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Méndez R, González-Jiménez P, Mengot N, Menéndez R. Treatment Failure and Clinical Stability in Severe Community-Acquired Pneumonia. Semin Respir Crit Care Med 2024; 45:225-236. [PMID: 38224700 DOI: 10.1055/s-0043-1778139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Treatment failure and clinical stability are important outcomes in community-acquired pneumonia (CAP). It is essential to know the causes and risk factors for treatment failure and delay in reaching clinical stability in CAP. The study of both as well as the associated underlying mechanisms and host response are key to improving outcomes in pneumonia.
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Affiliation(s)
- Raúl Méndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Paula González-Jiménez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Noé Mengot
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Rosario Menéndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
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2
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O’Farrell HE, Kok HC, Goel S, Chang AB, Yerkovich ST. Endotypes of Paediatric Cough-Do They Exist and Finding New Techniques to Improve Clinical Outcomes. J Clin Med 2024; 13:756. [PMID: 38337450 PMCID: PMC10856076 DOI: 10.3390/jcm13030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/23/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Chronic cough is a common symptom of many childhood lung conditions. Given the phenotypic heterogeneity of chronic cough, better characterization through endotyping is required to provide diagnostic certainty, precision therapies and to identify pathobiological mechanisms. This review summarizes recent endotype discoveries in airway diseases, particularly in relation to children, and describes the multi-omic approaches that are required to define endotypes. Potential biospecimens that may contribute to endotype and biomarker discoveries are also discussed. Identifying endotypes of chronic cough can likely provide personalized medicine and contribute to improved clinical outcomes for children.
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Affiliation(s)
- Hannah E. O’Farrell
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Hing Cheong Kok
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Department of Paediatrics, Sabah Women and Children’s Hospital, Kota Kinabalu 88996, Sabah, Malaysia
| | - Suhani Goel
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
| | - Anne B. Chang
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
- Department of Respiratory and Sleep Medicine, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
| | - Stephanie T. Yerkovich
- NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE), Child and Maternal Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, NT 0810, Australia; (H.C.K.); (A.B.C.); (S.T.Y.)
- Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, QLD 4000, Australia;
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3
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Zhao J, He X, Min J, Yao RSY, Chen Y, Chen Z, Huang Y, Zhu Z, Gong Y, Xie Y, Li Y, Luo W, Shi D, Xu J, Shen A, Wang Q, Sun R, He B, Lin Y, Shen N, Cao B, Yang L, She D, Shi Y, Zhou J, Su X, Zhou H, Ma Z, Fan H, Lin Y, Ye F, Nie X, Zhang Q, Tian X, Lai G, Zhou M, Ma J, Zhang J, Qu J. A multicenter prospective study of comprehensive metagenomic and transcriptomic signatures for predicting outcomes of patients with severe community-acquired pneumonia. EBioMedicine 2023; 96:104790. [PMID: 37708700 PMCID: PMC10507133 DOI: 10.1016/j.ebiom.2023.104790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/29/2023] [Accepted: 08/23/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) results in high mortality as well as massive economic burden worldwide, yet limited knowledge of the bio-signatures related to prognosis has hindered the improvement of clinical outcomes. Pathogen, microbes and host are three vital elements in inflammations and infections. This study aims to discover the specific and sensitive biomarkers to predict outcomes of SCAP patients. METHODS In this study, we applied a combined metagenomic and transcriptomic screening approach to clinical specimens gathered from 275 SCAP patients of a multicentre, prospective study. FINDINGS We found that 30-day mortality might be independent of pathogen category or microbial diversity, while significant difference in host gene expression pattern presented between 30-day mortality group and the survival group. Twelve outcome-related clinical characteristics were identified in our study. The underlying host response was evaluated and enrichment of genes related to cell activation, immune modulation, inflammatory and metabolism were identified. Notably, omics data, clinical features and parameters were integrated to develop a model with six signatures for predicting 30-day mortality, showing an AUC of 0.953 (95% CI: 0.92-0.98). INTERPRETATION In summary, our study linked clinical characteristics and underlying multi-omics bio-signatures to the differential outcomes of patients with SCAP. The establishment of a comprehensive predictive model will be helpful for future improvement of treatment strategies and prognosis with SCAP. FUNDING National Natural Science Foundation of China (No. 82161138018), Shanghai Municipal Key Clinical Specialty (shslczdzk02202), Shanghai Top-Priority Clinical Key Disciplines Construction Project (2017ZZ02014), Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases (20dz2261100).
