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Wang C, Damiano RJ, Ruebush LE, Engelen MPKJ, Mariani S, Liu L, Silva I, Borhani S, Cote GL, Conroy B, McFarlane D, Deutz NEP. A randomized, triple-blinded, placebo-controlled clinical trial evaluating immune responses of Typhim Vi and PPSV23 vaccines in healthy adults: The PREP study. Vaccine 2024; 42:126292. [PMID: 39245584 DOI: 10.1016/j.vaccine.2024.126292] [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: 04/30/2024] [Revised: 07/25/2024] [Accepted: 08/26/2024] [Indexed: 09/10/2024]
Abstract
Rapid and early identification of emergent infections is essential for delivering prompt clinical care. To advance the development of algorithms for the clinical management of infection identification, we performed a vaccination clinical trial to investigate the potential of using vaccination as a model for studying mild inflammation responses associated with different infections (NCT05346302). We collected data at various time points over 4 weeks from blood samples, wearable devices, and questionnaires. Following a 2-week baseline period, 210 healthy participants, aged 18-40 years, were administered either a Pneumococcal Polysaccharide vaccine (PPSV23), Typhoid Vi Polysaccharide vaccine (Typhim Vi), or placebo. In longitudinal analyses of blood biomarkers, we found that CRP was significantly higher at 2 days post-vaccination, whereas basophils, IL-10, IL-12p40, and MIG were significantly higher at 7 days post-vaccination in the PPSV23 group compared to both other groups (all p < 0.05). MIP-1β was significantly lower in the PPSV23 group than in the placebo group, while monocytes and MPV were significantly lower in the Typhim Vi group than in the placebo group at 7 days post-vaccination (all p < 0.05). The PPSV3 group showed a higher inflammatory profile, suggesting that PPSV23 induces a stronger immune response compared to Typhim Vi. The distinct immune responses induced by the two vaccines indicate the potential for utilizing vaccines as models for studying inflammation responses associated with different infectious pathogens.
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Affiliation(s)
| | | | - Laura E Ruebush
- Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX, USA
| | - Mariёlle P K J Engelen
- Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX, USA
| | | | - Luoluo Liu
- Philips North America, Cambridge, MA, USA
| | | | | | - Gerard L Cote
- Center for Remote Health Technologies and Systems, Texas A&M University, College Station, TX, USA
| | | | | | - Nicolaas E P Deutz
- Center for Translational Research in Aging and Longevity, Texas A&M University, College Station, TX, USA
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2
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Lin YT, Lin KM, Wu KH, Lien F. Enhancing pneumonia prognosis in the emergency department: a novel machine learning approach using complete blood count and differential leukocyte count combined with CURB-65 score. BMC Med Inform Decis Mak 2024; 24:118. [PMID: 38702739 PMCID: PMC11069213 DOI: 10.1186/s12911-024-02523-1] [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: 11/18/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Pneumonia poses a major global health challenge, necessitating accurate severity assessment tools. However, conventional scoring systems such as CURB-65 have inherent limitations. Machine learning (ML) offers a promising approach for prediction. We previously introduced the Blood Culture Prediction Index (BCPI) model, leveraging solely on complete blood count (CBC) and differential leukocyte count (DC), demonstrating its effectiveness in predicting bacteremia. Nevertheless, its potential in assessing pneumonia remains unexplored. Therefore, this study aims to compare the effectiveness of BCPI and CURB-65 in assessing pneumonia severity in an emergency department (ED) setting and develop an integrated ML model to enhance efficiency. METHODS This retrospective study was conducted at a 3400-bed tertiary medical center in Taiwan. Data from 9,352 patients with pneumonia in the ED between 2019 and 2021 were analyzed in this study. We utilized the BCPI model, which was trained on CBC/DC data, and computed CURB-65 scores for each patient to compare their prognosis prediction capabilities. Subsequently, we developed a novel Cox regression model to predict in-hospital mortality, integrating the BCPI model and CURB-65 scores, aiming to assess whether this integration enhances predictive performance. RESULTS The predictive performance of the BCPI model and CURB-65 score for the 30-day mortality rate in ED patients and the in-hospital mortality rate among admitted patients was comparable across all risk categories. However, the Cox regression model demonstrated an improved area under the ROC curve (AUC) of 0.713 than that of CURB-65 (0.668) for in-hospital mortality (p<0.001). In the lowest risk group (CURB-65=0), the Cox regression model outperformed CURB-65, with a significantly lower mortality rate (2.9% vs. 7.7%, p<0.001). CONCLUSIONS The BCPI model, constructed using CBC/DC data and ML techniques, performs comparably to the widely utilized CURB-65 in predicting outcomes for patients with pneumonia in the ED. Furthermore, by integrating the CURB-65 score and BCPI model into a Cox regression model, we demonstrated improved prediction capabilities, particularly for low-risk patients. Given its simple parameters and easy training process, the Cox regression model may be a more effective prediction tool for classifying patients with pneumonia in the emergency room.
