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Lee GR, Ko SH, Choi HS, Hong HP, Lee JS, Jeong KY. Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia. Clin Exp Emerg Med 2024; 11:171-180. [PMID: 38286501 PMCID: PMC11237258 DOI: 10.15441/ceem.23.142] [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: 10/08/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVE This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP). METHODS This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. RESULTS Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992-0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality. CONCLUSION A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.
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Affiliation(s)
- Ga Ram Lee
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Seok Hoon Ko
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Hoon Pyo Hong
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Jong Seok Lee
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Korea
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2
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Cavallazzi R, Ramirez JA. Definition, Epidemiology, and Pathogenesis of Severe Community-Acquired Pneumonia. Semin Respir Crit Care Med 2024; 45:143-157. [PMID: 38330995 DOI: 10.1055/s-0044-1779016] [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: 02/10/2024]
Abstract
The clinical presentation of community-acquired pneumonia (CAP) can vary widely among patients. While many individuals with mild symptoms can be managed as outpatients with excellent outcomes, there is a distinct subgroup of patients who present with severe CAP. In these cases, the mortality rate can reach approximately 25% within 30 days and even up to 50% within a year. It is crucial to focus attention on these patients who are at higher risk. Among the various definitions of severe CAP found in the literature, one commonly used criterion is the requirement for admission to intensive care unit. Notable epidemiological characteristics of these patients include the impact of acute cardiovascular diseases on clinical outcomes and the enduring, independent effect of pneumonia on long-term outcomes. Factors such as pathogen virulence, the presence of comorbidities, and the host response are important contributors to the pathogenesis of severe CAP. In these patients, the host response may be dysregulated and compartmentalized. Gaining a better understanding of the epidemiology and pathogenesis of severe CAP will provide a foundation for the development of new therapies for this condition. This manuscript aims to review the definition, epidemiology, and pathogenesis of severe CAP, shedding light on important aspects that can aid in the improvement of patient care and outcomes.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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3
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den Hartog I, Zwep LB, Meulman JJ, Hankemeier T, van de Garde EMW, van Hasselt JGC. Longitudinal metabolite profiling of Streptococcus pneumoniae-associated community-acquired pneumonia. Metabolomics 2024; 20:35. [PMID: 38441696 PMCID: PMC10914916 DOI: 10.1007/s11306-024-02091-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/17/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION Longitudinal biomarkers in patients with community-acquired pneumonia (CAP) may help in monitoring of disease progression and treatment response. The metabolic host response could be a potential source of such biomarkers since it closely associates with the current health status of the patient. OBJECTIVES In this study we performed longitudinal metabolite profiling in patients with CAP for a comprehensive range of metabolites to identify potential host response biomarkers. METHODS Previously collected serum samples from CAP patients with confirmed Streptococcus pneumoniae infection (n = 25) were used. Samples were collected at multiple time points, up to 30 days after admission. A wide range of metabolites was measured, including amines, acylcarnitines, organic acids, and lipids. The associations between metabolites and C-reactive protein (CRP), procalcitonin, CURB disease severity score at admission, and total length of stay were evaluated. RESULTS Distinct longitudinal profiles of metabolite profiles were identified, including cholesteryl esters, diacyl-phosphatidylethanolamine, diacylglycerols, lysophosphatidylcholines, sphingomyelin, and triglycerides. Positive correlations were found between CRP and phosphatidylcholine (34:1) (cor = 0.63) and negative correlations were found for CRP and nine lysophosphocholines (cor = - 0.57 to - 0.74). The CURB disease severity score was negatively associated with six metabolites, including acylcarnitines (tau = - 0.64 to - 0.58). Negative correlations were found between the length of stay and six triglycerides (TGs), especially TGs (60:3) and (58:2) (cor = - 0.63 and - 0.61). CONCLUSION The identified metabolites may provide insight into biological mechanisms underlying disease severity and may be of interest for exploration as potential treatment response monitoring biomarker.
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Affiliation(s)
- Ilona den Hartog
- Division of Systems Pharmacology & Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Laura B Zwep
- Division of Systems Pharmacology & Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands
| | - Jacqueline J Meulman
- LUXs Data Science, Leiden, The Netherlands
- Department of Statistics, Stanford University, Stanford, CA, USA
| | - Thomas Hankemeier
- Metabolomics Centre, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Ewoudt M W van de Garde
- Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J G Coen van Hasselt
- Division of Systems Pharmacology & Pharmacy, Leiden Academic Centre for Drug Research, Leiden University, Einsteinweg 55, 2333 CC, Leiden, The Netherlands.
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İlhan B, Bozdereli Berikol G, Doğan H. The prognostic value of rapid risk scores among patients with community-acquired pneumonia : A retrospective cohort study. Wien Klin Wochenschr 2023; 135:507-516. [PMID: 37405488 DOI: 10.1007/s00508-023-02238-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/04/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a frequent reason for emergency department (ED) presentations. Various risk scores have been validated in the management of CAP and are recommended for daily practice. OBJECTIVE The aim of the study was to evaluate the performance of the rapid risk scores (the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), the Worthing physiological scoring system (WPS), CURB-65 and CRB-65) among patients with CAP. METHODS This retrospective cohort study was conducted in the ED of a tertiary hospital between 1 January 2019 and 31 December 2019. Patients aged ≥ 18 years and diagnosed with CAP were included. Patients who were transferred from another center or with missing records were excluded. Demographic information, vital signs, level of consciousness, laboratory results, and outcomes were recorded. RESULTS A total of 2057 patients were included in the final analysis. The 30-day mortality of the patients was 15.2% (n = 312). The WPS achieved the most successful results for all three outcomes, 30-day mortality, intensive care unit (ICU) admission and mechanical ventilation (MV) needs (area under the curve, AUC 0.810, 0.918, and 0.910, respectively; p < 0.001). In the prediction of mortality, RAPS, REMS, CURB-65, and CRB-65 had a moderate overall performance (AUC 0.648, 0.752, 0.778, and 0.739, respectively). In the prediction of ICU admission and MV needs, RAPS, REMS, CURB-65, and CRB-65 had moderate to good overall performance (AUC at ICU admission 0.793, 0.873, 0.829, and 0.810; AUC for MV needs 0.759, 0.892, 0.754, and 0.738, respectively). Advanced age, lower levels of mean arterial pressure and peripheral oxygen saturation, presence of active malignancy and cerebrovascular disease, and ICU admission were associated with mortality (p < 0.05). CONCLUSION The WPS outperformed other risk scores in patients with CAP and can be used safely. The CRB-65 can be used to discriminate critically ill patients with CAP due to its high specificity. The overall performances of the scores were satisfactory for all three outcomes.
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Affiliation(s)
- Buğra İlhan
- Department of Emergency Medicine, Kırıkkale University Faculty of Medicine, Kırıkkale, Turkey.
| | - Göksu Bozdereli Berikol
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Halil Doğan
- Department of Emergency Medicine, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Wakabayashi T, Hamaguchi S, Morimoto K. Clinically defined aspiration pneumonia is an independent risk factor associated with long-term hospital stay: a prospective cohort study. BMC Pulm Med 2023; 23:351. [PMID: 37718411 PMCID: PMC10506309 DOI: 10.1186/s12890-023-02641-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Long-term hospital stay is associated with functional decline in patients with pneumonia, especially in the elderly. Among elderly patients with pneumonia, aspiration pneumonia is a major category. Clinical definition is usually used because it can occur without apparent aspiration episodes. It is still not clear whether a long-term hospital stay is due to aspiration pneumonia itself caused by underlying oropharyngeal dysfunction or simply due to functional decline in elderly patients with multiple comorbidities during acute infection. The aim of this study is to identify whether clinically defined aspiration pneumonia itself was associated with a long-term hospital stay. METHODS A prospective observational study on community-acquired (CAP) or healthcare-associated pneumonia (HCAP) was conducted from January 2012 through January 2014. Aspiration pneumonia was clinically defined as pneumonia not only occurring in patients after documented aspiration episodes, but also occurring in those with underlying oropharyngeal dysfunction: chronic disturbances of consciousness and/or chronic neuromuscular diseases. We defined thirty-day hospital stay as a long-term hospital stay and compared it with logistic regression analysis. Potential confounders included age, sex, HCAP, body mass index (BMI), long-term bed-ridden state, heart failure, cerebrovascular disorders, dementia, antipsychotics use, hypnotics use, and CURB score which is a clinical prediction tool used to assess the severity, standing for; C (presence of Confusion), U (high blood Urea nitrogen level), R (high Respiratory rate), and B (low Blood pressure). In a sub-analysis, we also explored factors associated with long-term hospital stay in patients with aspiration pneumonia. RESULTS Of 2,795 patients, 878 (31.4%) had aspiration pneumonia. After adjusting potential confounders, the aspiration pneumonia itself was significantly associated with long-term hospital stay (adjusted odds ratio 1.44; 95% confidence interval 1.09-1.89, p < 0.01), as were higher age, male sex, high CURB score, HCAP, low BMI, heart failure, cerebrovascular disease, and antipsychotics use. Sub-analysis revealed factors associated with long-term hospital stay in the aspiration pneumonia, which included male sex, and multi-lobar chest X-ray involvement. CONCLUSIONS Clinically defined aspiration pneumonia itself was independently associated with long-term hospital stay. This result could potentially lead to specific rehabilitation strategies for pneumonia patients with underlying oropharyngeal dysfunction.
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Affiliation(s)
- Takao Wakabayashi
- Department of General and Emergency Medicine, Japan Community Healthcare Organization Sapporo Hokushin Hospital, 2-1,2-Jo,6-Chome, Atsubetsu-Cho, Atsubetsu-Ku, Sapporo, 004-8618, Japan
- Department of General Internal Medicine, Ebetsu City Hospital, Hokkaido, Japan
| | - Sugihiro Hamaguchi
- Department of General Internal Medicine, Ebetsu City Hospital, Hokkaido, Japan.
- Department of General Internal Medicine, Fukushima Medical University, 1, Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Konosuke Morimoto
- Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Carr AC, Vlasiuk E, Zawari M, Scott-Thomas A, Storer M, Maze M, Chambers ST. Low Vitamin C Concentrations in Patients with Community-Acquired Pneumonia Resolved with Pragmatic Administration of Intravenous and Oral Vitamin C. Antioxidants (Basel) 2023; 12:1610. [PMID: 37627604 PMCID: PMC10451831 DOI: 10.3390/antiox12081610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/27/2023] Open
Abstract
Community-acquired pneumonia (CAP) is characterized by elevated markers of inflammation and oxidative stress and depleted circulating concentrations of the antioxidant nutrient vitamin C. A feasibility trial of intravenous and oral vitamin C supplementation, matched to the timing of intravenous and oral antibiotic formulations, was carried out and changes in vitamin C status were monitored to determine whether saturating status could be achieved throughout the administration period. Patients with moderate and severe CAP (CURB-65 ≥ 2; n = 75) who were receiving intravenous antimicrobial therapy were randomized to placebo (n = 39) or intravenous vitamin C (2.5 g per 8 h; n = 36) before moving to oral vitamin C (1 g three times daily) when prescribed oral antimicrobials. Blood samples were collected at baseline and then daily whilst in the hospital. Vitamin C concentrations were determined by high-performance liquid chromatography. The inflammatory and infection biomarkers C-reactive protein and procalcitonin were elevated at baseline (158 (61, 277) mg/L and 414 (155, 1708) ng/L, respectively), and vitamin C concentrations were depleted (15 (7, 25) µmol/L). There was an inverse association between vitamin C and C-reactive protein concentrations (r = -0.312, p = 0.01). Within one day of intervention initiation, plasma vitamin C concentrations in the vitamin C group reached median concentrations of 227 (109, 422) µmol/L, and circulating concentrations remained at ≥150 µmol/L for the duration of the intervention, whilst median vitamin C concentrations in the placebo group remained low (≤35 µmol/L). There was a trend toward decreased duration of hospital stay (p = 0.07) and time to clinical stability (p = 0.08) in the vitamin C group. In conclusion, patients with moderate to severe CAP have inadequate plasma vitamin C concentrations for the duration of their hospital stay. The administration of intravenous or oral vitamin C, titrated to match the antimicrobial formulation, provided saturating plasma vitamin C concentrations whilst in the hospital. There were trends toward shorter duration of hospital stay and time to clinical stability. Thus, larger trials assessing the impact of intravenous and oral vitamin C intervention on CAP clinical outcomes are indicated.
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Affiliation(s)
- Anitra C. Carr
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand; (A.C.C.); (E.V.); (M.Z.); (A.S.-T.)
| | - Emma Vlasiuk
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand; (A.C.C.); (E.V.); (M.Z.); (A.S.-T.)
| | - Masuma Zawari
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand; (A.C.C.); (E.V.); (M.Z.); (A.S.-T.)
| | - Amy Scott-Thomas
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand; (A.C.C.); (E.V.); (M.Z.); (A.S.-T.)
| | - Malina Storer
- Respiratory Services, Christchurch Hospital, Christchurch 4710, New Zealand; (M.S.); (M.M.)
| | - Michael Maze
- Respiratory Services, Christchurch Hospital, Christchurch 4710, New Zealand; (M.S.); (M.M.)
| | - Stephen T. Chambers
- Department of Pathology and Biomedical Science, University of Otago, Christchurch 8011, New Zealand; (A.C.C.); (E.V.); (M.Z.); (A.S.-T.)