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Affiliation(s)
- Jingya Zhao
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, China
| | - Xiangyan He
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Jiumeng Min
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Rosary Sin Yu Yao
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Yu Chen
- Department of Pulmonary and Critical Care Medicine, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhonglin Chen
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Yi Huang
- Department of Pulmonary and Critical Care Medicine, Changhai Hospital, Shanghai, China
| | - Zhongyi Zhu
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Yanping Gong
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Yusang Xie
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, China
| | - Yuping Li
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital Wenzhou Medical College, Zhejiang, China
| | - Weiwei Luo
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Dongwei Shi
- Department of Emergency Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jinfu Xu
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China
| | - Ao Shen
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Qiuyue Wang
- Department of Pulmonary and Critical Care Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Ruixue Sun
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Bei He
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Yang Lin
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Ning Shen
- Department of Pulmonary and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Bin Cao
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Lingling Yang
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Danyang She
- Department of Pulmonary and Critical Care Medicine, The General Hospital of the People's Liberation Army, Beijing, China
| | - Yi Shi
- Department of Pulmonary and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jiali Zhou
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Xin Su
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Hua Zhou
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital Zhejiang University, Hangzhou, China
| | - Zhenzi Ma
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Hong Fan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China
| | - Yongquan Lin
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Feng Ye
- Department of Pulmonary and Critical Care Medicine, The First Affiliate Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xifang Nie
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China
| | - Qiao Zhang
- Department of Pulmonary and Critical Care Medicine, Xinqiao Hospital of Army Medical University, Chongqing, China
| | - Xinlun Tian
- Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Guoxiang Lai
- Department of Pulmonary and Critical Care Medicine, Fuzhou General Hospital, Fuzhou, China
| | - Min Zhou
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, China.
| | - Jinmin Ma
- Clin Lab, BGI Genomics, Shenzhen 518083, China; PathoGenesis, BGI Genomics, Shenzhen 518083, China.
| | - Jing Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases, Shanghai, China.
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4
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Xie S, Wang J, Tuo W, Zhuang S, Cai Q, Yao C, Han F, Zhu H, Xiang Y, Yuan C. Serum level of S100A8/A9 as a biomarker for establishing the diagnosis and severity of community-acquired pneumonia in children. Front Cell Infect Microbiol 2023; 13:1139556. [PMID: 37180431 PMCID: PMC10172663 DOI: 10.3389/fcimb.2023.1139556] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/13/2023] [Indexed: 05/16/2023] Open
Abstract
Background S100A8/A9, which is a member of S100 proteins, may be involved in the pathophysiology of Community-acquired pneumonia (CAP) that seriously threatens children's health. However, circulating markers to assess the severity of pneumonia in children are yet to be explored. Therefore, we aimed to investigate the diagnostic performance of serum S100A8/A9 level in determining the severity of CAP in children. Methods In this prospective and observational study, we recruited 195 in-hospital children diagnosed with CAP. In comparison, 63 healthy children (HC) and 58 children with non-infectious pneumonia (pneumonitis) were included as control groups. Demographic and clinical data were collected. Serum S100A8/A9 levels, serum pro-calcitonin concentrations, and blood leucocyte counts were quantified. Results The serum S100A8/A9 levels in patients with CAP was 1.59 ± 1.32 ng/mL, which was approximately five and two times higher than those in healthy controls and those in children with pneumonitis, respectively. Serum S100A8/A9 was elevated parallelly with the clinical pulmonary infection score. The sensitivity, specificity, and Youden's index of S100A8/A9 ≥1.25 ng/mL for predicting the severity of CAP in children was optimal. The area under the receiver operating characteristic curve of S100A8/A9 was the highest among the indices used to evaluate severity. Conclusions S100A8/A9 may serve as a biomarker for predicting the severity of the condition in children with CAP and establishing treatment grading.
