhead M, Torres A. Towards a sensible comprehension of severe community-acquired pneumonia. Intensive Care Med 2011; 37: 214-223.
30. Marrie TJ, Lau CY, Wheeler SL, et al. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. CAPITAL Study Investigators. Community-Acquired Pneumonia Intervention Trial Assessing Levofloxacin. JAMA 2000; 283: 749-755.
31. Carratala J, Fernandez-Sabe N, Ortega L, et al. Outpatient care compared with hospitalization for community-acquired pneumonia: a randomized trial in low-risk patients. Ann Intern Med 2005; 142: 165-172.
32. Atlas SJ, Benzer TI, Borowsky LH, et al. Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial. Arch Intern Med 1998; 158: 1350-1356.
33. Renaud B, Coma E, Labarere J, et al. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis 2007; 44: 41-49.
34. Buising KL, Thursky KA, Black JF, et al. A prospective comparison of severity scores for identifying patients with severe community acquired pneumonia: reconsidering what is meant by severe pneumonia. Thorax 2006; 61: 419-424.
35. Chalmers JD, Singanayagam A, Hill AT. Predicting the need for mechanical ventilation and/or inotropic support for young adults admitted to the hospital with community-acquired pneumonia. Clin Infect Dis 2008; 47: 1571-1574.
36. Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ 2004; 329: 168-169.
37. Kothe H, Bauer T, Marre R, et al. Outcome of communityacquired pneumonia: influence of age, residence status and antimicrobial treatment. Eur Respir J 2008; 32: 139-146.
38. Akram AR, Singanayagam A, Choudhury G, et al. Incidence and prognostic implications of acute kidney injury on admission in patients with community-acquired pneumonia. Chest 2010; 138: 825-832.
39. Yende S, van der PT, Lee M, et al. The influence of pre-existing diabetes mellitus on the host immune response and outcome of pneumonia: analysis of two multicentre cohort studies. Thorax 2010; 65: 870-877.
40. Viasus D, Garcia-Vidal C, Castellote J, et al. Communityacquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity scores. Medicine (Baltimore) 2011; 90: 110-118.
41. Dremsizov T, Clermont G, Kellum JA, et al. Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course? Chest 2006; 129: 968-978.
42. American Thoracic Society. Infectious Diseases Society of America. Guidelines for the Management of Adults with Hospital-acquired, Ventilator-associated, and Healthcare-associated Pneumonia. Am J Respir Crit Care Med 2005; 171: 388-416.
43. Ewig S, Welte T, Chastre J, et al. Rethinking the concepts of community-acquired and health-care-associated pneumonia. Lancet Infect Dis 2010; 10: 279-287.
44. Polverino E, Dambrava P, Cilloniz C, et al. Nursing homeacquired pneumonia: a 10 year single-centre experience. Thorax 2010; 65: 354-359.
45. Garcia-Vidal C, Viasus D, Roset A, et al. Low incidence of multidrug-resistant organisms in patients with healthcareassociated pneumonia requiring hospitalization. Clin Microbiol Infect 2011; 17: 1659-1665.
46. Chalmers JD, Taylor JK, Singanayagam A, et al. Epidemiology, antibiotic therapy, and clinical outcomes in health care-associated pneumonia: a UK cohort study. Clin Infect Dis 2011; 53: 107-113.
47. Naito T, Suda T, Yasuda K, et al. A validation and potential modification of the pneumonia severity index in elderly patients with community-acquired pneumonia. J Am Geriatr Soc 2006; 54: 1212-1219.
48. Torres OH, Munoz J, Ruiz D, et al. Outcome predictors of pneumonia in elderly patients: importance of functional assessment. J Am Geriatr Soc 2004; 52: 1603-1609.
49. El-Solh AA, Alhajhusain A, Abou JP, et al. Validity of severity scores in hospitalized patients with nursing home-acquired pneumonia. Chest 2010; 138: 1371-1376.
50. Ewig S, Bauer T, Richter K, et al. Prediction of in-hospital death from community-acquired pneumonia by varying CRB-age groups. Eur Respir J 2012 [in press DOI: 10.1183/09031936. 00065212].
51. Halm EA, Fine MJ, Marrie TJ, et al. Time to clinical stability in patients hospitalized with community-acquired pneumonia: implications for practice guidelines. JAMA 1998; 279: 1452-1457.
52. Menendez R, Martinez R, Reyes S, et al. Stability in communityacquired pneumonia: one step forward with markers? Thorax 2009; 64: 987-992.
53. Halm EA, Fine MJ, Kapoor WN, et al. Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia. Arch Intern Med 2002; 162: 1278-1284.
54. Oosterheert JJ, Bonten MJ, Schneider MM, et al. Effectiveness of early switch from intravenous to oral antibiotics in severe community acquired pneumonia: multicentre randomised trial. BMJ 2006; 333: 1193-1197.
55. El Moussaoui R, de Borgie CA, van den BP, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ 2006; 332: 1355-1360.
56. Menendez R, Martinez R, Reyes S, et al. Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia. Thorax 2009; 64: 587-591.
