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Enersen CC, Egelund GB, Petersen PT, Andersen S, Ravn P, Rohde G, Lindegaard B, Jensen AV. The ratio of neutrophil-to-lymphocyte and platelet-to-lymphocyte and association with mortality in community-acquired pneumonia: a derivation-validation cohort study. Infection 2023; 51:1339-1347. [PMID: 36763284 DOI: 10.1007/s15010-023-01992-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
RATIONALE The ratio of neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR) and platelet-to-lymphocyte (PLR) are biomarkers that have shown potential for predicting mortality in several diseases. For patients hospitalized with community-acquired pneumonia (CAP), the prognostic capabilities of these biomarkers are unknown. OBJECTIVE Investigate whether NLR, MLR or PLR were associated with 90-day mortality in CAP. Further, investigate whether the prediction rule CURB-65 could be improved by adding these biomarkers. METHODS A derivation-validation study using a Danish multicentre retrospective cohort as the derivation cohort (N = 831) and a European multicentre prospective cohort as the validation cohort (N = 2463). Associations between biomarkers and mortality were assessed using Cox proportional hazard models with adjustments for sex, CURB-65 and comorbidities. A cut-off value for biomarkers was determined using Youden's J Statistics. The performance of CURB-65 with added biomarkers was evaluated using receiver-operating characteristics. RESULTS In both cohorts increasing NLR and PLR were associated with 90-day mortality. In the derivation cohort, the hazard ratios for NLR and PLR were 1.016 (95% confidence interval (CI) 1.001-1.032, P = 0.038) and 1.001 (95% CI 1.000-1.001, P = 0.035), respectively. Adding these biomarkers to CURB-65 did not improve its performance. CONCLUSIONS NLR and PLR were associated with 90-day mortality in CAP, but did not improve CURB-65.
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Affiliation(s)
| | | | - Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Stine Andersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
| | - Pernille Ravn
- Medical Department O, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Gernot Rohde
- CAPNETZ Stiftung, Hannover, Germany
- Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany
| | - Birgitte Lindegaard
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Significance of the Modified NUTRIC Score for Predicting Clinical Outcomes in Patients with Severe Community-Acquired Pneumonia. Nutrients 2021; 14:nu14010198. [PMID: 35011073 PMCID: PMC8747298 DOI: 10.3390/nu14010198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Nutritional status could affect clinical outcomes in critical patients. We aimed to determine the prognostic accuracy of the modified Nutrition Risk in Critically Ill (mNUTRIC) score for hospital mortality and treatment outcomes in patients with severe community-acquired pneumonia (SCAP) compared to other clinical prediction rules. We enrolled SCAP patients in a multi-center setting retrospectively. The mNUTRIC score and clinical prediction rules for pneumonia, as well as clinical factors, were calculated and recorded. Clinical outcomes, including mortality status and treatment outcome, were assessed after the patient was discharged. We used the receiver operating characteristic (ROC) curve method and multivariate logistic regression analysis to determine the prognostic accuracy of the mNUTRIC score for predicting clinical outcomes compared to clinical prediction rules, while 815 SCAP patients were enrolled. ROC curve analysis showed that the mNUTRIC score was the most effective at predicting each clinical outcome and had the highest area under the ROC curve value. The cut-off value for predicting clinical outcomes was 5.5. By multivariate logistic regression analysis, the mNUTRIC score was also an independent predictor of both clinical outcomes in SCAP patients. We concluded that the mNUTRIC score is a better prognostic factor for predicting clinical outcomes in SCAP patients compared to other clinical prediction rules.
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Postnikova LB, Klimkin PF, Boldina MV, Gudim AL, Kubysheva NI. [Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients]. TERAPEVT ARKH 2020; 92:42-49. [PMID: 32598792 DOI: 10.26442/00403660.2020.03.000538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/28/2023]
Abstract
Community-acquired pneumonia (CAP) is the most common disease and potentially life-threatening infection in the worldwide. In the Nizhny Novgorod region, no analysis of the causes of mortality and medical errors of severe CAP patients. AIM To analyze the patients structure who died severe CAP in hospitals of the Nizhny Novgorod region, to identify the leading risk factors, to assess the clinical characteristics of fatal severe CAP and medical errors according to medical records of patients from 20152016. MATERIALS AND METHODS This was a retrospective study of medical records of 139 patients with fatal severe CAP from medical organizations of the Nizhny Novgorod region. The 72 patients died in 2015. The mortality rate from pneumonia was 67 cases in 2016. RESULTS The key predictors of the fatal severe CAP in patients of the Nizhny Novgorod region identified: socio-demographic status (men of working age, unemployed, smoking, alcohol and drug dependence), late treatment and hospitalization, tachypnea, hypotension, tachycardia, confusion, leukocytosis or leukopenia, thrombocytopenia, anemia, hyperglycemia, bilateral lung damage, pleural effusion, acute respiratory failure. The leading medical errors in fatal CAP were incorrect assessment of the severity of the patients condition, untimely CAP, non-monitoring of SpO2 on the first day of hospitalization, late transfer of patients to the intensive care unit, there was no influenza therapy, inadequate starting antibacterial therapy. CONCLUSION The main ways to avoid or minimize medical errors and reduce the mortality of patients with TVP is strict adherence to clinical recommendations, active preventive measures, diagnosis and treatment of chronic diseases.