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Affiliation(s)
- Si Xie
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Wang
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbin Tuo
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shihao Zhuang
- Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qinzhen Cai
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Yao
- Health Care Department, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Han
- Department of Pediatric Respiratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongmin Zhu
- Department of Neurology, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hongmin Zhu, ; Yun Xiang, ; Chunhui Yuan,
| | - Yun Xiang
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hongmin Zhu, ; Yun Xiang, ; Chunhui Yuan,
| | - Chunhui Yuan
- Department of Laboratory Medicine, Wuhan Children’s Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Hongmin Zhu, ; Yun Xiang, ; Chunhui Yuan,
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5
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Korkmaz FT, Shenoy AT, Symer EM, Baird LA, Odom CV, Arafa EI, Dimbo EL, Na E, Molina-Arocho W, Brudner M, Standiford TJ, Mehta JL, Sawamura T, Jones MR, Mizgerd JP, Traber KE, Quinton LJ. Lectin-like oxidized low-density lipoprotein receptor 1 attenuates pneumonia-induced lung injury. JCI Insight 2022; 7:e149955. [PMID: 36264633 PMCID: PMC9746901 DOI: 10.1172/jci.insight.149955] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/18/2022] [Indexed: 01/12/2023] Open
Abstract
Identifying host factors that contribute to pneumonia incidence and severity are of utmost importance to guiding the development of more effective therapies. Lectin-like oxidized low-density lipoprotein receptor 1 (LOX-1, encoded by OLR1) is a scavenger receptor known to promote vascular injury and inflammation, but whether and how LOX-1 functions in the lung are unknown. Here, we provide evidence of substantial accumulation of LOX-1 in the lungs of patients with acute respiratory distress syndrome and in mice with pneumonia. Unlike previously described injurious contributions of LOX-1, we found that LOX-1 is uniquely protective in the pulmonary airspaces, limiting proteinaceous edema and inflammation. We also identified alveolar macrophages and recruited neutrophils as 2 prominent sites of LOX-1 expression in the lungs, whereby macrophages are capable of further induction during pneumonia and neutrophils exhibit a rapid, but heterogenous, elevation of LOX-1 in the infected lung. Blockade of LOX-1 led to dysregulated immune signaling in alveolar macrophages, marked by alterations in activation markers and a concomitant elevation of inflammatory gene networks. However, bone marrow chimeras also suggested a prominent role for neutrophils in LOX-1-mediated lung protection, further supported by LOX-1+ neutrophils exhibiting transcriptional changes consistent with reparative processes. Taken together, this work establishes LOX-1 as a tissue-protective factor in the lungs during pneumonia, possibly mediated by its influence on immune signaling in alveolar macrophages and LOX-1+ airspace neutrophils.
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Affiliation(s)
- Filiz T. Korkmaz
- Division of Immunology and Infectious Disease, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
| | | | | | | | | | | | | | | | | | - Matthew Brudner
- Flow Cytometry Core Facility, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Theodore J. Standiford
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jawahar L. Mehta
- Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences and the Central Arkansas Veterans Healthcare System, Little Rock, Arkansas, USA
| | - Tatsuya Sawamura
- Department of Molecular Pathophysiology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | | | - Joseph P. Mizgerd
- Pulmonary Center
- Department of Microbiology, and
- Department of Medicine and
- Department of Biochemistry, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Lee J. Quinton
- Division of Immunology and Infectious Disease, Department of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA
- Pulmonary Center
- Department of Medicine and
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6
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Cilloniz C, Torres A. What's Next in Pneumonia? Arch Bronconeumol 2022; 58:208-210. [PMID: 35312596 DOI: 10.1016/j.arbres.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/02/2021] [Accepted: 08/02/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona, Spain; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain.
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7
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Wittermans E, van der Zee PA, Qi H, van de Garde EMW, Blum CA, Christ-Crain M, Gommers D, Grutters JC, Voorn GP, Bos WJW, Endeman H. Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies. ERJ Open Res 2022; 8:00489-2021. [PMID: 35036417 PMCID: PMC8752939 DOI: 10.1183/23120541.00489-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022] Open
Abstract
Background Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) and whether the treatment effect of adjunctive corticosteroids differs between subgroups. Methods LCA was performed on baseline clinical and biomarker data from the Ovidius trial (n=304) and the Steroids in Pneumonia (STEP) trial (n=727), both randomised controlled trials investigating adjunctive corticosteroid treatment in CAP, and the observational TripleP cohort (n=201). Analyses were conducted independently in two cohorts (Ovidius–TripleP combined and the STEP trial). In both cohorts, differences in clinical outcomes and response to adjunctive corticosteroid treatment were examined between subgroups identified through LCA. Results A two-class model fitted both cohorts best. Class 2 patients had more signs of systemic inflammation compared to class 1. In both cohorts, length of stay was longer and in-hospital mortality rate was higher in class 2. In the Ovidius trial, corticosteroids reduced the median length of stay in class 2 (6.5 versus 9.5 days) but not in class 1 (p-value for interaction=0.02). In the STEP trial, there was no significant interaction for length of stay. We found no significant interaction between class assignment and adjunctive corticosteroid treatment for secondary outcomes. Conclusions In two independent cohorts, LCA identified two classes of CAP patients with different clinical characteristics and outcomes. Given the different response to adjunctive corticosteroids in the Ovidius trial, LCA might provide a useful basis to improve patient selection for future trials. Latent class analysis of baseline clinical and biomarker data identified two distinct classes of patients with community-acquired pneumonia in two cohorts. In one cohort, the response to adjunctive corticosteroid treatment differed between classes.https://bit.ly/3ClR92L
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Affiliation(s)
- Esther Wittermans