57. Chalmers JD, Singanayagam A, Hill AT. C-reactive protein is an independent predictor of severity in community-acquired pneumonia. Am J Med 2008; 121: 219-225.
58. Kruger S, Ewig S, Marre R, et al. Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes. Eur Respir J 2008; 31: 349-355.
59. Huang DT, Weissfeld LA, Kellum JA, et al. Risk prediction with procalcitonin and clinical rules in community-acquired pneumonia. Ann Emerg Med 2008; 52: 48-58.
60. Ramirez P, Ferrer M, Marti V, et al. Inflammatory biomarkers and prediction for intensive care unit admission in severe communityacquired pneumonia. Crit Care Med 2011; 39: 2211-2217.
61. Kolditz M, Halank M, Schulte-Hubbert B, et al. Adrenal function is related to prognosis in moderate community-acquired pneumonia. Eur Respir J 2010; 36: 615-621.
62. Charles PE, Tinel C, Barbar S, et al. Procalcitonin kinetics within the first days of sepsis: relationship with the appropriateness of antibiotic therapy and the outcome. Crit Care 2009; 13: R38.
63. Boussekey N, Leroy O, Alfandari S, et al. Procalcitonin kinetics in the prognosis of severe community-acquired pneumonia. Intensive Care Med 2006; 32: 469-472.
64. Bruns AH, Oosterheert JJ, Hak E, et al. Usefulness of consecutive C-reactive protein measurements in follow-up of severe community-acquired pneumonia. Eur Respir J 2008; 32: 726-732.
65. Coelho L, Povoa P, Almeida E, et al. Usefulness of C-reactive protein in monitoring the severe community-acquired pneumonia clinical course. Crit Care 2007; 11: R92-R100.
66. Kolditz M, Halank M, Schulte-Hubbert B, et al. Procalcitonin improves the differentiation between infectious and cryptogenic/secondary organizing pneumonia. J Infect 2012; 64: 122-124.
67. Christ-Crain M, Stolz D, Bingisser R, et al. Procalcitonin guidance of antibiotic therapy in community-acquired pneumonia: a randomized trial. Am J Respir Crit Care Med 2006; 174: 84-93.
68. Bouadma L, Luyt CE, Tubach F, et al. Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial. Lancet 2010; 375: 463-474.
69. Schuetz P, Chiappa V, Briel M, et al. Procalcitonin algorithms for antibiotic therapy decisions: a systematic review of randomized controlled trials and recommendations for clinical algorithms. Arch Intern Med 2011; 171: 1322-1331.
70. Hoffken G, Lorenz J, Kern W, et al. Epidemiologie, diagnostik, antimikrobielle therapie und management von erwachsenen patienten mit ambulant erworbenen unteren atemwegsinfektionen sowie ambulant erworbener pneumonie-Update 2009. S3 Leitlinie der Paul-Ehrlich-Gesellschaft für Chemotherapie, der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin, der Deutschen Gesellschaft für Infektiologie und vom Kompetenznetzwerk CAPNETZ. [Epidemiology, diagnosis, antimicrobial therapy and management of community-acquired pneumonia and lower respiratory tract infections in adults. Guidelines of the Paul-Ehrlich-Society for Chemotherapy, the German Respiratory Society, the German Society for Infectiology and the Competence Network CAPNETZ Germany.] Pneumologie 2009; 63: e1-e68.
71. Koeze J, Hendrix MG, van den Bergh FA, et al. In critically ill patients the procalcitonin level can be misleading. Crit Care 2011; 15: 422.
72. Kruger S, Ewig S, Papassotiriou J, et al. Inflammatory parameters predict etiologic patterns but do not allow for individual prediction of etiology in patients with CAP: results from the German competence network CAPNETZ. Respir Res 2009; 10: 65.
73. Schuetz P, Suter-Widmer I, Chaudri A, et al. Prognostic value of procalcitonin in community-acquired pneumonia. Eur Respir J 2011; 37: 384-392.
74. Jensen JU, Hein L, Lundgren B, et al. Procalcitonin-guided interventions against infections to increase early appropriate antibiotics and improve survival in the intensive care unit: a randomized trial. Crit Care Med 2011; 39: 2048-2058.
75. Nowak A, Breidthardt T, Christ-Crain M, et al. Direct comparison of three natriuretic peptides for prediction of short-and long-term mortality in patients with community-acquired pneumonia. Chest 2012; 141: 974-982.
76. Schuetz P, Christ-Crain M, Zimmerli W, et al. Repeated measurements of endothelin-1 precursor peptides predict the outcome in community-acquired pneumonia. Intensive Care Med 2011; 37: 970-980.
77. Kruger S, Ewig S, Giersdorf S, et al. Cardiovascular and inflammatory biomarkers to predict short-and long-term survival in community-acquired pneumonia: results from the German Competence Network, CAPNETZ. Am J Respir Crit Care Med 2010; 182: 1426-1434.
78. Schuetz P, Wolbers M, Christ-Crain M, et al. Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections. Crit Care 2010; 14: R106.