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Critical Parameters for the Development of Novel Therapies for Severe and Resistant Infections-A Case Study on CAL02, a Non-Traditional Broad-Spectrum Anti-Virulence Drug. Antibiotics (Basel) 2020; 9:antibiotics9020094. [PMID: 32098274 PMCID: PMC7168140 DOI: 10.3390/antibiotics9020094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Poor outcomes in severe and resistant infections, together with the economic struggles of companies active in the field of anti-infective development, call for new solutions and front runners with novel approaches. Among “non-traditional” approaches, blocking virulence could be a game changer. Objectives: This review offers a perspective on parameters that have determined the development path of CAL02, a novel anti-virulence agent, with a view to steering clear of the obstacles and limitations that impede market sustainability for new anti-infective drugs. Conclusions and implications of key findings: This case study highlights four pillars that may support the development of other non-traditional drugs and, concurrently, provide a new model that could reshape the field. Therapeutic triggers, study designs, and economic parameters are discussed.
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Horcajada JP, Salata RA, Álvarez-Sala R, Nitu FM, Lawrence L, Quintas M, Cheng CY, Cammarata S. A Phase 3 Study to Compare Delafloxacin With Moxifloxacin for the Treatment of Adults With Community-Acquired Bacterial Pneumonia (DEFINE-CABP). Open Forum Infect Dis 2020; 7:ofz514. [PMID: 31988972 PMCID: PMC6975251 DOI: 10.1093/ofid/ofz514] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/04/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The clinical and economic burden of community-acquired bacterial pneumonia (CABP) is significant and is anticipated to increase as the population ages and pathogens become more resistant. Delafloxacin is a fluoroquinolone antibiotic approved in the United States for the treatment of adults with acute bacterial skin and skin structure infections. Delafloxacin's shape and charge profile uniquely impact its spectrum of activity and side effect profile. This phase 3 study compared the efficacy and safety of delafloxacin with moxifloxacin for the treatment of CABP. METHODS A randomized, double-blind, comparator-controlled, multicenter, global phase 3 study compared the efficacy and safety of delafloxacin 300 mg twice daily or moxifloxacin 400 mg once daily in adults with CABP. The primary end point was early clinical response (ECR), defined as improvement at 96 (±24) hours after the first dose of study drug. Clinical response at test of cure (TOC) and microbiologic response were also assessed. RESULTS In the intent-to-treat analysis population (ITT), ECR rates were 88.9% in the delafloxacin group and 89.0% in the moxifloxacin group. Noninferiority of delafloxacin compared with moxifloxacin was demonstrated. At TOC in the ITT population, the success rates were similar between groups. Treatment-emergent adverse events that were considered at least possibly related to the study drug occurred in 65 subjects (15.2%) in the delafloxacin group and 54 (12.6%) in the moxifloxacin group. CONCLUSIONS Intravenous/oral delafloxacin monotherapy is effective and well tolerated in the treatment of adults with CABP, providing coverage for Gram-positive, Gram-negative, and atypical pathogens. CLINICALTRIALSGOV IDENTIFIER NCT03534622.