- Dept of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.,Dept of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.,These authors contributed equally
| | - Philip A van der Zee
- Dept of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands.,These authors contributed equally
| | - Hongchao Qi
- Dept of Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ewoudt M W van de Garde
- Dept of Clinical Pharmacology, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Claudine A Blum
- Depts of General Internal and Emergency Medicine, and Endocrinology, Diabetology and Clinical Nutrition, Medical University Clinic, Aarau, Switzerland
| | - Mirjam Christ-Crain
- Depts of Endocrinology, Diabetology and Metabolism, and Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Diederik Gommers
- Dept of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jan C Grutters
- Dept of Pulmonology, St Antonius Hospital, Nieuwegein, The Netherlands.,Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G Paul Voorn
- Dept of Medical Microbiology and Immunology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Willem Jan W Bos
- Dept of Internal Medicine, St Antonius Hospital, Nieuwegein, The Netherlands.,Dept of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henrik Endeman
- Dept of Adult Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
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8
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Abstract
Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location's epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
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Affiliation(s)
- Catia Cillóniz
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Antoni Torres
- Department of pneumology, Hospital Clinic of Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Biomedical Research Networking Centers in Respiratory Diseases (CIBERES), Barcelona, Spain
| | - Michael S Niederman
- Weill Cornell Medical College, Department of Pulmonary Critical Care Medicine, New York, NY, USA
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9
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Huang HK, Wang JH, Kao SL. Risk of developing pneumonia associated with clinically diagnosed hypothyroidism: a nationwide population-based cohort study. Fam Pract 2021; 38:630-636. [PMID: 33904923 DOI: 10.1093/fampra/cmab027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypothyroidism has a detrimental effect on the immune system, which may predispose patients to infection. However, evidence about the risk of developing either community- or hospital-acquired pneumonia in patients with hypothyroidism is scarce. OBJECTIVE To evaluate the association between hypothyroidism and the risk of developing pneumonia. METHODS This was a retrospective population-based cohort study from Taiwan's National Health Insurance Research Database. After 1:1 propensity score matching, 9749 patients (age ≥20 years) newly diagnosed with hypothyroidism between 2001 and 2014 and 9749 patients without hypothyroidism or other thyroid diseases were included in the hypothyroidism and non-hypothyroidism cohorts, respectively, and followed up until 2015. The development of pneumonia was defined as the primary outcome. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of developing pneumonia between hypothyroidism and non-hypothyroidism cohorts after adjusting for age, sex and baseline comorbidities. To evaluate whether thyroxine replacement therapy (TRT) modified the risk for pneumonia, we divided patients with hypothyroidism into subgroups: patients who received TRT and those who did not. RESULTS Hypothyroidism was associated with a higher risk of pneumonia [adjusted HR (aHR) 1.38, 95% confidence interval (CI) 1.29-1.49, P < 0.001]. Patients with hypothyroidism who received TRT had a lower risk of pneumonia than patients who did not (aHR 0.85, 95% CI 0.76-0.93, P = 0.001). Similar results were obtained in the age- and sex-stratified analyses. CONCLUSIONS Clinically diagnosed hypothyroidism was independently associated with the risk of pneumonia. In patients with hypothyroidism, TRT was associated with a lower risk of pneumonia.
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Affiliation(s)
- Huei-Kai Huang
- Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Sheng-Lun Kao
- Division of Geriatric Medicine, Department of Family Medicine, Hualien Tzu Chi Hospital and Tzu Chi University, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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10
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Grasselli G, Scaravilli V, Alagna L, Bombino M, De Falco S, Bandera A, Abbruzzese C, Patroniti N, Gori A, Pesenti A. Gastrointestinal colonization with multidrug-resistant Gram-negative bacteria during extracorporeal membrane oxygenation: effect on the risk of subsequent infections and impact on patient outcome. Ann Intensive Care 2019; 9:141. [PMID: 31853672 PMCID: PMC6920277 DOI: 10.1186/s13613-019-0615-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/05/2019] [Indexed: 01/12/2023] Open
Abstract
Background In ICU patients, digestive tract colonization by multidrug-resistant (MDR) Gram-negative (G−) bacteria is a significant risk factor for the development of infections. In patients undergoing extracorporeal membrane oxygenation (ECMO), colonization by MDR bacteria and risk of subsequent nosocomial infections (NIs) have not been studied yet. The aim of this study is to evaluate the incidence, etiology, risk factors, impact on outcome of gastrointestinal colonization by MDR G− bacteria, and risk of subsequent infections in patients undergoing ECMO. Methods This is a retrospective analysis of prospectively collected data: 105 consecutive patients, treated with ECMO, were admitted to the ICU of an Italian tertiary referral center (San Gerardo Hospital, Monza, Italy) from January 2010 to November 2015. Rectal swabs for MDR G− bacteria were cultured at admission and twice a week. Only colonization and NIs by MDR G− bacteria were analyzed. Results Ninety-one included patients [48.5 (37–56) years old, 63% male, simplified acute physiology score II 37 (32–47)] underwent peripheral ECMO (87% veno-venous) for medical indications (79% ARDS). Nineteen (21%) patients were colonized by MDR G− bacteria. Male gender (OR 4.03, p = 0.029) and duration of mechanical ventilation (MV) before ECMO > 3 days (OR 3.57, p = 0.014) were associated with increased risk of colonization. Colonized patients had increased odds of infections by the colonizing germs (84% vs. 29%, p < 0.001, OR 12.9), longer ICU length of stay (LOS) (43 vs. 24 days, p = 0.002), MV (50 vs. 22 days, p < 0.001) and ECMO (28 vs. 12 days, p < 0.001), but did not have higher risk of death (survival rate 58% vs. 67%, p = 0.480, OR 0.68). Infected patients had almost halved ICU survival (46% vs. 78%, p < 0.001, OR 4.11). Conclusions In patients undergoing ECMO for respiratory and/or circulatory failure, colonization by MDR G− bacteria is frequent and associated with more the tenfold odds for subsequent infection. Those infections are associated with an increased risk of death.
