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Volume 8, Number 12—December 2002

Research

Legionnaires’ Disease at a Dutch Flower Show: Prognostic Factors and Impact of Therapy

Kamilla D. Lettinga*Comments to Author , Annelies Verbon*, Gerrit-Jan Weverling*, Joop F.P. Schellekens†, Jeroen W. Den Boer†‡, Ed P.F. Yzerman§, Jacobus Prins¶, Wim G. Boersma#, Ruud J. van Ketel*, Jan M. Prins*, and Peter Speelman*
Author affiliations: *Academic Medical Center, Amsterdam, the Netherlands; †National Institute of Public Health and the Environment, Bilthoven, the Netherlands; ‡Municipal Health Service Zuid-Kennemerland, Haarlem, the Netherlands; §Regional Laboratory of Public Health Haarlem, Haarlem, the Netherlands; ¶Westfries Gasthuis, Hoorn, the Netherlands; #Medical Center Alkmaar, Alkmaar, the Netherlands;

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Table 1

Univariate analysis of factors determining outcomea

No. patients (%) Odds ratio (95% CI)b p value
Patient characteristics
Male 82 (58) 1.5 (0.7 to 3.1) 0.30
Age >67 years 75 (53) 1.0 (0.5 to 2.1) 0.98
Underlying diseases
COPD 11 (8) 0.8 (0.2 to 3.1) 0.73
Diabetes mellitus 16 (11) 1.0 (0.3 to 3.0) 0.95
Renal insufficiency 3 (2) 1.1 (0.1 to 12.1) 0.96
Cardiac disease 48 (34) 1.0 (0.5 to 2.0) 0.90
Cancer 10 (7) 0.5 (0.1 to 2.5) 0.41
Immunosuppressive medicationd 11 (8) 1.9 (0.5 to 6.5) 0.52
Smokingc 65 (48) 2.4 (1.2 to 5.1) 0.02
Alcohol intakec 26 (59) 3.7 (0.8 to 15.8) 0.08
Symptoms
Fever 119 (84) 0.8 (0.3 to 2.0) 0.63
Myalgia 31 (22) 0.6 (0.2 to 1.4) 0.21
Headache 36 (26) 0.6 (0.3 to 1.5) 0.30
Cough 97 (69) 1.0 (0.5 to 2.2) 0.99
Dyspnea 79 (56) 2.6 (1.2 to 5.5) 0.01
Diarrhea 25 (18) 1.3 (0.5 to 3.1) 0.63
Confusion 31 (22) 1.8 (0.8 to 4.0) 0.18
Physical examination
Temperature >38.5°C 101 (72) 3.6 (1.4 to 9.3) 0.009
Respiratory rate >18/minc 34 (85) 5.6 (0.6 to 53.4) 0
Biochemistryc
Sodium <130 mmol/L 36 (26) 2.1 (1.1 to 4.7) 0.06
Creatinine >100 µmol/L 73 (52) 2.1 (1.0 to 4.4) 0.05
CPK >200 U/L 25 (50) 1.4 (0.5 to 4.2) 0.57
ASAT >100 U/L 21 (18) 1.7 (0.6 to 4.4) 0.30
γ-GT >100 U/L 12 (13) 0.42 (0.09 to 2.03) 0.28
PO2 <9.7 kPa 96 (83) 0.64 (0.24 to 1.70) 0.37
X-ray results
Bilateral infiltratese 38 (27) 3.5 (1.6 to 7.6) 0.002
Pleural effusion 15 (11) 3.8 (1.2 to 11.3) 0.002
Progression within 48 hrsc,f 46 (41) 1.6 (0.7 to 3.4) 0.25

aCI: confidence interval, COPD, chronic obstructive pulmonary disease, CPK, creatinine phosphokinase; ASAT, aspartate aminotransferase; γ-GT, gamma glutamyltransferase.
bLogistic regression analysis.
cData for smoking (≥1 cigarette per day), alcohol intake (≥2 U per day), breathing frequencies, laboratory tests, and progression of infiltrates were available for a proportion of patients. Cutoff levels for CPK, ASAT, and γ-GT are two times the upper normal limit.
dImmunosuppressive medication is defined as ongoing treatment with chemotherapy or steroids >10 mg/day.
eUnilateral infiltrate was the reference group.
f Radiographic progression during 24–48 hours was defined as an increase in density or size of the infiltrate, or progression to multiple lobes.

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