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Chambers ST, Storer M, Scott-Thomas A, Slow S, Williman J, Epton M, Murdoch DR, Metcalf S, Carr A, Isenman H, Maze M. Adjunctive intravenous then oral vitamin C for moderate and severe community-acquired pneumonia in hospitalized adults: feasibility of randomized controlled trial. Sci Rep 2023; 13:11879. [PMID: 37482552 PMCID: PMC10363531 DOI: 10.1038/s41598-023-37934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/29/2023] [Indexed: 07/25/2023] Open
Abstract
Patients hospitalised with community acquired pneumonia (CAP) have low peripheral blood vitamin C concentrations and limited antioxidant capacity. The feasibility of a trial of vitamin C supplementation to improve patient outcomes was assessed. Participants with moderate and severe CAP (CURB-65 ≥ 2) on intravenous antimicrobial treatment were randomised to either intravenous vitamin C (2.5 g 8 hourly) or placebo before switching to oral intervention (1 g tds) for 7 days when they were prescribed oral antimicrobial therapy. Of 344 patients screened 75 (22%) were randomised and analysed. The median age was 76 years, and 43 (57%) were male. In each group, one serious adverse event that was potentially intervention related occurred, and one subject discontinued treatment. Vitamin C concentrations were 226 µmol/L in the vitamin C group and 19 µmol/L in the placebo group (p < 0.001) after 3 intravneous doses. There were no signficant differences between the vitamin C and placebo groups for death within 28 days (0 vs. 2; p = 0.49), median length of stay (69 vs. 121 h; p = 0.07), time to clinical stability (22 vs. 49 h; p = 0.08), or readmission within 30 days (1 vs. 4; p = 0.22). The vitamin C doses given were safe, well tolerated and saturating. A randomised controlled trial to assess the efficacy of vitamin C in patients with CAP would require 932 participants (CURB-65 ≥ 2) to observe a difference in mortality and 200 participants to observe a difference with a composite endpoint such as mortality plus discharge after 7 days in hospital. These studies are feasible in a multicentre setting.
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Affiliation(s)
- Stephen T Chambers
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.
| | - Malina Storer
- Canterbury Respiratory Research Group, Canterbury District Health Board, Christchurch, New Zealand
| | - Amy Scott-Thomas
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Sandy Slow
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
- Department of Agricultural Sciences, Lincoln University, Lincoln, New Zealand
| | - Jonathan Williman
- Biostatistics and Computation Biology Unit, University of Otago, Christchurch, New Zealand
| | - Michael Epton
- Canterbury Respiratory Research Group, Canterbury District Health Board, Christchurch, New Zealand
| | - David R Murdoch
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Sarah Metcalf
- Department of Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Anitra Carr
- Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Heather Isenman
- Department of Infectious Diseases, Christchurch Hospital, Canterbury District Health Board, Christchurch, New Zealand
| | - Michael Maze
- Canterbury Respiratory Research Group, Canterbury District Health Board, Christchurch, New Zealand
- Department of Medicine, University of Otago, Christchurch, New Zealand
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8
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Greco S, Salatiello A, Fabbri N, Riguzzi F, Locorotondo E, Spaggiari R, De Giorgi A, Passaro A. Rapid Assessment of COVID-19 Mortality Risk with GASS Classifiers. Biomedicines 2023; 11:831. [DOI: doi.org/10.3390/biomedicines11030831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023] Open
Abstract
Risk prediction models are fundamental to effectively triage incoming COVID-19 patients. However, current triaging methods often have poor predictive performance, are based on variables that are expensive to measure, and often lead to hard-to-interpret decisions. We introduce two new classification methods that can predict COVID-19 mortality risk from the automatic analysis of routine clinical variables with high accuracy and interpretability. SVM22-GASS and Clinical-GASS classifiers leverage machine learning methods and clinical expertise, respectively. Both were developed using a derivation cohort of 499 patients from the first wave of the pandemic and were validated with an independent validation cohort of 250 patients from the second pandemic phase. The Clinical-GASS classifier is a threshold-based classifier that leverages the General Assessment of SARS-CoV-2 Severity (GASS) score, a COVID-19-specific clinical score that recently showed its effectiveness in predicting the COVID-19 mortality risk. The SVM22-GASS model is a binary classifier that non-linearly processes clinical data using a Support Vector Machine (SVM). In this study, we show that SMV22-GASS was able to predict the mortality risk of the validation cohort with an AUC of 0.87 and an accuracy of 0.88, better than most scores previously developed. Similarly, the Clinical-GASS classifier predicted the mortality risk of the validation cohort with an AUC of 0.77 and an accuracy of 0.78, on par with other established and emerging machine-learning-based methods. Our results demonstrate the feasibility of accurate COVID-19 mortality risk prediction using only routine clinical variables, readily collected in the early stages of hospital admission.
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Affiliation(s)
- Salvatore Greco
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
- Department of Internal Medicine, Ospedale del Delta, Via Valle Oppio 2, 44023 Ferrara, Italy
| | - Alessandro Salatiello
- Section for Computational Sensomotorics, Department of Cognitive Neurology, Centre for Integrative Neuroscience & Hertie Institute for Clinical Brain Research, University Clinic Tübingen, Otfried-Müller-Straße 25, 72076 Tübingen, Germany
| | - Nicolò Fabbri
- Department of General Surgery, Ospedale del Delta, Via Valle Oppio 2, 44023 Ferrara, Italy
| | - Fabrizio Riguzzi
- Department of Mathematics and Informatics, Via Nicolò Machiavelli 30, 44121 Ferrara, Italy
| | - Emanuele Locorotondo
- Radiology Department, University Radiology Unit, Hospital of Ferrara Arcispedale Sant’Anna, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Riccardo Spaggiari
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Alfredo De Giorgi
- Clinica Medica Unit, Azienda Ospedaliero-Universitaria S. Anna of Ferrara, Via Aldo Moro 8, 44124 Ferrara, Italy
| | - Angelina Passaro
- Department of Translational Medicine, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
- Medical Department, University Hospital of Ferrara Arcispedale Sant’Anna, Via A. Moro 8, 44124 Ferrara, Italy
- Research and Innovation Section, University Hospital of Ferrara Arcispedale Sant’Anna, Via A. Moro 8, 44124 Ferrara, Italy
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9
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Rapid Assessment of COVID-19 Mortality Risk with GASS Classifiers. Biomedicines 2023; 11:biomedicines11030831. [PMID: 36979810 PMCID: PMC10045158 DOI: 10.3390/biomedicines11030831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023] Open
Abstract
Risk prediction models are fundamental to effectively triage incoming COVID-19 patients. However, current triaging methods often have poor predictive performance, are based on variables that are expensive to measure, and often lead to hard-to-interpret decisions. We introduce two new classification methods that can predict COVID-19 mortality risk from the automatic analysis of routine clinical variables with high accuracy and interpretability. SVM22-GASS and Clinical-GASS classifiers leverage machine learning methods and clinical expertise, respectively. Both were developed using a derivation cohort of 499 patients from the first wave of the pandemic and were validated with an independent validation cohort of 250 patients from the second pandemic phase. The Clinical-GASS classifier is a threshold-based classifier that leverages the General Assessment of SARS-CoV-2 Severity (GASS) score, a COVID-19-specific clinical score that recently showed its effectiveness in predicting the COVID-19 mortality risk. The SVM22-GASS model is a binary classifier that non-linearly processes clinical data using a Support Vector Machine (SVM). In this study, we show that SMV22-GASS was able to predict the mortality risk of the validation cohort with an AUC of 0.87 and an accuracy of 0.88, better than most scores previously developed. Similarly, the Clinical-GASS classifier predicted the mortality risk of the validation cohort with an AUC of 0.77 and an accuracy of 0.78, on par with other established and emerging machine-learning-based methods. Our results demonstrate the feasibility of accurate COVID-19 mortality risk prediction using only routine clinical variables, readily collected in the early stages of hospital admission.
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10
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Cavallazzi R, Bradley J, Chandler T, Furmanek S, Ramirez JA. Severity of Illness Scores and Biomarkers for Prognosis of Patients with Coronavirus Disease 2019. Semin Respir Crit Care Med 2023; 44:75-90. [PMID: 36646087 DOI: 10.1055/s-0042-1759567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The spectrum of disease severity and the insidiousness of clinical presentation make it difficult to recognize patients with coronavirus disease 2019 (COVID-19) at higher risk of worse outcomes or death when they are seen in the early phases of the disease. There are now well-established risk factors for worse outcomes in patients with COVID-19. These should be factored in when assessing the prognosis of these patients. However, a more precise prognostic assessment in an individual patient may warrant the use of predictive tools. In this manuscript, we conduct a literature review on the severity of illness scores and biomarkers for the prognosis of patients with COVID-19. Several COVID-19-specific scores have been developed since the onset of the pandemic. Some of them are promising and can be integrated into the assessment of these patients. We also found that the well-known pneumonia severity index (PSI) and CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) are good predictors of mortality in hospitalized patients with COVID-19. While neither the PSI nor the CURB-65 should be used for the triage of outpatient versus inpatient treatment, they can be integrated by a clinician into the assessment of disease severity and can be used in epidemiological studies to determine the severity of illness in patient populations. Biomarkers also provide valuable prognostic information and, importantly, may depict the main physiological derangements in severe disease. We, however, do not advocate the isolated use of severity of illness scores or biomarkers for decision-making in an individual patient. Instead, we suggest the use of these tools on a case-by-case basis with the goal of enhancing clinician judgment.
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Affiliation(s)
- Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Norton Healthcare, Louisville, Kentucky
| | - Thomas Chandler
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Stephen Furmanek
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
| | - Julio A Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, Kentucky
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11
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Graham FF, Baker MG. Epidemiology and direct health care costs of hospitalised legionellosis in New Zealand, 2000-2020. Infect Dis Health 2023; 28:27-38. [PMID: 36038465 DOI: 10.1016/j.idh.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Legionellosis is a collective term used for disease caused by Legionella species which result in community and hospital acquired pneumonia worldwide. The aim of this analysis was to describe the epidemiology of legionellosis hospitalisations in Aotearoa New Zealand (NZ) over a 21-year period and quantify the health care costs. METHOD This study combined national legionellosis notification and hospital discharge data that were linked via the National Health Index (NHI) to provide a more complete dataset of hospitalised cases. The direct cost of hospital care was estimated by multiplying the diagnosis-related group cost-weight by the national price and inflating to 2020/2021 values. RESULTS There were 1479 records matched across notifications and discharge databases, including 990 with principal and 489 with additional diagnosis of legionellosis. Incidence rose to an average of 143 cases per annum for 2016-2020, a rate of 3·2/100,000. The median LOS was 6 days (IQR 4-13·5) with direct costs of $2·1 million per annum over that period. Rates were highest in those aged 65 years and above, male, and of European/Other ethnicity. Hospitalisations showed a peak in spring and summer. CONCLUSION The rate of hospitalised legionellosis in New Zealand rose from 2000 to 2015, largely reflecting improved diagnosis. This preventable disease results in substantial health care costs. Greater efforts are needed to identify and control sources of exposure. Surveillance could be improved by routine integration of notification and hospital discharge data.
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Affiliation(s)
- Frances F Graham
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
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Epelboin L, Mahamat A, Bonifay T, Demar M, Abboud P, Walter G, Drogoul AS, Berlioz-Arthaud A, Nacher M, Raoult D, Djossou F, Eldin C. Q Fever as a Cause of Community-Acquired Pneumonia in French Guiana. Am J Trop Med Hyg 2022; 107:407-415. [PMID: 35977720 PMCID: PMC9393466 DOI: 10.4269/ajtmh.21-0711] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
In French Guiana, community-acquired pneumonia (CAP) represents over 90% of Coxiella burnetii acute infections. Between 2004 and 2007, we reported that C. burnetii was responsible for 24.4% of the 131 CAP hospitalized in Cayenne. The main objective of the present study was to determine whether the prevalence of Q fever pneumonia remained at such high levels. The secondary objectives were to identify new clinical characteristics and risk factors for C. burnetii pneumonia. A retrospective case-control study was conducted on patients admitted in Cayenne Hospital, between 2009 and 2012. All patients with CAP were included. The diagnosis of acute Q fever relied on titers of phase II IgG ≥ 200 and/or IgM ≥ 50 or seroconversion between two serum samples. Patients with Q fever were compared with patients with non-C. burnetii CAP in bivariate and multivariate analyses. During the 5-year study, 275 patients with CAP were included. The etiology of CAP was identified in 54% of the patients. C. burnetii represented 38.5% (106/275; 95% CI: 31.2-45.9%). In multivariate analysis, living in Cayenne area, being aged 30-60 years, C-reactive protein (CRP) > 185 mg/L, and leukocyte count < 10 G/L were independently associated with Q fever. The prevalence of Q fever among CAP increased to 38.5%. This is the highest prevalence ever reported in the world. This high prevalence justifies the systematic use of doxycycline in addition to antipneumococcal antibiotic regimens.
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Affiliation(s)
- Loïc Epelboin
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
| | - Aba Mahamat
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Corsica Centre for Healthcare-Associated Infections Control and Prevention, Hôpital Eugénie, Ajaccio, France
| | - Timothée Bonifay
- Département Universitaire de Médecine Générale, Université des Antilles, Pointe-à-Pitre, Guadeloupe
| | - Magalie Demar
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
- Laboratoire Hospitalo-Universitaire de Parasitologie et Mycologie, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, Guyane française
| | - Philippe Abboud
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
| | - Gaëlle Walter
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
| | | | | | - Mathieu Nacher
- Centre d’Investigation Clinique, CIC INSERM 1424, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | | | - Félix Djossou
- Infectious and Tropical Diseases Department, Centre Hospitalier de Cayenne Andrée Rosemon, Cayenne, French Guiana
- Equipe EA 3593, Ecosystèmes Amazoniens et Pathologie Tropicale, Université de la Guyane, Cayenne, Guyane française
| | - Carole Eldin
- Aix Marseille University, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
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Barlas RS, Clark AB, Loke YK, Kwok CS, Angus DC, Uranga A, España PP, Eurich DT, Huang DT, Man SY, Rainer TH, Yealy DM, Myint PK, Mor MK, Fine MJ. Comparison of the prognostic performance of the CURB-65 and a modified version of the pneumonia severity index designed to identify high-risk patients using the International Community-Acquired Pneumonia Collaboration Cohort. Respir Med 2022; 200:106884. [PMID: 35767924 DOI: 10.1016/j.rmed.2022.106884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although the PSI and CURB-65 represent well-validated prediction rules for pneumonia prognosis, PSI was designed to identify patients at low risk and CURB- 65 patients at high risk of mortality. We compared the prognostic performance of a modified version of the PSI designed to identify high-risk patients (i.e., PSI-HR) to CURB-65 in predicting short-term mortality. METHODS Using data from 6 pneumonia cohorts, we designed PSI-HR as a 6-class prediction rule using the original prognostic weights of all PSI variables and modifying the risk score thresholds to define risk classes. We calculated the proportion of low-risk and high-risk patients using CURB-65 and PSI-HR and 30-day mortality in these subgroups. We compared the rules' sensitivity, specificity, positive and negative predictive values for mortality at all risk class thresholds and assessed discriminatory power using areas under their receiver operating characteristic curves (AUROCs). RESULTS Among 13,874 patients with pneumonia, 1,036 (7.5%) died. For PSI-HR versus CURB-65, aggregate mortality was lower in low-risk patients (1.6% vs. 2.2%, p = 0.005) and higher in high-risk patients (36.5% vs. 32.2%, p = 0.27). PSI-HR had higher sensitivities than CURB-65 at all thresholds; PSI-HR also had higher specificities at the 3 lowest thresholds and specificities within 0.5% points of CURB-65 at the 2 highest thresholds. The AUROC was larger for PSI-HR than CURB- 65 (0.82 vs. 0.77, p < 0.0001). CONCLUSIONS PSI-HR demonstrated superior prognostic accuracy to CURB-65 at the lower end of the severity spectrum and identified high-risk patients with nonsignificant higher short-term mortality at the higher end.