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Affiliation(s)
- Giacomo Grasselli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy. .,Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy.
| | - Vittorio Scaravilli
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy
| | - Laura Alagna
- Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Michela Bombino
- Department of Anesthesia, Critical Care and Emergency, ASST Monza San Gerardo Hospital, Monza, MB, Italy
| | - Stefano De Falco
- Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy.,Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Chiara Abbruzzese
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy
| | - Nicolò Patroniti
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy.,Infectious Diseases Unit, IRCCS Ca' Granda Ospedale Maggiore Policlinico Foundation, Milan, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122, Milan, MI, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, MI, Italy
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11
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Torres A, Ceccato A, Ferrer M, Gabarrus A, Sibila O, Cilloniz C, Mendez R, Menendez R, Bermejo-Martin J, Niederman MS. Effect of Corticosteroids on C-Reactive Protein in Patients with Severe Community-Acquired Pneumonia and High Inflammatory Response: The Effect of Lymphopenia. J Clin Med 2019; 8:jcm8091461. [PMID: 31540339 PMCID: PMC6780068 DOI: 10.3390/jcm8091461] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/30/2019] [Accepted: 09/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background: Lymphopenic patients with community-acquired pneumonia (CAP) have shown high mortality rates. Corticosteroids have immunomodulatory properties and regulate cytokine storm in CAP. However, it is not known whether their modulatory effect on cytokine secretion differs in lymphopenic and non-lymphopenic patients with CAP. Therefore, we aimed to test whether the presence of lymphopenia may modify the response to corticosteroids (mainly in C reactive protein (CRP)) in patients with severe CAP and high inflammatory status). Methods: A post hoc analysis of a randomized controlled trial (NCT00908713) which evaluated the effect of corticosteroids in patients with severe CAP and high inflammatory response (CRP > 15 mg/dL). Patients were clustered according to the presence of lymphopenia (lymphocyte count below 1000 cell/mm3). Results: At day 1, 35 patients (59%) in the placebo group presented with lymphopenia, compared to 44 patients (73%) in the corticosteroid group. The adjusted mean changes from day 1 showed an increase of 1.19 natural logarithm (ln) cell/mm3 in the corticosteroid group and an increase of 0.67 ln cell/mm3 in the placebo group (LS mean difference of the changes in ln (methylprednisolone minus placebo) 0.51, 95% CI (0.02 to 1.01), p = 0.043). A significant effect was also found for the interaction (p = 0.043) between corticosteroids and lymphopenia in CRP values at day 3, with lower values in patients without lymphopenia receiving corticosteroids after adjustments for potential confounders. Conclusion: In this exploratory post hoc analysis from ramdomized controlled trial (RCT) data, the response to corticosteroids, measured by CRP, may differ according to lymphocyte count. Further larger studies are needed to confirm this data.
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Affiliation(s)
- Antoni Torres
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Correspondence:
| | - Adrian Ceccato
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Miquel Ferrer
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Albert Gabarrus
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Oriol Sibila
- Servei de Pneumologia, Hospital de la Santa Creu i Sant Pau, Sant Antoni Maria Claret 167, 08025 Barcelona, Spain;
| | - Catia Cilloniz
- Department of Pneumology, Institut Clinic de Respiratori, Hospital Clinic of Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), Villarroel 170, 08036 Barcelona, Spain; (A.C.); (A.G.); (C.C.)
