Advantages of using Genetically Elevated Lipoprotein(a) Levels in Predicting 5-Year Major Adverse Cardiovascular Events Relating to Coronary Artery Disease in Women.

Background: This study aimed to investigate major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) over 5 years, in general, and depending on sex, lipoprotein(a) level, and number of kringle IV type 2 (KIV-2) repeats in the Lipoprotein(A) (LPA) gene. Methods: This study comprised 216 patients (120 women and 96 men) hospitalized with a diagnosis of "CAD, unstable angina IIB class". The three-point risk of MACEs was assessed over 5 years: cardiovascular death, non-fatal myocardial infarction, and stroke. The number of KIV-2 repeats in the LPA gene was determined by quantitative real-time polymerase chain reaction (qPCR). Results: The relative risk of MACE in patients with elevated lipoprotein(a) (Lp(a)) was 2.0 (95% CI 1.04-3.87, p < 0.05) for quartile 4 (Q4) ≥ 48 mg/dL versus quartile 1 (Q1) ≤ 6 mg/dL. This was mainly attributable to an increase in men-relative risk (RR) 2.6 (95% CI 1.10-6.16, p < 0.05)-but not in women: RR 1.4 (95% CI 0.50-3.92). Mean lipoprotein(a) levels were inversely correlated with 42.5 and 7.5 for Q1 and Q4 KIV-2 repeat numbers, respectively. The relative risks of MACE for Q1 vs. Q4 KIV-2 repeats were as follows: 3.0 (95% CI 1.48-6.08, p < 0.001) for all patients; 3.0 (95% CI 1.20-6.55, p < 0.01) for men; 3.3 (95% CI 1.02-10.4, p < 0.05) for women. Conclusions: Quantifying kringle IV type 2 repeat copy number in the LPA gene using qPCR more accurately reflects the risk of major adverse cardiovascular events within 5 years in women with coronary artery disease.

[Evaluation of 2 invasive techniques for treating myofascial pain]. / Evaluación de dos técnicas invasivas en el tratamiento del dolor miofascial.

OBJECTIVE: To assess the efficacy of 2 invasive techniques for treating myofascial pain: trigger point acupuncture and 1% lidocaine infiltration of trigger points. MATERIAL AND METHODS: Patients who met the inclusion criteria were randomized to 2 groups for evaluation at our pain clinic over a period of 7 months. Each patient had 4 treatment sessions. Response was evaluated on a visual analog scale (VAS) and by means of the Lattinen test. RESULTS: Twenty-one patients were enrolled. Eleven underwent acupuncture and 10 received lidocaine infiltrations. When post-treatment pain was assessed, the mean (SD) VAS scores fell from 5.50 (2.08) to 2.45 (2.05) in the acupuncture group and from 4.8 (2.03) to 2.2 (1.91) in the lidocaine group. Lattinen test scores also fell, from 10.63 (2.69) to 8.54 (3.14) in the acupuncture group and from 10.9 (1.59) to 8.60 (2.63) in the lidocaine group. There were no statistically significant differences between the 2 treatment groups. CONCLUSION: Both acupuncture and lidocaine infiltration of trigger points were effective in reducing pain intensity after treatment and in improving quality of life. One method could not be shown to be better than the other for treating myofascial pain.

Datos de remisión y manejo de una población oncológica a una unidad de dolor. ¿Qué podemos mejorar? / Review of the remission and management of a cancer related pain population to a pain unit. What can we improve?