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Affiliation(s)
- Raphae S Barlas
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Derek C Angus
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ane Uranga
- Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | - Pedro P España
- Servicio de Neumología, Hospital de Galdakao, Galdakao, Bizkaia, Spain
| | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - David T Huang
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shin Y Man
- Emergency Medicine Unit, Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Timothy H Rainer
- Emergency Medicine Unit, Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Donald M Yealy
- Department of Emergency Medicine at the University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Norwich Medical School, University of East Anglia, Norwich, UK
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael J Fine
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
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Extensive epigenetic modification with large-scale chromosomal and plasmid recombination characterise the Legionella longbeachae serogroup 1 genome. Sci Rep 2022; 12:5810. [PMID: 35388097 PMCID: PMC8987031 DOI: 10.1038/s41598-022-09721-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 03/15/2022] [Indexed: 11/08/2022] Open
Abstract
Legionella longbeachae is an environmental bacterium that is the most clinically significant Legionella species in New Zealand (NZ), causing around two-thirds of all notified cases of Legionnaires’ disease. Here we report the sequencing and analysis of the geo-temporal genetic diversity of 54 L. longbeachae serogroup 1 (sg1) clinical isolates, derived from cases from around NZ over a 22-year period, including one complete genome and its associated methylome. The 54 sg1 isolates belonged to two main clades that last shared a common ancestor between 95 BCE and 1694 CE. There was diversity at the genome-structural level, with large-scale arrangements occurring in some regions of the chromosome and evidence of extensive chromosomal and plasmid recombination. This includes the presence of plasmids derived from recombination and horizontal gene transfer between various Legionella species, indicating there has been both intra- and inter-species gene flow. However, because similar plasmids were found among isolates within each clade, plasmid recombination events may pre-empt the emergence of new L. longbeachae strains. Our complete NZ reference genome consisted of a 4.1 Mb chromosome and a 108 kb plasmid. The genome was highly methylated with two known epigenetic modifications, m4C and m6A, occurring in particular sequence motifs within the genome.
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Waagsbø B, Buset EM, Longva JÅ, Bjerke M, Bakkene B, Ertesvåg AS, Holmen H, Nikodojevic M, Tran TT, Christensen A, Nilsen E, Damås JK, Heggelund L. Diagnostic stewardship aiming at expectorated or induced sputum promotes microbial diagnosis in community-acquired pneumonia. BMC Infect Dis 2022; 22:203. [PMID: 35236305 PMCID: PMC8889388 DOI: 10.1186/s12879-022-07199-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/16/2022] [Indexed: 12/16/2022] Open
Abstract
Purpose Studies on aetiology of community-acquired pneumonia (CAP) vary in terms of microbial sampling methods, anatomical locations, and laboratory analyses, since no gold standard exists. In this large, multicentre, retrospective, regional study from Norway, our primary objective was to report the results of a strategic diagnostic stewardship intervention, targeting diagnostic yield from lower respiratory tract sampling. The secondary objective was to report hospitalized CAP aetiology and the diagnostic yield of various anatomical sampling locations.
Methods Medical records from cases diagnosed with hospitalized CAP were collected retrospectively from March throughout May for three consecutive years at six hospitals. Between year one and two, we launched a diagnostic stewardship intervention at the emergency room level for the university teaching hospital only. The intervention was multifaceted aiming at upscaling specimen collection and enhancing collection techniques. Year one at the interventional hospital and every year at the five other emergency hospitals were used for comparison.
Results Of the 1280 included cases of hospitalized CAP, a microbiological diagnosis was established for 29.1% among 1128 blood cultures and 1444 respiratory tract specimens. Blood cultures were positive for a pathogenic respiratory tract microbe in 4.9% of samples, whereas upper and lower respiratory tract samples overall provided a probable microbiological diagnosis in 21.3% and 47.5%, respectively. Expectorated or induced sputum overall provided aetiology in 51.7% of the samples. At the interventional hospital, the number of expectorated or induced sputum samples were significantly increased, and diagnostic yield from expectorated or induced sputum was significantly enhanced from 41.2 to 62.0% after the intervention (p = 0.049). There was an over-representation of samples from the interventional hospital during the study period. Non-typeable Haemophilus influenza and Streptococcus pneumoniae accounted for 25.3% and 24.7% of microbiologically confirmed cases, respectively. Conclusion Expectorated or induced sputum outperformed other sampling methods in providing a reliable microbiological diagnosis for hospitalized CAP. A diagnostic stewardship intervention significantly improved diagnostic yield of lower respiratory tract sampling.
Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07199-4.
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Affiliation(s)
- Bjørn Waagsbø
- Regional Centre for Disease Control in Central Norway Regional Health Authority, St. Olavs Hospital Trondheim University Hospital, Trondheim, Norway.
| | | | - Jørn-Åge Longva
- Department of Medicine, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Merete Bjerke
- Central Norway Hospital Pharmacy Trust, Ålesund, Norway
| | | | | | - Hanne Holmen
- Central Norway Hospital Pharmacy Trust, Trondheim, Norway
| | | | - To Thy Tran
- Central Norway Hospital Pharmacy Trust, Trondheim, Norway
| | - Andreas Christensen
- Department of Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Einar Nilsen
- Department of Microbiology, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Jan Kristian Damås
- Department of Infectious Diseases, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Centre of Molecular Inflammation Research, NTNU, Trondheim, Norway
| | - Lars Heggelund
- Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway.,Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
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Bian Y, Le Y, Du H, Chen J, Zhang P, He Z, Wang Y, Yu S, Fang Y, Yu G, Ling J, Feng Y, Wei S, Huang J, Xiao L, Zheng Y, Yu Z, Li S. Efficacy and Safety of Anticoagulation Treatment in COVID-19 Patient Subgroups Identified by Clinical-Based Stratification and Unsupervised Machine Learning: A Matched Cohort Study. Front Med (Lausanne) 2021; 8:786414. [PMID: 35004751 PMCID: PMC8740912 DOI: 10.3389/fmed.2021.786414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/26/2021] [Indexed: 12/12/2022] Open
Abstract
Objective: To explore the efficacy of anticoagulation in improving outcomes and safety of Coronavirus disease 2019 (COVID-19) patients in subgroups identified by clinical-based stratification and unsupervised machine learning. Methods: This single-center retrospective cohort study unselectively reviewed 2,272 patients with COVID-19 admitted to the Tongji Hospital between Jan 25 and Mar 23, 2020. The association between AC treatment and outcomes was investigated in the propensity score (PS) matched cohort and the full cohort by inverse probability of treatment weighting (IPTW) analysis. Subgroup analysis, identified by clinical-based stratification or unsupervised machine learning, was used to identify sub-phenotypes with meaningful clinical features and the target patients benefiting most from AC. Results: AC treatment was associated with lower in-hospital death risk either in the PS matched cohort or by IPTW analysis in the full cohort. A higher incidence of clinically relevant non-major bleeding (CRNMB) was observed in the AC group, but not major bleeding. Clinical subgroup analysis showed that, at admission, severe cases of COVID-19 clinical classification, mild acute respiratory distress syndrome (ARDS) cases, and patients with a D-dimer level ≥0.5 μg/mL, may benefit from AC. During the hospital stay, critical cases and severe ARDS cases may benefit from AC. Unsupervised machine learning analysis established a four-class clustering model. Clusters 1 and 2 were non-critical cases and might not benefit from AC, while clusters 3 and 4 were critical patients. Patients in cluster 3 might benefit from AC with no increase in bleeding events. While patients in cluster 4, who were characterized by multiple organ dysfunction (neurologic, circulation, coagulation, kidney and liver dysfunction) and elevated inflammation biomarkers, did not benefit from AC. Conclusions: AC treatment was associated with lower in-hospital death risk, especially in critically ill COVID-19 patients. Unsupervised learning analysis revealed that the most critically ill patients with multiple organ dysfunction and excessive inflammation might not benefit from AC. More attention should be paid to bleeding events (especially CRNMB) when using AC.
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Affiliation(s)
- Yi Bian
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Le
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Han Du
- Germany Research Center for Artificial Intelligence, Saarland Informatics Campus, Saarbrücken, Germany
| | - Junfang Chen
- Intelligent Medicine Research Center, Greater Bay Area Institute of Precision Medicine (Guangzhou), Fudan University, Guangzhou, China
| | - Ping Zhang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhigang He
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ye Wang
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shanshan Yu
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Fang
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Yu
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jianmin Ling
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yikuan Feng
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Wei
- Ministry of Education Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan, Wuhan, China
| | - Liuniu Xiao
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yingfang Zheng
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Yu
- Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shusheng Li
- Department of Emergency Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- Department of Critical Care Medicine, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Adams K, Tenforde MW, Chodisetty S, Lee B, Chow EJ, Self WH, Patel MM. A literature review of severity scores for adults with influenza or community-acquired pneumonia - implications for influenza vaccines and therapeutics. Hum Vaccin Immunother 2021; 17:5460-5474. [PMID: 34757894 PMCID: PMC8903905 DOI: 10.1080/21645515.2021.1990649] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/02/2021] [Indexed: 12/11/2022] Open
Abstract
Influenza vaccination and antiviral therapeutics may attenuate disease, decreasing severity of illness in vaccinated and treated persons. Standardized assessment tools, definitions of disease severity, and clinical endpoints would support characterizing the attenuating effects of influenza vaccines and antivirals. We review potential clinical parameters and endpoints that may be useful for ordinal scales evaluating attenuating effects of influenza vaccines and antivirals in hospital-based studies. In studies of influenza and community-acquired pneumonia, common physiologic parameters that predicted outcomes such as mortality, ICU admission, complications, and duration of stay included vital signs (hypotension, tachypnea, fever, hypoxia), laboratory results (blood urea nitrogen, platelets, serum sodium), and radiographic findings of infiltrates or effusions. Ordinal scales based on these parameters may be useful endpoints for evaluating attenuating effects of influenza vaccines and therapeutics. Factors such as clinical and policy relevance, reproducibility, and specificity of measurements should be considered when creating a standardized ordinal scale for assessment.
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Affiliation(s)
- Katherine Adams
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mark W. Tenforde
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shreya Chodisetty
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Benjamin Lee
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eric J. Chow
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wesley H. Self
- Department of Emergency Medicine and Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manish M. Patel
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Liu Y, Ling L, Wong SH, Wang MHT, Fitzgerald J, Zou X, Fang S, Liu X, Wang X, Hu W, Chan H, Wang Y, Huang D, Li Q, Wong WT, Choi G, Zou H, Hui DSC, Yu J, Tse G, Gin T, Wu WKK, Chan MTV, Zhang L. Outcomes of respiratory viral-bacterial co-infection in adult hospitalized patients. EClinicalMedicine 2021; 37:100955. [PMID: 34386745 PMCID: PMC8343259 DOI: 10.1016/j.eclinm.2021.100955] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/20/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Viral infections of the respiratory tract represent a major global health concern. Co-infection with bacteria may contribute to severe disease and increased mortality in patients. Nevertheless, viral-bacterial co-infection patterns and their clinical outcomes have not been well characterized to date. This study aimed to evaluate the clinical features and outcomes of patients with viral-bacterial respiratory tract co-infections. METHODS We included 19,361 patients with respiratory infection due to respiratory viruses [influenza A and B, respiratory syncytial virus (RSV), parainfluenza] and/or bacteria in four tertiary hospitals in Hong Kong from 2013 to 2017 using a large territory-wide healthcare database. All microbiological tests were conducted within 48 h of hospital admission. Four etiological groups were included: (1) viral infection alone; (2) bacterial infection alone; (3) laboratory-confirmed viral-bacterial co-infection and (4) clinically suspected viral-bacterial co-infection who were tested positive for respiratory virus and negative for bacteria but had received at least four days of antibiotics. Clinical features and outcomes were recorded for laboratory-confirmed viral-bacterial co-infection patients compared to other three groups as control. The primary outcome was 30-day mortality. Secondary outcomes were intensive care unit (ICU) admission and length of hospital stay. Propensity score matching estimated by binary logistic regression was used to adjust for the potential bias that may affect the association between outcomes and covariates. FINDINGS Among 15,906 patients with respiratory viral infection, there were 8451 (53.1%) clinically suspected and 1,087 (6.8%) laboratory-confirmed viral-bacterial co-infection. Among all the bacterial species, Haemophilus influenzae (226/1,087, 20.8%), Pseudomonas aeruginosa (180/1087, 16.6%) and Streptococcus pneumoniae (123/1087, 11.3%) were the three most common bacterial pathogens in the laboratory-confirmed co-infection group. Respiratory viruses co-infected with non-pneumococcal streptococci or methicillin-resistant Staphylococcus aureus was associated with the highest death rate [9/30 (30%) and 13/48 (27.1%), respectively] in this cohort. Compared with other infection groups, patients with laboratory-confirmed co-infection had higher ICU admission rate (p < 0.001) and mortality rate at 30 days (p = 0.028), and these results persisted after adjustment for potential confounders using propensity score matching. Furthermore, patients with laboratory-confirmed co-infection had significantly higher mortality compared to patients with bacterial infection alone. INTERPRETATION In our cohort, bacterial co-infection is common in hospitalized patients with viral respiratory tract infection and is associated with higher ICU admission rate and mortality. Therefore, active surveillance for bacterial co-infection and early antibiotic treatment may be required to improve outcomes in patients with respiratory viral infection.