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
| | - Raúl Mendez
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, n° 106 Valencia, CIBERES, 46026 València, Spain;
- PhD program in Medicine and Traslational Research, University of Barcelona, Gran Via de les Corts Catalanes, 585, 08007 Barcelona, Spain
| | - Rosario Menendez
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Servicio de Neumología, IIS/Hospital Universitario y Politécnico La Fe, Avinguda de Fernando Abril Martorell, n° 106 Valencia, CIBERES, 46026 València, Spain;
| | - Jesus Bermejo-Martin
- Centro de Investigación Biomedica En Red-Enfermedades Respiratorias (CibeRes, CB06/06/0028), 28029 Madrid, Spain; (R.M.); (J.B.-M.)
- Group For Biomedical Research in Sepsis (BioSepsis), Instituto de Investigación BIomédica de Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Michael S. Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY 10065, USA;
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12
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Abstract
PURPOSE OF REVIEW Despite the improvements in its management, community-acquired pneumonia (CAP) still exhibits high global morbidity and mortality rates, especially in elderly patients. This review focuses on the most recent findings on the epidemiology, cause, diagnosis and management of CAP. RECENT FINDINGS There is consistent evidence that the trend in CAP mortality has declined over time. However, the mortality of pneumococcal CAP has not changed in the last two decades, with an increase in the rate of hospitalization and more severe forms of CAP. Streptococcus pneumoniae remains the most frequent cause of CAP in all settings, age groups and regardless of comorbidities. However, the implementation of molecular diagnostic tests in the last years has identified respiratory viruses as a common cause of CAP too. The emergency of multidrug-resistance pathogens is a worldwide concern. An improvement in our ability to promptly identify the causative cause of CAP is required in order to provide pathogen-directed antibiotic therapy, improve antibiotic stewardship programs and implement appropriate vaccine strategies. SUMMARY It is time to apply all the knowledge generated in the last decade in order to optimize the management of CAP.
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13
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Dela Cruz CS, Wunderink RG, Christiani DC, Cormier SA, Crothers K, Doerschuk CM, Evans SE, Goldstein DR, Khatri P, Kobzik L, Kolls JK, Levy BD, Metersky ML, Niederman MS, Nusrat R, Orihuela CJ, Peyrani P, Prince AS, Ramírez JA, Ridge KM, Sethi S, Suratt BT, Sznajder JI, Tsalik EL, Walkey AJ, Yende S, Aggarwal NR, Caler EV, Mizgerd JP. Future Research Directions in Pneumonia. NHLBI Working Group Report. Am J Respir Crit Care Med 2019; 198:256-263. [PMID: 29546996 DOI: 10.1164/rccm.201801-0139ws] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pneumonia is a complex pulmonary disease in need of new clinical approaches. Although triggered by a pathogen, pneumonia often results from dysregulations of host defense that likely precede infection. The coordinated activities of immune resistance and tissue resilience then dictate whether and how pneumonia progresses or resolves. Inadequate or inappropriate host responses lead to more severe outcomes such as acute respiratory distress syndrome and to organ dysfunction beyond the lungs and over extended time frames after pathogen clearance, some of which increase the risk for subsequent pneumonia. Improved understanding of such host responses will guide the development of novel approaches for preventing and curing pneumonia and for mitigating the subsequent pulmonary and extrapulmonary complications of pneumonia. The NHLBI assembled a working group of extramural investigators to prioritize avenues of host-directed pneumonia research that should yield novel approaches for interrupting the cycle of unhealthy decline caused by pneumonia. This report summarizes the working group's specific recommendations in the areas of pneumonia susceptibility, host response, and consequences. Overarching goals include the development of more host-focused clinical approaches for preventing and treating pneumonia, the generation of predictive tools (for pneumonia occurrence, severity, and outcome), and the elucidation of mechanisms mediating immune resistance and tissue resilience in the lung. Specific areas of research are highlighted as especially promising for making advances against pneumonia.