Objetivos: Determinar las características demográficas, clínicas y de manejo analgésico de una población con dolor oncológico remitida a nuestra unidad de dolor (UD). Descripción de su manejo clínico una vez recibidos en la unidad. Detectar aspectos de mejora.Material y métodos: Estudio retrospectivo y descriptivo, realizado durante un periodo de 23 meses, entre noviembre de 2019 y diciembre de 2021, de todos los pacientes oncológicos derivados a la UD, cuya causa de derivación fuera dolor de origen oncológico.Resultados: Se analizaron 78 pacientes, el 63,2 % hombres y el 46,8 % mujeres. La edad media poblacional fue de 64,84 ± 12,623 años. El 44,7 % fueron remitidos por servicios quirúrgicos. El 75 % presentaba dolor moderado o severo. Los tumores más frecuentes fueron los abdominales (31,6 %), y cabeza y cuello (22,4 %). La causa del dolor fue en 48,7 % de los casos de la infiltración tumoral y en un 60,5 % un dolor de origen de mixto. En el momento de la remisión el 60 % de los pacientes recibía opioides mayores, con una dosis de equivalentes diarios de morfina (EDM) de 163,57 ± 167,10 mg y el 38 % recibía antineuropáticos. El tiempo medio para atender a estos pacientes desde el momento de solicitarla fue de 9,18 ± 9,73 días. Se realizó intervencionismo menor en el 56,6 % (43) de los pacientes y mayor en el 2,6 % (2). Se inició en la UD el tratamiento con fármacos antineuropáticos en el 68,4 % de los casos. Tras el manejo en la UD, un 72,4 % de los pacientes refirieron mejoría del dolor.Conclusiones: Mejorar la tasa de remisión de pacientes desde servicios como Oncología médica y Atención primaria. Mejorar los tiempos de remisión a las unidades de dolor. Ajustar mejor los tratamientos analgésicos antes de la remisión. Generar un protocolo de remisión sencillo de pacientes que incluyan pautas básicas de manejo del dolor. Mejorar el diagnóstico de dolor neuropático. Aumentar la cartera de servicios de intervencionismos de la UD....(AU)

Aim: Studying the demographic profile, clinical characteristics and analgesic management of an oncologic population sent to our pain unit. To describe the pain management in our unit. To detect management aspects to be improved.Methodology: Retrospective and descriptive study, performed in a period of 23 months, between November 2019 and December 2021, of all patients sent to our pain unit for cancer pain management.Results: A total of 78 patients were analyzed, 63,2 % men and 46,8 % women. The average age was 64,84 ± 12,623 years. 44,7 % were sent by surgical services. In 75% the pain was moderate or severe. The main cancer location was abdominal (31,6 %), and head and neck (22,4 %). In 48,7 % the pain was originated by tumoral infiltration and in 60,5 % the pain was judged to be mixed. At the moment of the arrival 60 % of patients were on opioids, with an average dose of 163,57 ± 167,10 mg EDM and 38 % were on antineurophatic drugs. The average time to attend the patients from the moment or request was 9,18 ± 9,73 days. A minor interventional procedure was performed in 56,6 % (43) of the patients, and a major intervention in 2,6 % (2). We started antineurophatic drugs in 68,4 % of the cases. During the period of pain management in our unit a 72,4% of the patients referred an improvement of their cancer related pain.Conclusions: It is necessary to improve the rate of remission from medical oncology departments and primary care physicians. To reduce the remission time to our unit from the referral services. To improve analgesic management before referral. To create an easy protocol for remission of patients that includes basic pain management instructions. To improve the rate of neuropathic pain diagnosis before referral. To expand our interventional technics portfolio. Pain units can improve cancer related pain management. To create multidisciplinary cancer pain comities.(AU)

Respiratory infectious complications in the intensive care unit.

Ventilator-associated pneumonia is the most common infectious respiratory complication in intensive care unit patients, particularly those needing mechanical ventilation. Ventilator-associated pneumonia represents a challenging problem in terms of diagnosis, treatment, and prevention. Nosocomial sinusitis is another respiratory infection, not uncommon in mechanically ventilated patients. This type of infection has to be suspected in nasally intubated patients and may be a hidden focus of fever and sepsis.

[Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery bypass graft]. / Rotura de aneurisma ilíaco durante el precondicionamiento con levosimendán previo a cirugía de revascularización coronaria.

We present the case of a 77 year-old patient scheduled for coronary artery bypass. During the infusion of levosimendan as preconditioning for surgery, a rupture of right common iliac artery occurred. Surgery was delayed and an urgent aorto-bifemoral bypass was performed. We believe that the rupture of the artery was triggered by an increase in transmural pressure due to the inotropic effects of levosimendan in a dilated diseased vessel. To our knowledge, there are no cases of aneurysm rupture as a complication during levosimendan infusion, but the coincidence of events in time strongly suggests some kind of causal relationship.