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Affiliation(s)
- Yingzhi Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Lowell Ling
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Sunny H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Maggie HT Wang
- School of Public Health, The Chinese University of Hong Kong, Hong Kong, PR China
| | | | - Xuan Zou
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Shisong Fang
- Shenzhen Center for Disease Control and Prevention, No.8, Longyuan Road, Nanshan District, Shenzhen, Guangdong Province, PR China
| | - Xiaodong Liu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Xiansong Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wei Hu
- Department of Gastroenterology, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Hung Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Yan Wang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Dan Huang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Qing Li
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Wai T Wong
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Gordon Choi
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - David SC Hui
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
| | - Jun Yu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - Tony Gin
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
| | - William KK Wu
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Matthew TV Chan
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
| | - Lin Zhang
- Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China
- CUHK Shenzhen Research Institute, Shenzhen, PR China
- Corresponding at Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong, PR China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, PR China; State Key Laboratory of Digestive Diseases, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, PR China; CUHK Shenzhen Research Institute, Shenzhen, PR China.
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19
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Gao HM, Ambroggio L, Shah SS, Ruddy RM, Florin TA. Predictive Value of Clinician "Gestalt" in Pediatric Community-Acquired Pneumonia. Pediatrics 2021; 147:peds.2020-041582. [PMID: 33903161 PMCID: PMC8086001 DOI: 10.1542/peds.2020-041582] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Validated prognostic tools for pediatric community-acquired pneumonia (CAP) do not exist. Thus, clinicians rely on "gestalt" in management decisions for children with CAP. We sought to determine the ability of clinician gestalt to predict severe outcomes. METHODS We performed a prospective cohort study of children 3 months to 18 years old presenting to a pediatric emergency department (ED) with lower respiratory infection and receiving a chest radiograph for suspected CAP from 2013 to 2017. Clinicians reported the probability that the patient would develop severe complications of CAP (defined as respiratory failure, empyema or effusion, lung abscess or necrosis, metastatic infection, sepsis or septic shock, or death). The primary outcome was development of severe complications. RESULTS Of 634 children, 37 (5.8%) developed severe complications. Of children developing severe complications after the ED visit, 62.1% were predicted as having <10% risk by the ED clinician. Sensitivity was >90% at the <1% predicted risk threshold, whereas specificity was >90% at the 10% risk threshold. Gestalt performance was poor in the low-intermediate predicted risk category (1%-10%). Clinicians had only fair ability to discriminate children developing complications from those who did not (area under the receiver operator characteristic curve 0.747), with worse performance from less experienced clinicians (area under the receiver operator characteristic curve 0.693). CONCLUSIONS Clinicians have only fair ability to discriminate children with CAP who develop severe complications from those who do not. Clinician gestalt performs best at very low or higher predicted risk thresholds, yet many children fall in the low-moderate predicted risk range in which clinician gestalt is limited. Evidence-based prognostic tools likely can improve on clinician gestalt, particularly when risk is low-moderate.
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Affiliation(s)
- Hans M. Gao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lilliam Ambroggio
- Sections of Emergency Medicine and Hospital Medicine, Department of Pediatrics, Children’s Hospital Colorado and University of Colorado, Aurora, Colorado
| | - Samir S. Shah
- Divisions of Hospital Medicine and Infectious Diseases and
| | - Richard M. Ruddy
- Emergency Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio; and
| | - Todd A. Florin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois;,Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
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20
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Chen Y, Ouyang L, Bao FS, Li Q, Han L, Zhang H, Zhu B, Ge Y, Robinson P, Xu M, Liu J, Chen S. A Multimodality Machine Learning Approach to Differentiate Severe and Nonsevere COVID-19: Model Development and Validation. J Med Internet Res 2021; 23:e23948. [PMID: 33714935 PMCID: PMC8030658 DOI: 10.2196/23948] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/11/2020] [Accepted: 03/11/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Effectively and efficiently diagnosing patients who have COVID-19 with the accurate clinical type of the disease is essential to achieve optimal outcomes for the patients as well as to reduce the risk of overloading the health care system. Currently, severe and nonsevere COVID-19 types are differentiated by only a few features, which do not comprehensively characterize the complicated pathological, physiological, and immunological responses to SARS-CoV-2 infection in the different disease types. In addition, these type-defining features may not be readily testable at the time of diagnosis. OBJECTIVE In this study, we aimed to use a machine learning approach to understand COVID-19 more comprehensively, accurately differentiate severe and nonsevere COVID-19 clinical types based on multiple medical features, and provide reliable predictions of the clinical type of the disease. METHODS For this study, we recruited 214 confirmed patients with nonsevere COVID-19 and 148 patients with severe COVID-19. The clinical characteristics (26 features) and laboratory test results (26 features) upon admission were acquired as two input modalities. Exploratory analyses demonstrated that these features differed substantially between two clinical types. Machine learning random forest models based on all the features in each modality as well as on the top 5 features in each modality combined were developed and validated to differentiate COVID-19 clinical types. RESULTS Using clinical and laboratory results independently as input, the random forest models achieved >90% and >95% predictive accuracy, respectively. The importance scores of the input features were further evaluated, and the top 5 features from each modality were identified (age, hypertension, cardiovascular disease, gender, and diabetes for the clinical features modality, and dimerized plasmin fragment D, high sensitivity troponin I, absolute neutrophil count, interleukin 6, and lactate dehydrogenase for the laboratory testing modality, in descending order). Using these top 10 multimodal features as the only input instead of all 52 features combined, the random forest model was able to achieve 97% predictive accuracy. CONCLUSIONS Our findings shed light on how the human body reacts to SARS-CoV-2 infection as a unit and provide insights on effectively evaluating the disease severity of patients with COVID-19 based on more common medical features when gold standard features are not available. We suggest that clinical information can be used as an initial screening tool for self-evaluation and triage, while laboratory test results should be applied when accuracy is the priority.
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Affiliation(s)
- Yuanfang Chen
- Public Health Research Institute of Jiangsu Province, Nanjing, China
- Institute of HIV/AIDS/STI Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Liu Ouyang
- Department of Orthopaedics, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Forrest S Bao
- Department of Computer Science, Iowa State University, Ames, IA, United States
| | - Qian Li
- Department of Pediatrics, Affiliated Kunshan Hospital of Jiangsu University, Kunshan, China
| | - Lei Han
- Public Health Research Institute of Jiangsu Province, Nanjing, China
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hengdong Zhang
- Public Health Research Institute of Jiangsu Province, Nanjing, China
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Baoli Zhu
- Public Health Research Institute of Jiangsu Province, Nanjing, China
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- School of Public health, Nanjing Medical University, Nanjing, China
| | - Yaorong Ge
- Department of Software and Information Systems, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Patrick Robinson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Ming Xu
- Public Health Research Institute of Jiangsu Province, Nanjing, China
- Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Jie Liu
- Department of Radiology, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shi Chen
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, United States
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, United States
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21
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The prognostic value of serum albumin levels and respiratory rate for community-acquired pneumonia: A prospective, multi-center study. PLoS One 2021; 16:e0248002. [PMID: 33662036 PMCID: PMC7932099 DOI: 10.1371/journal.pone.0248002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/17/2021] [Indexed: 01/10/2023] Open
Abstract
Community-acquired pneumonia (CAP) is a respiratory disease frequently requiring hospital admission, and a significant cause of death worldwide. This study aimed to investigate the prognostic value of clinical indicators. A prospective, multi-center study was conducted (January 2017-December 2018) where patient demographic and clinical data were recorded (N = 366). The 30-day mortality rate was 5.46%. Cox Regression analyses showed that serum albumin (ALB) and respiratory rate (RR) were independent prognostic variables for 30-day survival in patients with CAP. Albumin negatively correlated with the Pneumonia Severity Index (PSI) and CURB-65 scores using Pearson and Spearman tests. Survival curves showed that a RR >24 breaths/min or ALB ≤30 g/L were associated with a significantly higher risk of mortality. The area-under-the-curve (AUC) for predicting 30-day mortality in patients with CAP was 0.762, 0.763, 0.790, and 0.784 for ALB, RR, PSI, and CURB-65, respectively. The AUC for the prediction of 30-day mortality using ALB combined with PSI, CURB-65 scores, and RR was 0.822 (95% CI 0.731-0.912), 0.847 (95% CI 0.755-0.938), and 0.847 (95% CI 0.738-0.955), respectively. Albumin and RR were found to be reliable prognostic factors for CAP. This combination showed equal predictive value when compared to adding ALB assessment to PSI and CURB-65 scores, which could improve their prognostic accuracy.
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22
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Bahlis LF, Diogo LP, Fuchs SC. Charlson Comorbidity Index and other predictors of in-hospital mortality among adults with community-acquired pneumonia. ACTA ACUST UNITED AC 2021; 47:e20200257. [PMID: 33656092 PMCID: PMC8332672 DOI: 10.36416/1806-3756/e20200257] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Objective: To compare the performance of Charlson Comorbidity Index (CCI) with those of the mental Confusion, Urea, Respiratory rate, Blood pressure, and age = 65 years (CURB-65) score and the Pneumonia Severity Index (PSI) as predictors of all-cause in-hospital mortality in patients with community-acquired pneumonia (CAP). Methods: This was a cohort study involving hospitalized patients with CAP between April of 2014 and March of 2015. Clinical, laboratory, and radiological data were obtained in the ER, and the scores of CCI, CURB-65, and PSI were calculated. The performance of the models was compared using ROC curves and AUCs (95% CI). Results: Of the 459 patients evaluated, 304 met the eligibility criteria. The all-cause in-hospital mortality rate was 15.5%, and 89 (29.3%) of the patients were admitted to the ICU. The AUC for the CCI was significantly greater than those for CURB-65 and PSI (0.83 vs. 0.73 and 0.75, respectively). Conclusions: In this sample of hospitalized patients with CAP, CCI was a better predictor of all-cause in-hospital mortality than were the PSI and CURB-65.
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Affiliation(s)
- Laura Fuchs Bahlis
- . Faculdade de Medicina, Universidade do Vale do Rio dos Sinos - UNISINOS - São Leopoldo (RS) Brasil.,. Programa de Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil.,. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Luciano Passamani Diogo
- . Faculdade de Medicina, Universidade do Vale do Rio dos Sinos - UNISINOS - São Leopoldo (RS) Brasil.,. Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Sandra Costa Fuchs
- . Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
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23
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Smith MD, Fee C, Mace SE, Maughan B, Perkins JC, Kaji A, Wolf SJ. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia. Ann Emerg Med 2021; 77:e1-e57. [PMID: 33349374 DOI: 10.1016/j.annemergmed.2020.10.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This clinical policy from the American College of Emergency Physicians is a revision of the 2009 "Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia." A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In the adult emergency department patient diagnosed with community-acquired pneumonia, what clinical decision aids can inform the determination of patient disposition? (2) In the adult emergency department patient with community-acquired pneumonia, what biomarkers can be used to direct initial antimicrobial therapy? (3) In the adult emergency department patient diagnosed with community-acquired pneumonia, does a single dose of parenteral antibiotics in the emergency department followed by oral treatment versus oral treatment alone improve outcomes? Evidence was graded and recommendations were made based on the strength of the available data.
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24
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Camões J, Lobato CT, Beires F, Gomes E. Legionella and SARS-CoV-2 Coinfection in a Patient With Pneumonia - An Outbreak in Northern Portugal. Cureus 2021; 13:e12476. [PMID: 33552790 PMCID: PMC7857337 DOI: 10.7759/cureus.12476] [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] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has plagued virtually every continent and country, and Portugal is no exception. The high number of cases has caused a major burden on health services and obvious economic consequences, forcing an important reformulation in the health sectors' organization. In the past weeks, counties in the country's northern coastal region have reported an increasing number of Legionella cases, whose origin is yet to be determined. This exacerbates the already important pressure on the region's health facilities. We present a case of a patient diagnosed with Legionella pneumonia and concomitant coronavirus disease 2019 (COVID-19) pneumonia, highlighting the need for etiological investigation not only for common community agents but also for pandemic pathogens and regional outbreaks.
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Affiliation(s)
- João Camões
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Porto, PRT
| | - Carolina Tintim Lobato
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Porto, PRT
| | - Francisca Beires
- Department of Internal Medicine, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Porto, PRT
| | - Ernestina Gomes
- Intensive Care Unit, Unidade Local de Saúde de Matosinhos - Hospital Pedro Hispano, Porto, PRT
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25
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Rodriguez-Nava G, Yanez-Bello MA, Trelles-Garcia DP, Chung CW, Friedman HJ, Hines DW. Performance of the quick COVID-19 severity index and the Brescia-COVID respiratory severity scale in hospitalized patients with COVID-19 in a community hospital setting. Int J Infect Dis 2021; 102:571-576. [PMID: 33181332 PMCID: PMC7833674 DOI: 10.1016/j.ijid.2020.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the performance of the Quick COVID-19 Severity Index (qCSI) and the Brescia-COVID Respiratory Severity Scale (BCRSS) in predicting intensive care unit (ICU) admissions and in-hospital mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia. METHODS This was a retrospective cohort study of 313 consecutive hospitalized adult patients (18 years or older) with confirmed COVID-19. The area under the receiver operating characteristic curve (AUC) was used to assess the discriminatory power of the qCSI score and BCRSS prediction rule compared to the CURB-65 score for predicting mortality and intensive care unit admission. RESULTS The overall in-hospital fatality rate was 32.3%, and the ICU admission rate was 31.3%. The CURB-65 score had the highest numerical AUC to predict in-hospital mortality (AUC 0.781) compared to the qCSI score (AUC 0.711) and the BCRSS prediction rule (AUC 0.663). For ICU admission, the qCSI score had the highest numerical AUC (AUC 0.761) compared to the BCRSS prediction rule (AUC 0.735) and the CURB-65 score (AUC 0.629). CONCLUSIONS The CURB-65 and qCSI scoring systems showed a good performance for predicting in-hospital mortality. The qCSI score and the BCRSS prediction rule showed a good performance for predicting ICU admission.
