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Screening for Humoral Immunodeficiency in Patients with Community‐Acquired Pneumonia
Author(s) -
Vadamalai Karthik,
SanchezTejera Denise,
Bress Jonathan,
Mustafa S Shahzad
Publication year - 2019
Publication title -
journal of hospital medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.128
H-Index - 65
eISSN - 1553-5606
pISSN - 1553-5592
DOI - 10.12788/jhm.3106
Subject(s) - medicine , pneumonia , immunology , human immunodeficiency virus (hiv) , immunodeficiency , intensive care medicine , virology , immune system
BACKGROUND Immunodeficiency is an underrecognized risk factor for infections, such as community‐acquired pneumonia (CAP). OBJECTIVE We evaluated patients admitted with CAP for humoral immunodeficiency. DESIGN Prospective cohort study SETTING Inpatients PATIENTS, INTERVENTION, AND MEASUREMENTS We enrolled 100 consecutive patients admitted with a diagnosis of CAP from February 2017 to April 2017. Serum IgG, IgM, IgA, and IgE levels were obtained within the first 24 hours of admission. CURB‐65 score and length of hospital stay were calculated. The Wilcoxon rank‐sum test, Kruskal‐Wallis test, and simple linear regression analysis were used in data analysis. RESULTS The prevalence of hypogammaglobinemia in patients with CAP was 38% (95% CI: 28.47% to 48.25%). Twenty‐seven of 100 patients had IgG hypogammaglobinemia (median: 598 mg/dL, IQ range: 459‐654), 23 of 100 had IgM hypogammaglobinemia (median: 38 mg/dL, IQ range: 25‐43), and 6 of 100 had IgA hypogammaglobinemia (median: 36 mg/dL, IQ range: 18‐50). The median hospital length of stay for patients with IgG hypogammaglobinemia was significantly higher when compared to patients with normal IgG levels (five days, IQ range [3‐10] vs three days, IQ range [2‐5], P = .0085). Fourteen patients underwent further immune evaluation, resulting in one diagnosis of multiple myeloma, three patients diagnosed with specific antibody deficiency, and one patient diagnosed with selective IgA deficiency. CONCLUSION There is a high prevalence of hypogammaglobinemia in patients hospitalized with CAP, with IgG and IgM being the most commonly affected classes. IgG hypogammaglobinemia was associated with an increased length of hospitalization. Screening immunoglobulin levels in CAP patients may also uncover underlying humoral immunodeficiency or immunoproliferative disorders.