Plan Universitario de Formación en Dolor de la Sociedad Española del Dolor / No disponible

No disponible

Réplica a la carta de V.L. Villanueva / No disponible

No disponible

Ketamina en el dolor del miembro fantasma / Ketamine and phantom limb pain

El dolor en miembro fantasma es una de las principales complicaciones a largo plazo tras la amputación de un miembro. Entre las opciones disponibles y que cuentan con respaldo bibliográfico de casos puntuales, se encuentra el uso de la ketamina. Se presenta el caso de un varón de 65 años, con dolor en miembro fantasma desde hacia10 años, con respuesta parcial a los anticonvulsionantes y antidepresivos. El paciente refería un dolor basal de 4, medido con la escala visual analógica, y episodios frecuentes de dolor lancinante de 10. El índice de Lattinen tenía un valor de 12 y, además, el paciente estaba deprimido y con afectación de su vida familiar. Ante esta situación decidimos, tras revisar la bibliografía, citarlo para perfusión continua intravenosa de ketamina. Evaluamos al paciente a la semana, a los 3 y a los 6 meses con un EVA a los 6 meses de 0en reposo y con disminución de los episodios de dolor lancinante menos de 2 a la semana, con un EVA en estos episodios de 6, Lattinen de 5 y mejoría del estado de ánimo (AU)

Phantom limb pain is one of the main long-term complications of amputation. Among the available options that have been reported in sporadic cases in the literature is the use of ketamine. We present the case of a 65-year-old man with phantom limb pain for 10 years and partial response to anticonvulsants and antidepressants. The patient reported a baseline visual analog scale (VAS) pain score of 4 and frequent episodes of lancinating pain with a score of 10. The Lattinen index was 12. The patient was depressed with repercussions on his family life. After reviewing the literature, we decided to administer continuous intravenous ketamine perfusion. The patient was evaluated at 1 week, at 3 months and at 6 months. VAS score at 6 months was 0 with the patient at rest and the number of episodes of lancinating pain was reduced to two per week, with a VAS score of 6, Lattinen index of 5, and improvement in the patient’s mood (AU)

Inflammatory response associated with pulmonary complications in non-HIV immunocompromised patients.

BACKGROUND: A study was undertaken to evaluate the local and systemic inflammatory response associated with pulmonary complications in immunocompromised patients and potential implications regarding severity and prognosis. METHODS: Levels of different inflammatory mediators were measured in the bronchoalveolar lavage (BAL) fluid and serum on days 1 and 4 after the identification of the pulmonary complication in 127 patients with different immunosuppressive conditions. RESULTS: Pulmonary complications were characterised by a high percentage of neutrophils and increased levels of tumour necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-8 and IL-10 in the BAL fluid and high serum levels of TNF-alpha, IL-6, and plasma C-reactive protein (CRP). The inflammatory response was similar in the different groups of immunocompromised patients evaluated. The levels of proinflammatory cytokines were higher in patients with pulmonary infections, particularly those of bacterial aetiology. Patients with a more severe pulmonary infection had a more intense local and systemic inflammatory response. A BAL fluid IL-6 level of >40 pg/ml was an independent predictor of mortality (OR 4.65, 95% CI 1.3 to 16.1), together with a need for mechanical ventilation (OR 13.5, 95% CI 3.2 to 57.3). Patients who died had persistently high levels of CRP on day 4. CONCLUSIONS: The evaluation of the inflammatory response, particularly the determination of IL-6 levels in the BAL fluid and CRP in the serum, may be useful for deciding the appropriate management of pulmonary complications in immunocompromised patients.

Rotura de aneurisma ilíaco durante el precondicionamiento con levosimendán previo a cirugía de revascularización coronaria / Iliac aneurysm rupture during preconditioning with levosimendan for coronary artery bypass graft

Presentamos el caso de un paciente de 77 años programado para cirugía de revascularización coronaria. Coincidiendo con la infusión de levosimendán como precondicionamiento previo a la cirugía, se produjo la rotura de un aneurisma ilíaco derecho, lo que obligó a suspender la intervención y realizar un bypass aortobifemoral urgente. Creemos que esta rotura pudo verse precipitada por el incremento de la presión transmural debida al efecto inotrópico del levosimendán sobre un vaso dilatado y aterosclerótico. Por lo que sabemos, no existe ningún caso de rotura de aneurisma como complicación durante la infusión de levosimendán, pero la coincidencia de acontecimientos en el tiempo nos hace pensar en cierta relación causa-efecto (AU)

We present the case of a 77-year-old patient scheduled for coronary artery bypass. During the infusion of levosimendan as preconditioning for surgery, the break of an aneurysm took place iliac rightly, which forced to suspend the intervention and to fulfil an urgent bypass aortobyfemoral. We believe that this break could turn precipitated by the increase of the pressure transmural owed to the effect inotropic of the levosimendan on an extensive glass and aterosclerotic. For what we know, there does not exist any case of break of aneurysm as complication during the infusion of levosimendan, but the coincidence of events in the time makes us think about certain cause and effect relationship (AU)

Pulmonary complications in patients with haematological malignancies treated at a respiratory ICU.