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Affiliation(s)
| | | | | | - Chul Won Chung
- Department of Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, Illinois, USA
| | - Harvey J Friedman
- Critical Care Units, AMITA Health Saint Francis Hospital, Evanston, Illinois, USA; University of Illinois College of Medicine, Chicago, Illinois, USA
| | - David W Hines
- Department of Infectious Diseases and Infection Control, AMITA Health Saint Francis Hospital, Evanston, Illinois, USA; Metro Infectious Disease Consultants, LLC, Burr Ridge, Illinois, USA
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26
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Graham FF. The mysterious illness that drove them to their knees - Ah, that Legionnaires' disease - A historical reflection of the work in Legionnaires' disease in New Zealand (1978 to mid-1990s) and the 'One Health' paradigm. One Health 2020; 10:100149. [PMID: 33117867 PMCID: PMC7582211 DOI: 10.1016/j.onehlt.2020.100149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022] Open
Abstract
And so, formed the basis for the song Legionnaires' disease (LD) composed by the legendry musician Bob Dylan shortly after this mysterious illness dramatically entered the clinical and epidemiological scene in July 1976 at an American hotel. Now more than forty years have passed since Legionella pneumophila, the causative agent of LD, was formally identified in 1977. Once the publicity associated with the outbreak subsided, there was the challenge to science and health professionals of what was an extremely complex and intriguing health concern. In the United States, the outbreak investigation that eventually solved the mystery had taken an array of surprising twists and turns. Globally, it revealed the strengths and weakness of countries' health systems in response to the outbreak from an unknown agent. Extensive international coverage of the outbreak also marked a turning point in journalism's efforts to hold officials accountable for their response to epidemics that had the potential to threaten the lives of hundreds of people. In 1979, New Zealand became an active participant in the international efforts towards increasing the understanding of infection caused by Legionella species and set up a centralized laboratory diagnostic service. By 1980 LD had become a notifiable disease making New Zealand one of the first countries globally to do so. This historical narrative in the decade or so from its recognition, provides a unique insight into how the One Health paradigm was instrumental in New Zealand's early response to LD in tandem with control strategies. The findings show that from 1979 the distribution of the Legionella species in New Zealand did not follow patterns observed in studies carried out globally.
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Affiliation(s)
- Frances F. Graham
- Department of Public Health, University of Otago, P O Box 7343, Wellington South 6242, New Zealand
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27
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Liang W, Liang H, Ou L, Chen B, Chen A, Li C, Li Y, Guan W, Sang L, Lu J, Xu Y, Chen G, Guo H, Guo J, Chen Z, Zhao Y, Li S, Zhang N, Zhong N, He J. Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Intern Med 2020; 180:1081-1089. [PMID: 32396163 PMCID: PMC7218676 DOI: 10.1001/jamainternmed.2020.2033] [Citation(s) in RCA: 934] [Impact Index Per Article: 233.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
IMPORTANCE Early identification of patients with novel coronavirus disease 2019 (COVID-19) who may develop critical illness is of great importance and may aid in delivering proper treatment and optimizing use of resources. OBJECTIVE To develop and validate a clinical score at hospital admission for predicting which patients with COVID-19 will develop critical illness based on a nationwide cohort in China. DESIGN, SETTING, AND PARTICIPANTS Collaborating with the National Health Commission of China, we established a retrospective cohort of patients with COVID-19 from 575 hospitals in 31 provincial administrative regions as of January 31, 2020. Epidemiological, clinical, laboratory, and imaging variables ascertained at hospital admission were screened using Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to construct a predictive risk score (COVID-GRAM). The score provides an estimate of the risk that a hospitalized patient with COVID-19 will develop critical illness. Accuracy of the score was measured by the area under the receiver operating characteristic curve (AUC). Data from 4 additional cohorts in China hospitalized with COVID-19 were used to validate the score. Data were analyzed between February 20, 2020 and March 17, 2020. MAIN OUTCOMES AND MEASURES Among patients with COVID-19 admitted to the hospital, critical illness was defined as the composite measure of admission to the intensive care unit, invasive ventilation, or death. RESULTS The development cohort included 1590 patients. the mean (SD) age of patients in the cohort was 48.9 (15.7) years; 904 (57.3%) were men. The validation cohort included 710 patients with a mean (SD) age of 48.2 (15.2) years, and 382 (53.8%) were men and 172 (24.2%). From 72 potential predictors, 10 variables were independent predictive factors and were included in the risk score: chest radiographic abnormality (OR, 3.39; 95% CI, 2.14-5.38), age (OR, 1.03; 95% CI, 1.01-1.05), hemoptysis (OR, 4.53; 95% CI, 1.36-15.15), dyspnea (OR, 1.88; 95% CI, 1.18-3.01), unconsciousness (OR, 4.71; 95% CI, 1.39-15.98), number of comorbidities (OR, 1.60; 95% CI, 1.27-2.00), cancer history (OR, 4.07; 95% CI, 1.23-13.43), neutrophil-to-lymphocyte ratio (OR, 1.06; 95% CI, 1.02-1.10), lactate dehydrogenase (OR, 1.002; 95% CI, 1.001-1.004) and direct bilirubin (OR, 1.15; 95% CI, 1.06-1.24). The mean AUC in the development cohort was 0.88 (95% CI, 0.85-0.91) and the AUC in the validation cohort was 0.88 (95% CI, 0.84-0.93). The score has been translated into an online risk calculator that is freely available to the public (http://118.126.104.170/). CONCLUSIONS AND RELEVANCE In this study, a risk score based on characteristics of COVID-19 patients at the time of admission to the hospital was developed that may help predict a patient's risk of developing critical illness.
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Affiliation(s)
- Wenhua Liang
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Hengrui Liang
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Limin Ou
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Binfeng Chen
- Department of Rheumatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ailan Chen
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Hankou Hospital, Wuhan, China
| | - Caichen Li
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weijie Guan
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Jinyintan Hospital, Wuhan, China
| | | | - Yuanda Xu
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | | | | | - Zisheng Chen
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, China
| | - Yi Zhao
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nuofu Zhang
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Hankou Hospital, Wuhan, China
| | - Nanshan Zhong
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Fujita J, Kinjo T. Where is Chlamydophila pneumoniae pneumonia? Respir Investig 2020; 58:336-343. [PMID: 32703757 DOI: 10.1016/j.resinv.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Molecular diagnostic methods have recently gained widespread use, and consequently, the importance of viral pathogens in community-acquired pneumonia (CAP) has undergone re-evaluation. Under these circumstances, the role of Chlamydophila pneumoniae as a pathogen that causes CAP also needs to be reviewed. METHODS We reviewed articles that contained data on the frequency of identification of C. pneumoniae pneumonia as a causative pathogen for CAP. The articles were identified by performing a search in PubMed with the keywords "community-acquired pneumonia" and "pathogen". RESULTS Sixty-three articles were identified. The reviewed articles demonstrated that the rates of identification of C. pneumoniae as the causative pathogen for CAP were significantly lower in assessments based on polymerase chain reaction (PCR) methods than in those based on serological methods. In some studies, it was possible to compare both serological and PCR methods directly using the same set of samples. CONCLUSIONS The use of PCR methods, including multiplex PCR assays, has revealed that C. pneumoniae may play a limited role as a pathogen for CAP.
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Affiliation(s)
- Jiro Fujita
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
| | - Takeshi Kinjo
- Department of Infectious, Respiratory, and Digestive Medicine, Control and Prevention of Infectious Diseases, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Liang W, Yao J, Chen A, Lv Q, Zanin M, Liu J, Wong S, Li Y, Lu J, Liang H, Chen G, Guo H, Guo J, Zhou R, Ou L, Zhou N, Chen H, Yang F, Han X, Huan W, Tang W, Guan W, Chen Z, Zhao Y, Sang L, Xu Y, Wang W, Li S, Lu L, Zhang N, Zhong N, Huang J, He J. Early triage of critically ill COVID-19 patients using deep learning. Nat Commun 2020; 11:3543. [PMID: 32669540 PMCID: PMC7363899 DOI: 10.1038/s41467-020-17280-8] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/12/2020] [Indexed: 01/08/2023] Open
Abstract
The sudden deterioration of patients with novel coronavirus disease 2019 (COVID-19) into critical illness is of major concern. It is imperative to identify these patients early. We show that a deep learning-based survival model can predict the risk of COVID-19 patients developing critical illness based on clinical characteristics at admission. We develop this model using a cohort of 1590 patients from 575 medical centers, with internal validation performance of concordance index 0.894 We further validate the model on three separate cohorts from Wuhan, Hubei and Guangdong provinces consisting of 1393 patients with concordance indexes of 0.890, 0.852 and 0.967 respectively. This model is used to create an online calculation tool designed for patient triage at admission to identify patients at risk of severe illness, ensuring that patients at greatest risk of severe illness receive appropriate care as early as possible and allow for effective allocation of health resources.
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Affiliation(s)
- Wenhua Liang
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Ailan Chen
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Hankou Hospital, Wuhan, China
| | | | - Mark Zanin
- School of Public Health, The University of Hong Kong, Hong Kong SAR, China
| | - Jun Liu
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - SookSan Wong
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Hengrui Liang
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | | | - Rong Zhou
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Limin Ou
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | | | | | | | | | | | - Weijie Guan
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zisheng Chen
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Respiratory Disease, The Sixth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yi Zhao
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ling Sang
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanda Xu
- Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ligong Lu
- Zhuhai People Hospital, Zhuhai, China
| | - Nuofu Zhang
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
| | | | - Jianxing He
- China State Key Laboratory of Respiratory Disease and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Cavallazzi R, Furmanek S, Arnold FW, Beavin LA, Wunderink RG, Niederman MS, Ramirez JA. The Burden of Community-Acquired Pneumonia Requiring Admission to ICU in the United States. Chest 2020; 158:1008-1016. [PMID: 32298730 DOI: 10.1016/j.chest.2020.03.051] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/31/2020] [Accepted: 03/14/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A paucity of studies have assessed the epidemiology of community-acquired pneumonia (CAP) that require ICU admission. We conducted a study on this group of patients with the primary objective of defining the incidence, epidemiology, and mortality rate of CAP in the ICUs in Louisville, Kentucky. The secondary objective was to estimate the number of patients who were hospitalized and the number of deaths that were associated with CAP in ICU in the United States. RESEARCH QUESTIONS What is epidemiology of CAP in the ICU in Louisville, Kentucky, and the projected incidence in the United States? STUDY DESIGN AND METHODS This was a secondary analysis of a prospective population-based cohort study. The setting was all nine adult hospitals in Louisville, Kentucky. The annual incidence of CAP in the ICU per 100,000 adults was calculated for the whole adult population of Louisville. The number of patients who were hospitalized because of CAP in ICU in the United States was estimated by multiplying the Louisville incidence rate of CAP in ICU by the 2014 US adult population. RESULTS From a total of 7,449 unique patients who were hospitalized with CAP, 1,707 patients (23%) were admitted to the ICU. The incidence of CAP in the ICU was 145 cases per 100,000 population of adults. Cases of CAP in the ICU were clustered in patients from areas of the city with high poverty. The mortality rate of patients with CAP in ICU was 27% at 30 days and 47% at one year. In the United States, the estimated number of patients who were hospitalized with CAP requiring the ICU was 356,326 per year, and the estimated number of deaths at 30 days and one year were 96,206 and 167,474, respectively. INTERPRETATION Almost one in five patients who are hospitalized with CAP requires intensive care. Poverty is associated with CAP in the ICU. Nearly one-half of patients with CAP in the ICU will die within one year. Because of its significant burden, CAP in the ICU should be a high priority in research agenda and health policy.
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Affiliation(s)
- Rodrigo Cavallazzi
- Divisions of Pulmonary, Critical Care Medicine, and Sleep Disorders, University of Louisville, Louisville, KY.
| | - Stephen Furmanek
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Forest W Arnold
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Leslie A Beavin
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
| | - Richard G Wunderink
- Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Julio A Ramirez
- Divisions of Infectious Diseases, University of Louisville, Louisville, KY
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Nguyen MTN, Saito N, Wagatsuma Y. The effect of comorbidities for the prognosis of community-acquired pneumonia: an epidemiologic study using a hospital surveillance in Japan. BMC Res Notes 2019; 12:817. [PMID: 31856910 PMCID: PMC6923893 DOI: 10.1186/s13104-019-4848-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/07/2019] [Indexed: 11/10/2022] Open
Abstract
Objective Pneumonia is a common but serious illness that continues to present significant morbidity and mortality. Although the effect of severity at admission on outcome has been well reported, the role of comorbidity is still not widely understood. The Charlson Comorbidity Index measures comorbidity with a well-established history of predicting long-term outcome but its utility in pneumonia prognosis is still limited. Here, we use the Charlson Comorbidity Index and hospital surveillance data to investigate associations between comorbidities and in-hospital mortality due to community-acquired pneumonia. Results Among the 535 eligible adult patients (69.0% male, median [IQR] age, 79 [70–84] years), 100 (18.7%) acquired severe to extremely severe pneumonia. The median [IQR] CCI was 1 [1–3]. Malignancy (129 of 535, 24.1%), chronic pulmonary diseases (113 of 535, 21.1%) and congestive heart failure (103 of 535, 19.3%) were frequent. Higher Charlson Comorbidity Index scores were associated with higher risk of in-hospital mortality (OR 1.28; 95% CI 1.07–1.53). These results support the inclusion of comorbid burden in predicting community-acquired pneumonia outcome.