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Affiliation(s)
- Juan P Horcajada
- Hospital del Mar, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona and Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | - Floarea Mimi Nitu
- Victor Babes Clinical Hospital of Infectious Diseases and Pneumophtisiology, Craiova, Romania
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Risk Factors for Severe Community-aquired Pneumonia Among Children Hospitalized With CAP Younger Than 5 Years of Age. Pediatr Infect Dis J 2019; 38:224-229. [PMID: 29746377 DOI: 10.1097/inf.0000000000002098] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) causes great morbidity and mortality as well as enormous economic burden worldwide. This study intended to describe the clinical characteristics of CAP and explore the risk factors of severe CAP among children in downtown Suzhou, China. METHODS This was a retrospective study of childhood hospitalizations in Soochow University Affiliated Children's Hospital from January 1, 2010, to December 31, 2014. Children who were residents of downtown Suzhou, 29 days to < 5 years of age, with discharge diagnosis codes J09 to J18 and J20 to J22 were included. Medical charts and chest radiograph reports were reviewed for included children to collect clinical information. CAP with intensive care unit (ICU) admission and poor clinical outcome were categorized as severe CAP. RESULTS A total of 28,043 children were identified with CAP; 17,501 (62.4%) of these children were male, and 20,747 (74.0%) children were less than 2 years of age. The common clinical symptoms at admission were cough (94.8%), fever (52.9%), wheezing (37.7%) and respiratory distress (9.5%). In total, 21,898 (78.1%) children had radiologic evidence of pneumonia, and 1,403 (5.0%) children developed at least 1 complication. Multivariate regression analysis showed that younger age, congenital heart disease and abnormal white blood cells, and C-reactive protein results were independent risk factors for both ICU admission and poor clinical outcome (odds ratio [OR] > 1 for all). Respiratory distress symptoms at admission (OR = 12.10) greatly increased the risk for ICU admission, while ICU admission (OR = 8.87) and complications (OR = 2.55) increased the risk of poor outcome. However, cough was a protective factor for ICU admission, so were wheezing, antibiotic and antiviral therapies for clinical failure. CONCLUSION Pediatric CAP hospitalizations of those of younger age, with congenital heart diseases, respiratory distress symptoms/tachypnea, abnormal white blood cells and C-reactive protein results as well as complications were at higher risk for progressing to severe CAP.
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Andersen SB, Baunbæk Egelund G, Jensen AV, Petersen PT, Rohde G, Ravn P. Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia. Infect Dis (Lond) 2016; 49:251-260. [DOI: 10.1080/23744235.2016.1253860] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Stine Bang Andersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Gertrud Baunbæk Egelund
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Vestergaard Jensen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Pelle Trier Petersen
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Gernot Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, Netherlands
- CAPNETZ-Stiftung, Hannover Medical School, Hannover, Germany
| | - Pernille Ravn
- Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital – Hillerød, Hillerød, Denmark
- Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Forstner C, Rohde G, Rupp J, Schuette H, Ott SR, Hagel S, Harrison N, Thalhammer F, von Baum H, Suttorp N, Welte T, Pletz MW. Community-acquired Haemophilus influenzae pneumonia--New insights from the CAPNETZ study. J Infect 2016; 72:554-63. [PMID: 26940505 DOI: 10.1016/j.jinf.2016.02.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 02/04/2016] [Accepted: 02/20/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to identify clinical characteristics and to assess effectiveness of different initial antibiotic regimens in adult patients with community-acquired pneumonia (CAP) caused by Haemophilus influenzae. METHODS Characteristics were compared between patients with H. influenzae monoinfection versus CAP of other and unknown aetiology enrolled by the German prospective cohort study CAPNETZ. Impact of initial antibiotic treatment on "early clinical response" according to FDA criteria and overall clinical cure were analysed. RESULTS H. influenzae was found in 176 out of 2790 patients with pathogen detection (6.3%). Characteristics significantly associated with a H. influenzae CAP (p < 0.017) included purulent sputum, prior pneumococcal vaccination and respiratory co-morbidities. Early clinical response rates on day 4 did not differ between patients receiving any mono- versus combination therapy (85.9% versus 88%), but were numerically higher for regimens including any fluoroquinolone (96.7%) and lower under macrolide monotherapy (70%). Initial CURB-65 score and chronic liver disease were identified as negative predictors for "early clinical response". At day 14, overall clinical cure was 91.9%. CONCLUSIONS H. influenzae was a common CAP pathogen, particularly in patients with previous pneumococcal vaccination and respiratory co-morbidities. Severity of illness and chronic liver disease were associated with a lower rate of "early clinical response".
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Affiliation(s)
- Christina Forstner
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
| | - Gernot Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Carl-Neuberg-Strasse 1, 30625 Hannover, Germany; CAPNETZ STIFTUNG, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Jan Rupp
- Department of Infectious Diseases and Microbiology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany; CAPNETZ STIFTUNG, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Hartwig Schuette
- Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; CAPNETZ STIFTUNG, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Sebastian R Ott
- Department of Pulmonary Medicine, University Hospital (Inselspital) and University of Bern, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Stefan Hagel
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
| | - Nicole Harrison
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Florian Thalhammer
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Heike von Baum
- Institute for Medical Microbiology and Hygiene, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Norbert Suttorp
- Department of Internal Medicine/Infectious Diseases and Pulmonary Medicine, Charité Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; CAPNETZ STIFTUNG, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Tobias Welte
- Department of Pulmonary Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Carl-Neuberg-Strasse 1, 30625 Hannover, Germany; CAPNETZ STIFTUNG, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany; CAPNETZ STIFTUNG, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany
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Pea F. Antimicrobial treatment of bacterial infections in frail elderly patients: the difficult balance between efficacy, safety and tolerability. Curr Opin Pharmacol 2015; 24:18-22. [DOI: 10.1016/j.coph.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/05/2015] [Accepted: 06/17/2015] [Indexed: 12/12/2022]
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