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Affiliation(s)
- Charles S Dela Cruz
- 1 Pulmonary, Critical Care and Sleep Medicine, Center for Pulmonary Infection Research and Treatment, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Richard G Wunderink
- 2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David C Christiani
- 3 Department of Environmental Health, Harvard T. H. Chan School of Public Health, and.,4 Pulmonary and Critical Care Division, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts
| | - Stephania A Cormier
- 5 Department of Biological Sciences, Louisiana State University, Baton Rouge, Louisiana
| | - Kristina Crothers
- 6 Department of Medicine, University of Washington, Seattle, Washington
| | - Claire M Doerschuk
- 7 Marsico Lung Institute and.,8 Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Scott E Evans
- 9 Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Goldstein
- 10 Department of Internal Medicine.,11 Department of Microbiology and Immunology, and.,12 Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Purvesh Khatri
- 13 Center for Biomedical Information Research, Stanford University, Stanford, California
| | - Lester Kobzik
- 3 Department of Environmental Health, Harvard T. H. Chan School of Public Health, and
| | - Jay K Kolls
- 14 Center for Translational Research in Infection and Inflammation, Tulane School of Medicine, New Orleans, Louisiana
| | - Bruce D Levy
- 15 Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark L Metersky
- 16 Division of Pulmonary, Critical Care and Sleep Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael S Niederman
- 17 Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Roomi Nusrat
- 18 Department of Medicine, Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey
| | - Carlos J Orihuela
- 19 Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paula Peyrani
- 20 Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Alice S Prince
- 21 Department of Pediatrics, Columbia University, New York, New York
| | - Julio A Ramírez
- 20 Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Karen M Ridge
- 2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sanjay Sethi
- 22 Pulmonary, Critical Care and Sleep Medicine, Jacobs School of Medicine, University at Buffalo, State University of New York, Buffalo, New York
| | - Benjamin T Suratt
- 23 Pulmonary and Critical Care Medicine, University of Vermont College of Medicine, Burlington, Vermont
| | - Jacob I Sznajder
- 2 Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ephraim L Tsalik
- 24 Emergency Medicine Service, Durham Veterans Affairs Health Care System, Durham, North Carolina.,25 Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Allan J Walkey
- 26 Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
| | - Sachin Yende
- 27 Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness Center, University of Pittsburgh, Pittsburgh, Pennsylvania.,28 Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; and
| | - Neil R Aggarwal
- 29 Division of Lung Diseases, NHLBI, NIH, Bethesda, Maryland
| | | | - Joseph P Mizgerd
- 26 Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts
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14
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Simultaneous Depression of Immunological Synapse and Endothelial Injury is Associated with Organ Dysfunction in Community-Acquired Pneumonia. J Clin Med 2019; 8:jcm8091404. [PMID: 31500177 PMCID: PMC6780106 DOI: 10.3390/jcm8091404] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 01/07/2023] Open
Abstract
Rationale: A depressed expression of antigen presentation is, along with endothelial dysfunction, a recognized signature of severe community-acquired pneumonia (CAP). We aimed to evaluate the expression of a number of genes involved in the immunological synapse in non-critically ill CAP patients with or without organ dysfunction and to profile endothelial biomarkers such as proendothelin-1 (proET1) and proadrenomedullin (proADM). Methods: A nested study in a prospective cohort in CAP patients was performed. Expression levels of major histocompatibility complex class II DR alpha (HLA-DRA), CD40 ligand (CD40LG), CD3E, CD28, and inducible T-cell costimulator (ICOS) were quantified by using droplet digital polymerase chain reaction and endothelial biomarkers by immunofluorescence. Results: Ninety-four patients were included, 44.7% of whom had organ failure in one or more organs. A significant decrease in the expression of the five genes with increased levels of proadrenomedullin (proADM) and proendothelin-1 (proET1) was found in CAP with organ failure. The depressed expression of HLA-DRA (odds ratio (OR), 2.94), CD40LG (OR, 3.90), and CD28 (OR, 3.48) was independently associated with organ failure after adjustment for age, Charlson score, and severity. Conclusions. CAP with organ failure showed depressed expression of immunological synapse genes with increased levels of biomarkers denoting endothelial damage. Simultaneous profiling of immunological and endothelial signatures could help in the early identification of organ failure in CAP and in the implementation of personalized treatment.
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15
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Ceccato A, Panagiotarakou M, Ranzani OT, Martin-Fernandez M, Almansa-Mora R, Gabarrus A, Bueno L, Cilloniz C, Liapikou A, Ferrer M, Bermejo-Martin JF, Torres A. Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia. J Clin Med 2019; 8:jcm8060843. [PMID: 31200458 PMCID: PMC6617552 DOI: 10.3390/jcm8060843] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP. METHODS Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016). RESULTS Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94). CONCLUSION Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.
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Affiliation(s)
- Adrian Ceccato
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
| | | | - Otavio T Ranzani
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
- Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01246-903, Brazil.
| | - Marta Martin-Fernandez
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Grupo de Investigación Biomédica en Sepsis (Bio∙Sepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain.
| | - Raquel Almansa-Mora
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Grupo de Investigación Biomédica en Sepsis (Bio∙Sepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain.
| | - Albert Gabarrus
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
| | - Leticia Bueno
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
| | - Catia Cilloniz
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
| | | | - Miquel Ferrer
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
| | - Jesus F Bermejo-Martin
- Group for Biomedical Research in Sepsis (Bio∙Sepsis), Grupo de Investigación Biomédica en Sepsis (Bio∙Sepsis), Instituto de Investigación Biomédica de Salamanca (IBSAL), Paseo de San Vicente, 58-182, 37007 Salamanca, Spain.
| | - Antoni Torres
- Pneumology Department, Respiratory Institute (ICR), Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) - University of Barcelona, Ciber de Enfermedades Respiratorias (CIBERES), ICREA Academia, 08036 Barcelona, Spain.