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Affiliation(s)
- Mai Thi Ngoc Nguyen
- Department of Clinical Trials and Clinical Epidemiology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Nobuyuki Saito
- The Shock and Trauma Center, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba, 270-1694, Japan
| | - Yukiko Wagatsuma
- Department of Clinical Trials and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Haque MA. Seasonal Incidence of Community-acquired Pneumonia: A Retrospective Study in a Tertiary Care Hospital in Kathmandu, Nepal. Cureus 2019; 11:e6417. [PMID: 31988818 PMCID: PMC6970104 DOI: 10.7759/cureus.6417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Community-acquired pneumonia (CAP) is the major cause of death in adult and elderly persons with a variety of presentations. Seasonal variation in the incidence of the disease is essential for clinicians and epidemiologists who deal with such diseases. The study was aimed at analysing the clinical profile and outcomes of community-acquired pneumonia during different seasons of the year in a tertiary care hospital, Manmohan Memorial Teaching Hospital (MMTH), of Kathmandu, Nepal. Method The aetiology and clinical profile of 378 patients with CAP who were admitted to MMTH over a period of one year were taken into account in this retrospective cross-sectional hospital-based study. Data were retrieved from the hospital medical records section and the Department of Pathology. All patients with a primary diagnosis of CAP admitted to the hospital were included in the study. Monthly and seasonal trends, aetiology, comorbidities, and mortality rates were analysed. Results Of 378 patients with CAP, 160 patients (42.3%) had associated chronic obstructive pulmonary disease (COPD), 92 patients (24.3%) had hypertension (HTN), 59 patients (15.6%) had diabetes, 12 patients (3.1%) had active pulmonary tuberculosis, seven patients (1.85%) had kidney disease, and the remaining 48 patients (12.6%) had only CAP. Seasonal variation of CAP was noted in 131 patients (35%) in the winter, 98 (26%) in autumn, 86 (23%) in spring, and 63 patients (16%) in summer seasons. None of the patients were vaccinated against influenza and pneumococcus. The most common organism isolated in CAP was Acinetobacter calcoaceticus baumannii (ACB) complex (4.7%), which was more distinguished in the winter season. The second most isolated organism was Pseudomonas aeruginosa (2.6%). The most common clinical presentation was fever (63%), followed by cough (47%) and shortness of breath (47%). Sputum culture was found to be positive in 51 cases (13.4%). Among 378 patients, 78 patients (20.6%) received treatment in the Intensive Care Unit (ICU) and the rest of the patients received treatment in the general medical ward. The mortality rate was found to be 6.6%. Conclusion An incidence of sputum-positive CAP was found in 51 cases (13.4%). The most common organism was ACB complex, followed by Pseudomonas aeruginosa, which were sensitive to polymyxins. Both of them were predominant in the winter and spring.
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George N, Elie-Turenne MC, Seethala RR, Baslanti TO, Bozorgmehri S, Mark K, Meurer D, Bihorac A, Aisiku IP, Hou PC. External Validation of the qSOFA Score in Emergency Department Patients With Pneumonia. J Emerg Med 2019; 57:755-764. [DOI: 10.1016/j.jemermed.2019.08.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 08/18/2019] [Accepted: 08/26/2019] [Indexed: 10/25/2022]
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Bloom AS, Suchindran S, Steinbrink J, McClain MT. Utility of predictive tools for risk stratification of elderly individuals with all-cause acute respiratory infection. Infection 2019; 47:617-627. [PMID: 30929142 DOI: 10.1007/s15010-019-01299-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 03/18/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A number of scoring tools have been developed to predict illness severity and patient outcome for proven pneumonia, however, less is known about the utility of clinical prediction scores for all-cause acute respiratory infection (ARI), especially in elderly subjects who are at increased risk of poor outcomes. METHODS We retrospectively analyzed risk factors and outcomes of individuals ≥ 60 years of age presenting to the emergency department with a clinical diagnosis of ARI. RESULTS Of 276 individuals in the study, 40 had proven viral infection and 52 proven bacterial infection, but 184 patients with clinically adjudicated ARI (67%) remained without a proven microbial etiology despite extensive clinical (and expanded research) workup. Patients who were older, had multiple comorbidities, or who had proven bacterial infection were more likely to require hospital and ICU admission. We identified a novel model based on 11 demographic and clinical variables that were significant risk factors for ICU admission or mortality in elderly subjects with all-cause ARI. As comparators, a modified PORT score was found to correlate more closely with all-cause ARI severity than a modified CURB-65 score (r, 0.54, 0.39). Interestingly, modified Jackson symptom scores were found to inversely correlate with severity (r, - 0.34) but show potential for differentiating viral and bacterial etiologies. CONCLUSIONS Modified PORT, CURB-65, Jackson symptom scores, and a novel ARI scoring tool presented herein all offer predictive ability for all-cause ARI in elderly subjects. Such broadly applicable scoring metrics have the potential to assist in treatment and triage decisions at the point of care.
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Affiliation(s)
| | - Sunil Suchindran
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Julie Steinbrink
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Micah T McClain
- Center for Applied Genomics and Precision Medicine, Department of Medicine, Duke University, Durham, NC, USA.
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
- Durham Veteran's Affairs Medical Center, Durham, NC, USA.
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Miyashita N, Horita N, Higa F, Aoki Y, Kikuchi T, Seki M, Tateda K, Maki N, Uchino K, Ogasawara K, Kiyota H, Watanabe A. Validation of a diagnostic score model for the prediction of Legionella pneumophila pneumonia. J Infect Chemother 2019; 25:407-412. [PMID: 30935766 DOI: 10.1016/j.jiac.2019.03.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/22/2019] [Accepted: 03/11/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Community-acquired pneumonia (CAP) due to Legionella has a high mortality rate in patients who do not receive adequate antibiotic therapy. In a previous study, we developed a simple Legionella Score to distinguish patients with Legionella and non-Legionella pneumonia based on clinical information at diagnosis. In the present study, we validated this Legionella Score for the presumptive diagnosis of Legionella CAP. METHODS This validation cohort included 109 patients with Legionella CAP and 683 patients with non-Legionella CAP. The Legionella Score includes six parameters by assigning one point for each of the following items: being male, absence of cough, dyspnea, C-reactive protein (CRP) ≥ 18 mg/dL, lactate dehydrogenase (LDH) ≥ 260 U/L, and sodium < 134 mmol/L. RESULTS When the Legionella CAP and non-Legionella CAP were compared by univariate analysis, most of the evaluated symptoms and laboratory test results differed substantially. The six parameters that were used for the Legionella Score also indicated clear differences between the Legionella and non-Legionella CAP. All Legionella patients had a score of 2 points or higher. The median Legionella Scores were 4 in the Legionella CAP cases and 2 in the non-Legionella CAP cases. A receiver operating characteristics curve showed that the area under the curve was 0.93. The proposed best cutoff, total score ≥3, had sensitivity of 93% and specificity of 75%. CONCLUSION Our Legionella Score was shown to have good diagnostic ability with a positive likelihood of 3.7 and a negative likelihood of 0.10.
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Affiliation(s)
- Naoyuki Miyashita
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan.
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan
| | - Futoshi Higa
- National Hospital Organization Okinawa National Hospital, Japan
| | - Yosuke Aoki
- Department of Infectious Disease and Hospital Epidemiology, Saga University Hospital, Japan
| | - Toshiaki Kikuchi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Japan
| | - Masafumi Seki
- Division of Infectious Diseases and Infection Control, Tohoku Medical and Pharmaceutical University Hospital, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Japan
| | - Nobuko Maki
- Taisho Toyama Pharmaceutical Co., Ltd, Japan
| | | | - Kazuhiko Ogasawara
- First Department of Internal Medicine, Division of Respiratory Medicine, Infectious Disease and Allergology, Kansai Medical University, Japan
| | - Hiroshi Kiyota
- Department of Urology, The Jikei University Katsushika Medical Center, Japan
| | - Akira Watanabe
- Development of Anti-Infective Agents, Faculty of Medical Science and Welfare, Tohoku Bunka Gakuen University, Japan
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NanZhu Y, Xin L, Xianghua Y, Jun C, Min L. Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction. Medicine (Baltimore) 2019; 98:e15045. [PMID: 30921230 PMCID: PMC6456111 DOI: 10.1097/md.0000000000015045] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 12/22/2022] Open
Abstract
To investigate the risk factors of nosocomial pneumonia (NP) in elderly patients with acute cerebral infarction (ACI).In this study, 324 aged 70 years and over patients with ACI who were admitted to the inpatient department of TianJin First Hospital (China) from January 2012 to February 2018 were retrospectively analyzed. The patients were divided into NP group (80 patients) and non-NP group (244 patients) according to whether NP was occurred 48 hours after hospitalization. Baseline profiles and biochemical analyses were compared between 2 groups. Information regarding risk factors for NP in elderly patients with ACI was collected from all patients. Associations with NP and outcome were evaluated.Among the total patients, NP occurred in 80 (24.69%) patients. There were no statistically significant differences between risk of NP and sex, current drinking, diabetes mellitus, stroke history, and levels of serum UA, TG, HDL-C, LDL-C, Glucose, chloride, potassium. Multivariate logistic regression analysis showed that the independent risk factors for NP were living alone (OR 4.723; CI 1.743∼12.802; P = .002), initial NIHSS score (OR 1.441; CI 1.191∼1.743; P = .000), NRS2002 score (OR 0.139; CI 0.087∼0.223; P = .000), BMI (OR 1.586; CI 1.353∼1.858; P = .000), a past pneumonia history (OR 0.073; CI 0.017∼0.321; P = .001), atrial fibrillation (AF) (OR 0.129; CI 0.033∼0.499; P = .003), CRP (OR 1.050; CI 1.017∼1.085; P = .003), BUN (OR 0.603; CI 0.448∼0.812; P = .001) and Cr (OR 1.036; CI 1.015∼1.057; P = .001). Level of albumin was an independent protective factor of NP in elderly patients with ACI (OR 0.865; CI 0.750∼0.999; P = .048). Furthermore, elderly patients with ACI who had NP had worse clinical outcomes both during hospitalization and after discharge (P < .05).We identified significant risk factors for NP in elderly patients with ACI, including living alone, initial NIHSS score, malnutrition, a past pneumonia history, AF, CRP, and Renal function were associated with NP in elderly patients with ACI. The clinical course was worse and the duration of hospital stay was longer in NP patients than in non-NP patients.
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Affiliation(s)
| | - Li Xin
- Department of Neurology, the Second Hospital of Tianjin Medical University
| | | | - Chen Jun
- Department of Clinical laboratory, TianJin First Hospital, China
| | - Li Min
- Department of Clinical laboratory, TianJin First Hospital, China
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Bourke SC, Piraino T, Pisani L, Brochard L, Elliott MW. Beyond the guidelines for non-invasive ventilation in acute respiratory failure: implications for practice. THE LANCET RESPIRATORY MEDICINE 2018; 6:935-947. [DOI: 10.1016/s2213-2600(18)30388-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 12/31/2022]
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Buss IM, Birkhamshaw E, Innes MA, Magadoro I, Waitt PI, Rylance J. Validating a novel index (SWAT-Bp) to predict mortality risk of community-acquired pneumonia in Malawi. Malawi Med J 2018; 30:230-235. [PMID: 31798800 PMCID: PMC6863414 DOI: 10.4314/mmj.v30i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia is a major cause of mortality worldwide. Early assessment and initiation of management improves outcomes. In higher-income countries, scores assist in predicting mortality from pneumonia. These have not been validated for use in most lower-income countries. AIM To validate a new score, the SWAT-Bp score, in predicting mortality risk of clinical community-acquired pneumonia amongst hospital admissions at Queen Elizabeth Central Hospital, Blantyre, Malawi. METHODS The five variables constituting the SWAT-Bp score (male [S]ex, muscle [W]asting, non-[A]mbulatory, [T]emperature (>38°C or <35°C) and [B]lood [p]ressure (systolic<100 and/or diastolic<60)) were recorded for all patients with clinical presentation of a lower respiratory tract infection, presumed to be pneumonia, over four months (N=216). The sensitivity and specificity of the score were calculated to determine accuracy of predicting mortality risk. RESULTS Median age was 35 years, HIV prevalence was 84.2% amongst known statuses, and mortality rate was 12.5%. Mortality for scores 0-5 was 0%, 8.5%, 12.7%, 19.0%, 28.6%, 100% respectively. Patients were stratified into three mortality risk groups dependent on their score. SWAT-Bp had moderate discriminatory power overall (AUROC 0.744). A SWAT-Bp score of ≥2 was 82% sensitive and 51% specific for predicting mortality, thereby assisting in identifying individuals with a lower mortality risk. CONCLUSION In this validation cohort, the SWAT-Bp score has not performed as well as in the derivation cohort. However, it could potentially assist clinicians identifying low-risk patients, enabling rapid prioritisation of treatment in a low-resource setting, as it helps contribute towards individual patient risk stratification.