Patients with haematological malignancies developing severe pulmonary complications have a poor outcome, especially after bone-marrow transplantation (BMT). We studied the aetiology, the yield of different diagnostic tools, as well as the outcome and prognostic factors in the corresponding population admitted to our respiratory intensive care unit (RICU). Overall, 89 patients with haematological malignancies and pulmonary complications treated within a 10 yr period were included. The underlying malignancies were predominantly acute leukaemia and chronic myeloid leukaemia (66/89, 74%). Fifty-two of 89 (58%) patients were bone marrow recipients. An aetiological diagnosis could be obtained in 61/89 (69%) of cases. The aetiology was infectious in 37/89 (42%) and noninfectious in 24/89 (27%). Blood cultures and cytological examinations of bronchoalveolar lavage fluid were the diagnostic tools with the highest yield (13/43 (30%) and 13/45 (29%) positive results, respectively). Necropsy results were coincident with results obtained during the lifetime in 43% of cases with infectious and 60% with noninfectious aetiologies. Overall mortality was 70/89 (79%), and 47/52 (90%) in transplant recipients. The requirement of mechanical ventilation, BMT, and an interval <90 days of BMT prior to ICU admission were independent adverse prognostic factors. The outcome in this patient population was uniformly poor. It was worst in bone marrow recipients developing pulmonary complications <90 days after transplantation and requiring mechanical ventilation. Decisions about intensive care unit admission and mech-anical ventilation should seriously consider the dismal prognosis of these patients.

Role of glucocorticoids on inflammatory response in nonimmunosuppressed patients with pneumonia: a pilot study.

The aim of the study was to assess the potential role of glucocorticoids (GC) in modulating systemic and pulmonary inflammatory responses in mechanically ventilated patients with severe pneumonia. Twenty mechanically ventilated patients with pneumonia treated at a respiratory intensive care unit (RICU) of a 1,000-bed teaching hospital were prospectively studied. All patients had received prior antimicrobial treatment. Eleven patients received GC (mean+/-SD dose of i.v. methylprednisolone 677+/-508 mg for 9+/-7 days), mainly for bronchial dilatation. Serum and bronchoalveolar lavage fluid (BALF) tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta, IL-6 and C-reactive protein levels were measured in all patients. The inflammatory response was attenuated in patients receiving GC, both systemically (IL-6 1,089+/-342 versus 630+/-385 pg x mL(-1), p=0.03; C-reactive protein 34+/-5 versus 19+/-5 mg x L(-1), p=0.04) and locally in BALF (TNF-alpha 118+/-50 versus 24+/-5 pg x mL(-1), p= 0.05; neutrophil count: 2.4+/-1.1 x 10(9) cells x L(-1) (93+/-3%) versus 1.9+/-1.8 x 10(9) cells x L(-1) (57+/-16%), p=0.03). Four of the 11 (36%) patients receiving GC died compared to six (67%) who were not receiving GC (p=0.37). The present pilot study suggests that glucocorticoids decrease systemic and lung inflammatory responses in mechanically ventilated patients with severe pneumonia receiving antimicrobial treatment.

Bronchial inflammation and colonization in patients with clinically stable bronchiectasis.