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16
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Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock. J Clin Med 2019; 8:jcm8050754. [PMID: 31137863 PMCID: PMC6572378 DOI: 10.3390/jcm8050754] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023] Open
Abstract
Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.
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17
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Lymphopenic community-acquired pneumonia is associated with a dysregulated immune response and increased severity and mortality. J Infect 2019; 78:423-431. [PMID: 30965065 DOI: 10.1016/j.jinf.2019.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/20/2019] [Accepted: 04/02/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Lymphopenic (<724 lymphocytes/µL) community-acquired pneumonia (L-CAP) is an immunophenotype with an increased risk of mortality. We aimed to characterize the l-CAP immunophenotype though lymphocyte subsets and the inflammatory response and its relationship with severity at presentation and outcome. METHODS Prospective study of 217 immunocompetent patients hospitalized for CAP. Lymphocyte subsets (CD4+, CD8+, CD19+, and natural killer [NK] cells) and inflammatory cytokines were analyzed on days 1 and 4, and immunoglobulin subclasses were analyzed on day 1 in a nested group. RESULTS 39% of patients showed l-CAP, with decreased levels of all lymphocyte subsets with a partial recovery of CD4+ and CD8+ cells by day 4. l-CAP patients exhibited higher initial severity and systemic levels of interleukin (IL)-8, IL-10, granulocyte colony-stimulating factor, and monocyte chemoattractant protein-1. Initial IgG2 levels were lower in patients with <724 lymphocytes/µL and positively correlated with ALC, CD4+, and CD19+ cell counts. Low CD4+ counts (<129 cells/µL) also independently predicted 30-day mortality after adjusting for age, gender, and the CURB-65 score. CONCLUSIONS l-CAP is characterized by CD4+ depletion, a higher inflammatory response, and low IgG2 levels that correlated with greater severity at presentation and worse prognosis. l-CAP is an immunophenotype useful for rapidly recognizing severity.
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Mahashur A, Thomas PK, Mehta P, Nivangune K, Muchhala S, Jain R. Pidotimod: In-depth review of current evidence. Lung India 2019; 36:422-433. [PMID: 31464215 PMCID: PMC6710962 DOI: 10.4103/lungindia.lungindia_39_19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Pidotimod, an immunostimulant, is researched for over two decades. Current evidence indicates its utility in a variety of indications in children as well as in adults. Its immunostimulant activity has been firmly established in the management of recurrent respiratory infections in children with or without asthma. Compared to standard of care alone, addition of pidotimod to standard of care significantly prevents the recurrences and reduces the severity and duration of acute episodes, ultimately resulting in reduced visits to pediatric clinics and lower absenteeism at school. In adults, pidotimod is effective in the prevention and treatment of acute infectious exacerbations of chronic bronchitis and chronic obstructive pulmonary disease (COPD). Further, it has been evaluated in indications such as pneumonia, hand–food–mouth disease, bronchiectasis, and chronic idiopathic urticaria. From a total of 32 studies conducted in child (24 studies) and adult (8 studies) population, this in-depth review discusses the current evidence of pidotimod. With further exploration, the immunostimulant activity of pidotimod might be extended to different immunological disorders.
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Affiliation(s)
- Ashok Mahashur
- PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - P K Thomas
- Department of Respiratory Medicine, Apollo Clinic, Chennai, Tamil Nadu, India
| | - Parthiv Mehta
- Department of Respiratory Medicine, Mehta Hospital, Ahmedabad, Gujarat, India
| | - Kundan Nivangune
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Snehal Muchhala
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
| | - Rishi Jain
- Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
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Ceccato A, Ferrer M, Barbeta E, Torres A. Adjunctive Therapies for Community-Acquired Pneumonia. Clin Chest Med 2018; 39:753-764. [DOI: 10.1016/j.ccm.2018.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Menéndez R, Amara-Elori I, Méndez R. Corticosteroids and pneumonia - targeting the ideal candidate. Expert Rev Respir Med 2018; 12:721-724. [PMID: 30016132 DOI: 10.1080/17476348.2018.1502085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Rosario Menéndez
- a Pneumology Department , University and Polytechnic Hospital La Fe , Valencia , Spain
| | - Isabel Amara-Elori
- a Pneumology Department , University and Polytechnic Hospital La Fe , Valencia , Spain
| | - Raul Méndez
- a Pneumology Department , University and Polytechnic Hospital La Fe , Valencia , Spain
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