79. Kruger S, Ewig S, Kunde J, et al. Pro-atrial natriuretic peptide and pro-vasopressin for predicting short-term and long-term survival in community-acquired pneumonia: results from the German Competence Network CAPNETZ. Thorax 2010; 65: 208-214.
80. Muller B, Morgenthaler N, Stolz D, et al. Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections. Eur J Clin Invest 2007; 37: 145-152.
81. Kruger S, Papassotiriou J, Marre R, et al. Pro-atrial natriuretic peptide and pro-vasopressin to predict severity and prognosis in community-acquired pneumonia: results from the German competence network CAPNETZ. Intensive Care Med 2007; 33: 2069-2078.
82. Masia M, Papassotiriou J, Morgenthaler NG, et al. Midregional pro-A-type natriuretic peptide and carboxy-terminal provasopressin may predict prognosis in community-acquired pneumonia. Clin Chem 2007; 53: 2193-2201.
83. Kruger S, Ewig S, Kunde J, et al. C-terminal provasopressin (copeptin) in patients with community-acquired pneumonia-influence of antibiotic pre-treatment: results from the German competence network CAPNETZ. J Antimicrob Chemother 2009; 64: 159-162.
84. Kolditz M, Halank M, Schulte-Hubbert B, et al. Copeptin predicts clinical deterioration and persistent instability in communityacquired pneumonia. Respir Med 2012; 106: 1320-1328.
85. Christ-Crain M, Morgenthaler NG, Stolz D, et al. Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]. Crit Care 2006; 10: R96.
86. Huang DT, Angus DC, Kellum JA, et al. Midregional proadrenomedullin as a prognostic tool in community-acquired pneumonia. Chest 2009; 136: 823-831.
87. Albrich WC, Dusemund F, Ruegger K, et al. Enhancement of CURB65 score with proadrenomedullin (CURB65-A) for outcome prediction in lower respiratory tract infections: derivation of a clinical algorithm. BMC Infect Dis 2011; 11: 112.
88. Guertler C, Wirz B, Christ-Crain M, et al. Inflammatory responses predict long-term mortality risk in communityacquired pneumonia. Eur Respir J 2011; 37: 1439-1446.
89. Bello S, Lasierra AB, Minchole E, et al. Prognostic power of proadrenomedullin in community-acquired pneumonia is independent of aetiology. Eur Respir J 2012; 39: 1144-1155.
90. Suberviola B, Castellanos-Ortega A, Llorca J, et al. Prognostic value of proadrenomedullin in severe sepsis and septic shock patients with community-acquired pneumonia. Swiss Med Wkly 2012; 142: w13542.
91. Renaud B, Schuetz P, Claessens YE, et al. Proadrenomedullin improves REA-ICU score for predicting Early Severe Community-Acquired Pneumonia. Chest 2012; 142: 1447-1454.
92. Querol-Ribelles JM, Tenias JM, Grau E, et al. Plasma D-dimer levels correlate with outcomes in patients with communityacquired pneumonia. Chest 2004; 126: 1087-1092.
93. Chalmers JD, Singanayagam A, Scally C, et al. Admission Ddimer can identify low-risk patients with community-acquired pneumonia. Ann Emerg Med 2009; 53: 633-638.
94. Mirsaeidi M, Peyrani P, Aliberti S, et al. Thrombocytopenia and thrombocytosis at time of hospitalization predict mortality in patients with community-acquired pneumonia. Chest 2010; 137: 416-420.
95. Christ-Crain M, Stolz D, Jutla S, et al. Free and total cortisol levels as predictors of severity and outcome in community-acquired pneumonia. Am J Respir Crit Care Med 2007; 176: 913-920.
96. Gotoh S, Nishimura N, Takahashi O, et al. Adrenal function in patients with community-acquired pneumonia. Eur Respir J 2008; 31: 1268-1273.
97. Salluh JI, Bozza FA, Soares M, et al. Adrenal response in severe community-acquired pneumonia: impact on outcomes and disease severity. Chest 2008; 134: 947-954.
98. Remmelts HH, Meijvis SC, Kovaleva A, et al. Changes in serum cortisol levels during community-acquired pneumonia: the influence of dexamethasone. Respir Med 2012; 106: 905-908.
99. Kolditz M, Hoffken G, Martus P, et al. Serum cortisol predicts death and critical disease independently of CRB-65 score in community-acquired pneumonia: a prospective observational cohort study. BMC Infect Dis 2012; 12: 90.
100. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. New Eng J Med 2003; 348: 727-734.
101. Arafah BM. Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods. J Clin Endocrinol Metab 2006; 91: 3725-3745.
102. Katan M, Christ-Crain M. The stress hormone copeptin: a new prognostic biomarker in acute illness. Swiss Med Wkly 2010; 140: w13101.
103. Van den Berghe G, de Zegher F, Bouillon R. Clinical review 95: acute and prolonged critical illness as different neuroendocrine paradigms. J Clin Endocrinol Metab 1998; 83: 1827-1834.