To evaluate the bronchial inflammatory response and its relationship to bacterial colonization in bronchiectasis, we performed a bronchoalveolar lavage (BAL) in 49 patients in stable clinical condition and in nine control subjects. BAL was processed for differential cell count, quantitative bacteriologic cultures, and measurement of inflammatory mediators. An increase was observed in the percentage of neutrophils (37 [0 to 98]) (median[range]) versus 1[0 to 4]%, p = 0.01), in the concentration of elastase (90.5 [8 to 2,930] versus 34 [9 to 44], p = 0.03), myeloperoxidase (9.1 [0 to 376] versus 0.3 [0.1 to 1.4], p = 0.01), and in the levels of TNF-alpha (4 [0 to 186] versus 0 [0 to 7], p = 0.03), IL-8 (195 [0 to 5,520] versus 3 [0 to 31], p = 0.001), and IL-6 (6 [0 to 115] versus 0 [0 to 3], p = 0.001) in patients with bronchiectasis compared with control subjects. Noncolonized patients showed a more intense bronchial inflammatory reaction than did control subjects. This inflammatory reaction was exaggerated in patients colonized by microorganisms with potential pathogenicity (MPP), with a clear relationship with the bronchial bacterial load. Patients with bronchiectasis showed a slight systemic inflammatory response, with poor correlations between systemic and bronchial inflammatory mediators, suggesting that the inflammatory process was mostly compartmentalized. We conclude that patients with bronchiectasis in a stable clinical condition present an active neutrophilic inflammation in the airways that is exaggerated by the presence of MPP, and the higher the bacterial load the more intense the inflammation.

Bacterial colonisation in patients with bronchiectasis: microbiological pattern and risk factors.

BACKGROUND: A study was undertaken to investigate the incidence, diagnostic yield of non-invasive and bronchoscopic techniques, and risk factors of airway colonisation in patients with bronchiectasis in a stable clinical situation. METHODS: A 2 year prospective study of 77 patients with bronchiectasis in a stable clinical condition was performed in an 800 bed tertiary university hospital. The interventions used were pharyngeal swabs, sputum cultures and quantitative protected specimen brush (PSB) bacterial cultures (cut off point > or =10(2) cfu/ml) and bronchoalveolar lavage (BAL) (cut off point > or =10(3) cfu/ml). RESULTS: The incidence of bronchial colonisation with potential pathogenic microorganisms (PPMs) was 64%. The most frequent PPMs isolated were Haemophilus influenzae (55%) and Pseudomonas spp (26%). Resistance to antibiotics was found in 30% of the isolated pathogens. When the sample was appropriate, the operative characteristics of the sputum cultures were similar to those obtained with the PSB taken as a gold standard. Risk factors associated with bronchial colonisation by PPMs in the multivariate analysis were: (1) diagnosis of bronchiectasis before the age of 14 years (odds ratio (OR)=3.92, 95% CI 1.29 to 11.95), (2) forced expiratory volume in 1 second (FEV1) <80% predicted (OR=3.91, 95% CI 1.30 to 11.78), and (3) presence of varicose or cystic bronchiectasis (OR=4.80, 95% CI 1.11 to 21.46). CONCLUSIONS: Clinically stable patients with bronchiectasis have a high prevalence of bronchial colonisation by PPMs. Sputum culture is a good alternative to bronchoscopic procedures for evaluation of this colonisation. Early diagnosis of bronchiectasis, presence of varicose-cystic bronchiectasis, and FEV1 <80% predicted appear to be risk factors for bronchial colonisation with PPMs.

Pulmonary infiltrates in non-HIV immunocompromised patients: a diagnostic approach using non-invasive and bronchoscopic procedures.

BACKGROUND: The development of pulmonary infiltrates is a frequent life threatening complication in immunocompromised patients, requiring early diagnosis and specific treatment. In the present study non-invasive and bronchoscopic diagnostic techniques were applied in patients with different non-HIV immunocompromised conditions to determine the aetiology of the pulmonary infiltrates and to evaluate the impact of these methods on therapeutic decisions and outcome in this population. METHODS: The non-invasive diagnostic methods included serological tests, blood antigen detection, and blood, nasopharyngeal wash (NPW), sputum and tracheobronchial aspirate (TBAS) cultures. Bronchoscopic techniques included fibrobronchial aspirate (FBAS), protected specimen brush (PSB), and bronchoalveolar lavage (BAL). Two hundred consecutive episodes of pulmonary infiltrates were prospectively evaluated during a 30 month period in 52 solid organ transplant recipients, 53 haematopoietic stem cell transplant (HSCT) recipients, 68 patients with haematological malignancies, and 27 patients requiring chronic treatment with corticosteroids and/or immunosuppressive drugs. RESULTS: An aetiological diagnosis was obtained in 162 (81%) of the 200 patients. The aetiology of the pulmonary infiltrates was infectious in 125 (77%) and non-infectious in 37 (23%); 38 (19%) remained undiagnosed. The main infectious aetiologies were bacterial (48/125, 24%), fungal (33/125, 17%), and viral (20/125, 10%), and the most frequent pathogens were Aspergillus fumigatus (n=29), Staphylococcus aureus (n=17), and Pseudomonas aeruginosa (n=12). Among the non-infectious aetiologies, pulmonary oedema (16/37, 43%) and diffuse alveolar haemorrhage (10/37, 27%) were the most common causes. Non-invasive techniques led to the diagnosis of pulmonary infiltrates in 41% of the cases in which they were used; specifically, the diagnostic yield of blood cultures was 30/191 (16%); sputum cultures 27/88 (31%); NPW 9/50 (18%); and TBAS 35/55 (65%). Bronchoscopic techniques led to the diagnosis of pulmonary infiltrates in 59% of the cases in which they were used: FBAS 16/28 (57%), BAL 68/135 (51%), and PSB 30/125 (24%). The results obtained with the different techniques led to a change in antibiotic treatment in 93 cases (46%). Although changes in treatment did not have an impact on the overall mortality, patients with pulmonary infiltrates of an infectious aetiology in whom the change was made during the first 7 days had a better outcome (29% mortality) than those in whom treatment was changed later (71% mortality; p=0.001). CONCLUSIONS: Non-invasive and bronchoscopic procedures are useful techniques for the diagnosis of pulmonary infiltrates in immunocompromised patients. Bronchial aspirates (FBAS and TBAS) and BAL have the highest diagnostic yield and impact on therapeutic decisions.