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Affiliation(s)
- Imogen M Buss
- Department of Medicine, North Bristol NHS Trust, Bristol, United Kingdom
| | - Edmund Birkhamshaw
- Department of Infectious Diseases, Heartlands Hospital, Heart of England Foundation Trust, Birmingham, United Kingdom
| | - Michael A Innes
- General Practitioner, Stirchley Medical Practice, Telford, United Kingdom
| | - Itai Magadoro
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Peter I Waitt
- Acute Medical Unit, Wirrall University Hospital Foundation Trust, United Kingdom
| | - Jamie Rylance
- Senior Clinical Lecturer in respiratory medicine, Liverpool School of Tropical Medicine, United Kingdom.,Lung Health Group Lead, Malawi-Liverpool-Wellcome Program, Blantyre, Malawi
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Wallihan RG, Suárez NM, Cohen DM, Marcon M, Moore-Clingenpeel M, Mejias A, Ramilo O. Molecular Distance to Health Transcriptional Score and Disease Severity in Children Hospitalized With Community-Acquired Pneumonia. Front Cell Infect Microbiol 2018; 8:382. [PMID: 30425971 PMCID: PMC6218690 DOI: 10.3389/fcimb.2018.00382] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/09/2018] [Indexed: 01/09/2023] Open
Abstract
Background: Community-acquired pneumonia (CAP) is a leading cause of hospitalization and mortality in children. Diagnosis remains challenging and there are no reliable tools to objectively risk stratify patients or predict clinical outcomes. Molecular distance to health (MDTH) is a genomic score that measures the global perturbation of the transcriptional profile and may help classify patients by disease severity. We evaluated the value of MDTH to assess disease severity in children hospitalized with CAP. Methods: Children hospitalized with CAP and matched healthy controls were enrolled in a prospective observational study. Blood samples were obtained for transcriptome analyses within 24 h of hospitalization. MDTH scores were calculated to assess disease severity and correlated with laboratory markers, such as white blood cell count, c-reactive protein (CRP), and procalcitonin (PCT), and clinical outcomes, including duration of fever and duration of hospitalization (LOS). Univariate and multivariable logistic regression were applied to assess factors associated with LOS and duration of fever after hospitalization. Results: Among children hospitalized with CAP (n = 152), pyogenic bacteria (PB) were detected in 16 (11%), Mycoplasma pneumoniae was detected in 41 (28%), respiratory viruses (RV) alone were detected in 78 (51%), and no pathogen was detected in 17 (11%) children. Statistical group comparisons identified 6,726 genes differentially expressed in patients with CAP vs. healthy controls (n = 39). Children with confirmed PB had higher MDTH scores than those with RV (p < 0.05) or M. pneumoniae (p < 0.01) detected alone. CRP (r = 0.39, p < 0.0001), PCT (r = 0.39, p < 0.0001), and MDTHs (r = 0.24, p < 0.01) correlated with duration of fever, while only MDTHs correlated with LOS (r = 0.33, p < 0.0001). Unadjusted analyses showed that both higher CRP and MDTHs were associated with longer LOS (OR 1.04 [1–1.07] and 1.12 [1.04–1.20], respectively), however, only MDTH remained significant when adjusting for other covariates (aOR 1.11 [1.01–1.22]). Conclusions: In children hospitalized with CAP MDTH score measured within 24 h of admission was independently associated with longer duration of hospitalization, regardless of the pathogen detected. This suggests that transcriptional biomarkers may represent a promising approach to assess disease severity in children with CAP.
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Affiliation(s)
- Rebecca G Wallihan
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, United States
| | - Nicolás M Suárez
- Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Daniel M Cohen
- Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Mario Marcon
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Melissa Moore-Clingenpeel
- Biostatistics Core, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Asuncion Mejias
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, United States.,Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
| | - Octavio Ramilo
- Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, United States.,Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH, United States
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Pneumonia Risk Stratification Scores for Children in Low-Resource Settings: A Systematic Literature Review. Pediatr Infect Dis J 2018; 37:743-748. [PMID: 29278608 PMCID: PMC6014863 DOI: 10.1097/inf.0000000000001883] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Pneumonia is the leading infectious cause of death among children less than 5 years of age. Predictive tools, commonly referred to as risk scores, can be employed to identify high-risk children early for targeted management to prevent adverse outcomes. This systematic review was conducted to identify pediatric pneumonia risk scores developed, validated and implemented in low-resource settings. METHODS We searched CAB Direct, Cochrane Reviews, Embase, PubMed, Scopus and Web of Science for studies that developed formal risk scores to predict treatment failure or mortality among children less than 5 years of age diagnosed with a respiratory infection or pneumonia in low-resource settings. Data abstracted from articles included location and study design, sample size, age, diagnosis, score features and model discrimination. RESULTS Three pediatric pneumonia risk scores predicted mortality specifically, and 2 treatment failure. Scores developed using World Health Organization-recommended variables for pneumonia assessment demonstrated better predictive fit than scores developed using alternative features. Scores developed using routinely collected healthcare data performed similarly well as those developed using clinical trial data. No score has been implemented in low-resource settings. CONCLUSIONS While pediatric pneumonia-specific risk scores have been developed and validated, it is yet unclear if implementation is feasible, what impact, if any, implemented scores may have on child outcomes, or how broadly scores may be generalized. To increase the feasibility of implementation, future research should focus on developing scores based on routinely collected data.
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Lee MS, Oh JY, Kang CI, Kim ES, Park S, Rhee CK, Jung JY, Jo KW, Heo EY, Park DA, Suh GY, Kiem S. Guideline for Antibiotic Use in Adults with Community-acquired Pneumonia. Infect Chemother 2018; 50:160-198. [PMID: 29968985 PMCID: PMC6031596 DOI: 10.3947/ic.2018.50.2.160] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Community-acquired pneumonia is common and important infectious disease in adults. This work represents an update to 2009 treatment guideline for community-acquired pneumonia in Korea. The present clinical practice guideline provides revised recommendations on the appropriate diagnosis, treatment, and prevention of community-acquired pneumonia in adults aged 19 years or older, taking into account the current situation regarding community-acquired pneumonia in Korea. This guideline may help reduce the difference in the level of treatment between medical institutions and medical staff, and enable efficient treatment. It may also reduce antibiotic resistance by preventing antibiotic misuse against acute lower respiratory tract infection in Korea.
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Affiliation(s)
- Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jee Youn Oh
- Division of Respiratory, Allergy and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sunghoon Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology, The Institute of Chest Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Wook Jo
- Division of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ah Park
- Division of Healthcare Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
| | - Gee Young Suh
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sungmin Kiem
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
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Hamaguchi S, Suzuki M, Sasaki K, Abe M, Wakabayashi T, Sando E, Yaegashi M, Morimoto S, Asoh N, Hamashige N, Aoshima M, Ariyoshi K, Morimoto K. Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study. BMC Pulm Med 2018; 18:88. [PMID: 29792181 PMCID: PMC5967104 DOI: 10.1186/s12890-018-0648-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/10/2018] [Indexed: 11/16/2022] Open
Abstract
Background Mortality prediction of pneumonia by severity scores in patients with multiple underlying health conditions has not fully been investigated. This prospective cohort study is to identify mortality-associated underlying health conditions and to analyse their influence on severity-based pneumonia mortality prediction. Methods Adult patients with community-acquired pneumonia or healthcare-associated pneumonia (HCAP) who visited four community hospitals between September 2011 and January 2013 were enrolled. Candidate underlying health conditions, including demographic and clinical characteristics, were incorporated into the logistic regression models, along with CURB (confusion, elevated urea nitrogen, tachypnoea, and hypotension) score as a measure of disease severity. The areas under the receiver operating characteristic curves (AUROC) of the predictive index based on significant underlying health conditions was compared to that of CURB65 (CURB and age ≥ 65) score or Pneumonia severity index (PSI). Mortality association between disease severity and the number of underlying health conditions was analysed. Results In total 1772 patients were eligible for analysis, of which 140 (7.9%) died within 30 days. Six underlying health conditions were independently associated: home care (adjusted odds ratio, 5.84; 95% confidence interval, CI, 2.28–14.99), recent hospitalization (2.21; 1.36–3.60), age ≥ 85 years (2.15; 1.08–4.28), low body mass index (1.99, 1.25–3.16), neoplastic disease (1.82; 1.17–2.85), and male gender (1.78; 1.16–2.75). The predictive index based on these conditions alone had a significantly or marginally higher AUROC than that based on CURB65 score (0.78 vs 0.66, p = 0.02) or PSI (0.78 vs 0.71, p = 0.05), respectively. Compared to this index, the AUROC of the total score consisting of six underlying health conditions and CURB score (range 0–10) did not improve mortality predictions (p = 0.3). In patients with one or less underlying health conditions, the mortality was discretely associated with severe pneumonia (CURB65 ≥ 3) (risk ratio: 7.24, 95%CI: 3.08–25.13), whereas in patients with 2 or more underlying health conditions, the mortality association with severe pneumonia was not detected (risk ratio: 1.53, 95% CI: 0.94–2.50). Conclusions Mortality prediction based on pneumonia severity scores is highly influenced by the accumulating number of underlying health conditions in an ageing society. The validation using a different cohort is necessary to generalise the conclusion. Electronic supplementary material The online version of this article (10.1186/s12890-018-0648-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, Japan.,Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Motoi Suzuki
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Kota Sasaki
- Department of Laboratory Medicine, Ebetsu City Hospital, Ebetsu, Japan
| | - Masahiko Abe
- Department of General Internal Medicine, Ebetsu City Hospital, Ebetsu, Japan
| | - Takao Wakabayashi
- Department of General Medicine, Sapporo Hokushin Hospital, Sapporo, Japan
| | - Eiichiro Sando
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.,Department of General Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Makito Yaegashi
- Department of General Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Shimpei Morimoto
- Innovation platform & office for precision medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Norichika Asoh
- Department of Internal Medicine, Juzenkai Hospital, Nagasaki, Japan
| | | | - Masahiro Aoshima
- Department of Pulmonology, Kameda Medical Centre, Kamogawa, Japan
| | - Koya Ariyoshi
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Konosuke Morimoto
- Department of Clinical Medicine, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
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Progression of the Radiologic Severity Index predicts mortality in patients with parainfluenza virus-associated lower respiratory infections. PLoS One 2018; 13:e0197418. [PMID: 29771962 PMCID: PMC5957350 DOI: 10.1371/journal.pone.0197418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 05/02/2018] [Indexed: 01/29/2023] Open
Abstract
Background Radiologic severity may predict adverse outcomes after lower respiratory tract infection (LRI). However, few studies have quantified radiologic severity of LRIs. We sought to evaluate whether a semi-quantitative scoring tool, the Radiologic Severity Index (RSI), predicted mortality after parainfluenza virus (PIV)-associated LRI. Methods We conducted a retrospective review of consecutively-enrolled adult patients with hematologic malignancy or hematopoietic stem cell transplantation and with PIV detected in nasal wash who subsequently developed radiologically-confirmed LRI. We measured RSI (range 0–72) in each chest radiograph during the first 30 days after LRI diagnosis. We used extended Cox proportional hazards models to identify factors associated with mortality after onset of LRI with all-cause mortality as our failure event. Results After adjustment for patient characteristics, each 1-point increase in RSI was associated with an increased hazard of death (HR 1.13, 95% confidence interval [CI] 1.05–1.21, p = 0.0008). Baseline RSI was not predictive of death, but both peak RSI and the change from baseline to peak RSI (delta-RSI) predicted mortality (odds ratio for mortality, peak: 1.11 [95%CI 1.04–1.18], delta-RSI: 1.14 [95%CI 1.06–1.22]). A delta-RSI of ≥19.5 was 89% sensitive and 91% specific in predicting 30-day mortality. Conclusions We conclude that the RSI offers precise, informative and reliable assessments of LRI severity. Progression of RSI predicts 30-day mortality after LRI, but baseline RSI does not. Our results were derived from a cohort of patients with PIV-associated LRI, but can be applied in validated in other populations of patients with LRI.
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Development of a prediction tool for patients presenting with acute cough in primary care: a prognostic study spanning six European countries. Br J Gen Pract 2018; 68:e342-e350. [PMID: 29632005 DOI: 10.3399/bjgp18x695789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 01/02/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Accurate prediction of the course of an acute cough episode could curb antibiotic overprescribing, but is still a major challenge in primary care. AIM The authors set out to develop a new prediction rule for poor outcome (re-consultation with new or worsened symptoms, or hospital admission) in adults presenting to primary care with acute cough. DESIGN AND SETTING Data were collected from 2604 adults presenting to primary care with acute cough or symptoms suggestive of lower respiratory tract infection (LRTI) within the Genomics to combat Resistance against Antibiotics in Community-acquired LRTI in Europe (GRACE; www.grace-lrti.org) Network of Excellence. METHOD Important signs and symptoms for the new prediction rule were found by combining random forest and logistic regression modelling. Performance to predict poor outcome in acute cough patients was compared with that of existing prediction rules, using the models' area under the receiver operator characteristic curve (AUC), and any improvement obtained by including additional test results (C-reactive protein [CRP], blood urea nitrogen [BUN], chest radiography, or aetiology) was evaluated using the same methodology. RESULTS The new prediction rule, included the baseline Risk of poor outcome, Interference with daily activities, number of years stopped Smoking (> or <45 years), severity of Sputum, presence of Crackles, and diastolic blood pressure (> or <85 mmHg) (RISSC85). Though performance of RISSC85 was moderate (sensitivity 62%, specificity 59%, positive predictive value 27%, negative predictive value 86%, AUC 0.63, 95% confidence interval [CI] = 0.61 to 0.67), it outperformed all existing prediction rules used today (highest AUC 0.53, 95% CI = 0.51 to 0.56), and could not be significantly improved by including additional test results (highest AUC 0.64, 95% CI = 0.62 to 0.68). CONCLUSION The new prediction rule outperforms all existing alternatives in predicting poor outcome in adult patients presenting to primary care with acute cough and could not be improved by including additional test results.
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Thea DM, Seidenberg P, Park DE, Mwananyanda L, Fu W, Shi Q, Baggett HC, Brooks WA, Feikin DR, Howie SRC, Knoll MD, Kotloff KL, Levine OS, Madhi SA, O'Brien KL, Scott JAG, Antonio M, Awori JO, Baillie VL, DeLuca AN, Driscoll AJ, Higdon MM, Hossain L, Jahan Y, Karron RA, Kazungu S, Li M, Moore DP, Morpeth SC, Ofordile O, Prosperi C, Sangwichian O, Sawatwong P, Sylla M, Tapia MD, Zeger SL, Murdoch DR, Hammitt LL. Limited Utility of Polymerase Chain Reaction in Induced Sputum Specimens for Determining the Causes of Childhood Pneumonia in Resource-Poor Settings: Findings From the Pneumonia Etiology Research for Child Health (PERCH) Study. Clin Infect Dis 2018; 64:S289-S300. [PMID: 28575363 PMCID: PMC5447848 DOI: 10.1093/cid/cix098] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background. Sputum examination can be useful in diagnosing the cause of pneumonia in adults but is less well established in children. We sought to assess the diagnostic utility of polymerase chain reaction (PCR) for detection of respiratory viruses and bacteria in induced sputum (IS) specimens from children hospitalized with severe or very severe pneumonia. Methods. Among children aged 1–59 months, we compared organism detection by multiplex PCR in IS and nasopharyngeal/oropharyngeal (NP/OP) specimens. To assess whether organism presence or density in IS specimens was associated with chest radiographic evidence of pneumonia (radiographic pneumonia), we compared prevalence and density in IS specimens from children with radiographic pneumonia and children with suspected pneumonia but without chest radiographic changes or clinical or laboratory findings suggestive of pneumonia (nonpneumonia group). Results. Among 4232 cases with World Health Organization–defined severe or very severe pneumonia, we identified 1935 (45.7%) with radiographic pneumonia and 573 (13.5%) with nonpneumonia. The organism detection yield was marginally improved with IS specimens (96.2% vs 92.4% for NP/OP specimens for all viruses combined [P = .41]; 96.9% vs 93.3% for all bacteria combined [P = .01]). After accounting for presence in NP/OP specimens, no organism was detected more frequently in the IS specimens from the radiographic pneumonia compared with the nonpneumonia cases. Among high-quality IS specimens, there were no statistically significant differences in organism density, except with cytomegalovirus, for which there was a higher quantity in the IS specimens from cases with radiographic pneumonia compared with the nonpneumonia cases (median cycle threshold value, 27.9 vs 28.5, respectively; P = .01). Conclusions. Using advanced molecular methods with IS specimens provided little additional diagnostic information beyond that obtained with NP/OP swab specimens.
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Affiliation(s)
- Donald M Thea
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts
| | - Phil Seidenberg
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts.,Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Daniel E Park
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, DC
| | - Lawrence Mwananyanda
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts.,University Teaching Hospital, Lusaka, Zambia
| | - Wei Fu
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Rheumatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Qiyuan Shi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W Abdullah Brooks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia.,Department of Paediatrics University of Auckland and.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore
| | - Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shabir A Madhi
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine and
| | - Martin Antonio
- Medical Research Council Unit, Basse, The Gambia.,London School of Hygiene & Tropical Medicine, London, and.,Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Juliet O Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Vicky L Baillie
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrea N DeLuca
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Epidemiology
| | - Amanda J Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Melissa M Higdon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lokman Hossain
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Yasmin Jahan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Ruth A Karron
- Department of International Health, Center for Immunization Research, and
| | - Sidi Kazungu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Mengying Li
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David P Moore
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit and.,Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics & Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa
| | - Susan C Morpeth
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine and.,Microbiology Laboratory, Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ornuma Sangwichian
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi
| | - Pongpun Sawatwong
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi
| | - Mamadou Sylla
- Centre pour le Déloppement des Vaccins (CVD-Mali), Bamako, Mali
| | - Milagritos D Tapia
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore
| | - Scott L Zeger
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - David R Murdoch
- Department of Pathology, University Otago and.,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
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Kılıc H, Kanbay A, Karalezlı A, Babaoglu E, Hasanoglu HC, Erel O, Ates C. The Relationship between Hypomagnesemia and Pulmonary Function Tests in Patients with Chronic Asthma. Med Princ Pract 2018; 27:139-144. [PMID: 29455196 PMCID: PMC5968247 DOI: 10.1159/000487760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 02/16/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the relationship between serum values of magnesium and the parameters of the pulmonary function tests (PFT) in patients with chronic asthma. SUBJECTS AND METHODS This study recruited 50 patients with chronic stable asthma and 40 healthy individuals as a control group. Data on age, sex, severity of asthma, PFT, and details of drug therapy were obtained from each group. Serum magnesium, potassium, phosphorus, calcium, and sodium levels were also measured. To evaluate differences between groups, the Student t test or Mann-Whitney U test was performed for continuous variables, and the χ2 test for categorical variables. RESULTS In the asthma group, 10% (n = 9) of the patients had hypomagnesemia and 5.5% (n = 5) had hypophosphatemia. Patients with asthma were divided into two groups: the hypomagnesemic group (n = 9) and the normomagnesemic group (n = 41). Forced expiratory volume in 1 s (FEV1), FEV1%, peak expiratory flow (PEF), and PEF% were lower in the hypomagnesemic group than in the normomagnesemic group (p = 0.02). Multiple logistic regression analysis revealed a statistically significant association between hypomagnesemia and PFT in the hypomagnesemic asthmatic group. The correlations of age with FEV1, FEV1%, PEF, and PEF% were as follows: p = 0.00, r = 0.29; p = 0.00, r = 0.43; p = 0.03, r = 0.22; p = 0.00, r = 0.38; and p = 0.03, r = 0.22, respectively. The correlation of serum magnesium levels with PFT (FEV1, FEV1%, PEF, PEF%) were as follows: p = 0.001, r = 0.29; p = 0.001, r = 0.43; p = 0.03, r = 0.22; and p = 0.001, r = 0.38, respectively. The other electrolytes were within the normal range in both groups. CONCLUSION In this study, hypomagnesemia and hypophosphatemia were found to be the most common electrolyte abnormalities in patients with chronic stable asthma. FEV1, FEV1%, PEF, and PEF% were significantly lower in asthmatic patients with hypomagnesemia compared to asthmatic patients with normomagnesemia.
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Affiliation(s)
- Hatice Kılıc
- Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Asiye Kanbay
- Department of Pulmonary Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayşegul Karalezlı
- Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - Elif Babaoglu
- Department of Pulmonary Medicine, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - H. Canan Hasanoglu
- Department of Pulmonary Medicine, Faculty of Medicine, Yıldırım Beyazit University, Ankara, Turkey
| | - Ozcan Erel
- Department of Biochemistry, Faculty of Medicine, Yıldırım Beyazit University, Ankara, Turkey
| | - Can Ates
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
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Ferrari R, Viale P, Muratori P, Giostra F, Agostinelli D, Lazzari R, Voza R, Cavazza M. Rebounds after discharge from the emergency department for community-acquired pneumonia: focus on the usefulness of severity scoring systems. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 88:519-528. [PMID: 29350672 PMCID: PMC6166183 DOI: 10.23750/abm.v88i4.6685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/23/2022]
Abstract
Background: Community-acquired pneumonia (CAP) is common cause of hospital admission and leading cause of morbidity and mortality. Severity scoring systems are used to predict risk profile, outcome and mortality, and to help decisions about management strategies. Aim of the work and Methods: To critically analyze pneumonia “rebound” cases, once discharged from the emergency department (ED) and afterwards admitted. We conducted an observational clinical study in the acute setting of a university teaching hospital, prospectively analyzing, in a 1 year period, demographic, medical, clinical and laboratory data, and the outcome. Results: 249 patients were discharged home with diagnosis of CAP; 80 cases (32.1%) resulted in the high-intermediate risk class according to CURB-65 or CRB-65. Twelve patients (4.8%) presented to the ED twice and were then admitted. At their first visit 5 were in the high-intermediate risk group; just 4 of them were in the non-low risk group at the time of their admission. The rebound cohort showed some peculiar abnormalities in laboratory parameters (coagulation and renal function) and severe chest X-rays characteristics. None died in 30 days. Conclusions: The power of CURB-65 to correctly predict mortality for CAP patients discharged home from the ED is not confirmed by our results; careful clinical judgement seems to be irreplaceable in the management process. Many patients with a high-intermediate risk according to CURB-65 can be safely treated as outpatients, according to adequate welfare conditions; we identified a subgroup of cases that should worth a special attention and, therefore, a brief observation period in the ED before the final decision to safely discharge or admit. (www.actabiomedica.it)
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Affiliation(s)
- Rodolfo Ferrari
- Policlinico Sant'Orsola - Malpighi. Azienda Ospedaliero - Universitaria di Bologna..
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Chan S, Cheung W, Cocks R. Factors Influencing the Hospital Admission Decision of Low-Risk Patients with Community Acquired Pneumonia: Evaluating the Usefulness of a Prediction Rule. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790100800201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The Pneumonia Patient Outcomes Research Team (PORT) derived and validated a Prediction Rule to identify low-risk patients with community-acquired pneumonia (CAP).1 This prediction rule was implemented in the Accident & Emergency (A&E) Department of Prince of Wales Hospital to help select patients suitable for outpatient treatment. Materials & Methods A retrospective study of all cases of CAP admitted from A&E, age above 14, over a six-month period (the period of implementation of the Prediction Rule) was performed. Patients belonging to the low-risk categories were identified after review of the records. Factors likely to influence the admission decision were noted. Descriptive statistics was generated. Results Eighty-five patients were identified, 61 (71.8%) females and 24 (28.2%) males. The mean age was 59.1 years (±17.3 years, SD). Fifty-three (62.3%) patients had at least one significant comordid condition (e.g. chronic lung disease, diabetes). Of the remaining patients, 20 (23.5%) had at least one identifiable factor (e.g. haemoptysis, multilobar infiltrates in chest radiograph) influencing the hospitalisation decision; and only 12 (14.1%) had no reason, identifiable retrospectively, to justify hospitalised care. Conclusions A substantial number of low-risk patients with CAP (classified according to the Prediction Rule) were admitted. Most of these patients had identifiable comorbid conditions and prognostic factors that had not been accounted for by the Prediction Rule guidelines. Further evaluation of the significance of these additional variables is required in order to give the guidelines a better predictive value.
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Affiliation(s)
- Ssw Chan
- Prince of Wales Hospital, Accident and Emergency Department, 30–32 Ngan Shing Street, Shatin, N.T., Hong Kong
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Murillo-Zamora E, Medina-González A, Zamora-Pérez L, Vázquez-Yáñez A, Guzmán-Esquivel J, Trujillo-Hernández B. Performance of the PSI and CURB-65 scoring systems in predicting 30-day mortality in healthcare-associated pneumonia. Med Clin (Barc) 2017; 150:99-103. [PMID: 28778682 DOI: 10.1016/j.medcli.2017.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/30/2017] [Accepted: 06/01/2017] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Healthcare-associated pneumonia (HCAP) is the leading cause of infection in a hospital setting and is associated with a high mortality rate. This study aimed to evaluate the performance of the pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age≥65 (CURB-65) systems in predicting 30-day mortality in HCAP in adult patients. PATIENTS AND METHODS A cross-sectional study took place and data from 109 non-immunocompromised individuals aged>18 years were analyzed. The clinical diagnosis of HCAP included the presence of radiographic infiltrates in patients≥48hours after hospital admission. The PSI and CURB-65 scores were calculated and performance measures were estimated. Summary statistics were used to describe the study sample. The PSI and CURB-65 scores were calculated based on 20 and 5 criteria, respectively, and the performance indicators of the screening tools were estimated. RESULTS The overall 30-day mortality was 59.6%. At every given threshold, PSI sensitivity was higher, but showed a lower specificity than the CURB-65, and the highest Youden index (0.392) was observed at cut-off V in the PSI. The area under the ROC curve was 0.737 (95% CI: 0.646-0.827) and 0.698 (95% CI: 0.600-0.797) using the PSI and CURB-65 systems, respectively (P=.323). CONCLUSION Our findings suggest that the performance of the PSI and CURB-65 is reasonable for predicting 30-day mortality in adult HCAP patients and may be used in healthcare settings.
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Affiliation(s)
- Efrén Murillo-Zamora
- Departamento de Epidemiología, Unidad de Medicina Familiar n.(o) 19, Instituto Mexicano del Seguro Social, Colima, Colima, Méjico
| | - Alfredo Medina-González
- Coordinación de Planeación y Enlace Institucional, Jefatura de Servicios de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Colima, Colima, Méjico
| | - Liliana Zamora-Pérez
- Departamento de Medicina Interna, Hospital General de Zona n.(o) 1, Instituto Mexicano del Seguro Social, Villa de Álvarez, Colima, Méjico
| | - Andrés Vázquez-Yáñez
- Departamento de Epidemiología, Hospital General de Zona n.(o) 10, Instituto Mexicano del Seguro Social, Manzanillo, Colima, Méjico
| | - José Guzmán-Esquivel
- Unidad de Investigación en Epidemiología Clínica, Hospital General de Zona n.(o) 1, Instituto Mexicano del Seguro Social, Villa de Álvarez, Colima, Méjico.
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Precision-guided, Personalized Intrapleural Fibrinolytic Therapy for Empyema and Complicated Parapneumonic Pleural Effusions: The Case for the Fibrinolytic Potential. ACTA ACUST UNITED AC 2017; 24:163-169. [PMID: 29081644 DOI: 10.1097/cpm.0000000000000216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Complicated pleural effusions and empyema with loculation and failed drainage are common clinical problems. In adults, intrapleural fibrinolytic therapy is commonly used with variable results and therapy remains empiric. Despite the intrapleural use of various plasminogen activators; fibrinolysins, for about sixty years, there is no clear consensus about which agent is most effective. Emerging evidence demonstrates that intrapleural administration of plasminogen activators is subject to rapid inhibition by plasminogen activator inhibitor-1 and that processing of fibrinolysins is importantly influenced by other factors including the levels and quality of pleural fluid DNA. Current therapy for loculation that accompanies pleural infections also includes surgery, which is invasive and for which patient selection can be problematic. Most of the clinical literature published to date has used flat dosing of intrapleural fibrinolytic therapy in all subjects but little is known about how that strategy influences the processing of the administered fibrinolysin or how this influences outcomes. We developed a new test of pleural fluids ex vivo, which is called the Fibrinolytic Potential or FP, in which a dose of a fibrinolysin is added to pleural fluids ex vivo after which the fibrinolytic activity is measured and normalized to baseline levels. Testing in preclinical and clinical empyema fluids reveals a wide range of responses, indicating that individual patients will likely respond differently to flat dosing of fibrinolysins. The test remains under development but is envisioned as a guide for dosing of these agents, representing a novel candidate approach to personalization of intrapleural fibrinolytic therapy.
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