Pulmonary infiltrates in HIV-infected patients in the highly active antiretroviral therapy era in Spain.

OBJECTIVE: To study the incidence, etiology, and outcome of pulmonary infiltrates (PIs) in HIV-infected patients and to evaluate the yield of diagnostic procedures. DESIGN: Prospective observational study of consecutive hospital admissions. SETTING: Tertiary hospital. PATIENTS: HIV-infected patients with new-onset radiologic PIs from April 1998 to March 1999. METHODS: The study protocol included chest radiography, blood and sputum cultures, serologic testing for "atypical" causes of pneumonia, testing for Legionella urinary antigen, testing for cytomegalovirus antigenemia, and bronchoscopy in case of diffuse or progressive PIs. RESULTS: One hundred two episodes in 92 patients were recorded. The incidence of PIs was 18 episodes per 100 hospital admission-years (95% confidence interval [CI]: 15-21). An etiologic diagnosis was achieved in 62 cases (61%). Bacterial pneumonia (BP), Pneumocystis carinii pneumonia (PCP), and mycobacteriosis were the main diagnoses. The incidences of BP and mycobacteriosis were not statistically different in highly active antiretroviral therapy (HAART) versus non-HAART patients. The incidence of PCP was lower in those receiving HAART (p =.011), however. Nine patients died (10%). Independent factors associated with higher mortality were mechanical ventilation (odds ratio [OR] = 83; CI: 4.2-1,682), age >50 years (OR = 23; CI: 2-283), and not having an etiologic diagnosis (OR = 22; CI: 1.6-293). CONCLUSIONS: Pulmonary infiltrates are still a frequent cause of hospital admission in the HAART era, and BP is the main etiology. There was no difference in the rate of BP and mycobacteriosis in HAART and non-HAART patients. Not having an etiologic diagnosis is an independent factor associated with mortality.

Factors associated with unknown aetiology in patients with community-acquired pneumonia.

Despite comprehensive diagnostic work-up, the aetiology of community-acquired pneumonia (CAP) remains undetermined in 30-60% of cases. The authors studied factors associated with undiagnosed pneumonia. Patients hospitalised with CAP and being evaluated by two blood cultures, at least one valid lower respiratory tract sample, and serology on admission were prospectively recorded. Patients who had received antimicrobial pretreatment were excluded. Patients with definite or probable aetiology were compared to those with undetermined aetiology by uni- and multivariable analysis. A total 204 patients were eligible for the study. The aetiology remained undetermined in 82 (40%) patients, whereas a definite aetiology could be established in 89 (44%) and a probable one in 33 (16%). In multivariable analysis, factors associated with undetermined aetiology included age >70 yrs, renal and cardiac comorbidity, and nonalveolar infiltrates on the chest radiograph. There was no association of undiagnosed pneumonia with mortality. Age and host factors were associated with unknown aetiology of community-acquired pneumonia. Some of these cases may also represent fluid volume overload mimicking pneumonia.