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Affiliation(s)
- Yin-Ting Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih, Chiayi County, 613, Taiwan
| | - Ko-Ming Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd, Puzih, Chiayi County, 613, Taiwan
| | - Kai-Hsiang Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd., Puzih, Chiayi County, 613, Taiwan.
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Chiayi, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Frank Lien
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chang Gung Memorial Hospital, No. 6, W. Sec., Jiapu Rd, Puzih, Chiayi County, 613, Taiwan.
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Hameiri-Bowen D, Yindom LM, Sovershaeva E, Bandason T, Mayini J, M Rehman A, Simms V, Gift Ngwira L, Flagestad T, Jarl Gutteberg T, McHugh G, Abbas Ferrand R, Rowland-Jones SL. "The effect of 48-weeks azithromycin therapy on levels of soluble biomarkers associated with HIV-associated chronic lung disease". Int Immunopharmacol 2023; 116:109756. [PMID: 36682262 PMCID: PMC10914635 DOI: 10.1016/j.intimp.2023.109756] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES HIV-associated immune activation contributes to chronic lung disease (CLD) in children and adolescents living with HIV. Azithromycin has immunomodulatory and anti-microbial properties that may be useful for treating HIV-associated CLD (HCLD). This study describes the effect of azithromycin on expression of plasma soluble biomarkers in children and adolescents with HCLD. METHODS This study was nested within a multi-site double-blind, placebo controlled, randomised controlled trial (RCT) of azithromycin in individuals aged 6-19 years with HCLD (defined as FEV1 z-score < -1) in Malawi and Zimbabwe (BREATHE (NCT02426112)). Participants were randomized 1:1 to once-weekly oral azithromycin with weight-based dosing, for 48 weeks, or placebo. Twenty-six plasma soluble biomarkers were measured on a MagPix Luminex instrument at enrolment, after 48-weeks of treatment and 24-weeks after treatment cessation. Mixed effects models were constructed to compare biomarker expression across treatment and placebo groups. RESULTS Weekly azithromycin was associated with reduced levels of C-Reactive Protein (CRP), E-Selectin, Matrix metalloproteinase 10 (MMP-10). Treatment effects for all soluble biomarkers were not sustained 24-weeks after treatment cessation with biomarker expression returning to pre-treatment levels. CONCLUSIONS We observed real-world effects of azithromycin on acute inflammation, neutrophil accumulation, and extracellular matrix degradation, that were not sustained after treatment cessation. These results are pertinent when using azithromycin for its immunomodulatory properties, or targeting pathways represented by the soluble biomarkers in this study.
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Affiliation(s)
- Dan Hameiri-Bowen
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
| | - Louis-Marie Yindom
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Evgeniya Sovershaeva
- UiT The Arctic University of Norway, University Hospital of North Norway, Tromsø, Norway
| | - Tsitsi Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Justin Mayini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Andrea M Rehman
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Victoria Simms
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lucky Gift Ngwira
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Malawi-Liverpool Wellcome Trust Clinical Research Program, Blantyre, Malawi
| | - Trond Flagestad
- UiT The Arctic University of Norway, University Hospital of North Norway, Tromsø, Norway
| | - Tore Jarl Gutteberg
- UiT The Arctic University of Norway, University Hospital of North Norway, Tromsø, Norway
| | - Grace McHugh
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Rashida Abbas Ferrand
- Biomedical Research and Training Institute, Harare, Zimbabwe; Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Nowak JM, Surma S, Romańczyk M, Wojtowicz A, Filipiak KJ, Czerniuk MR. Assessment of the Effect of A-PRF Application during the Surgical Extraction of Third Molars on Healing and the Concentration of C-Reactive Protein. Pharmaceutics 2021; 13:1471. [PMID: 34575547 PMCID: PMC8469162 DOI: 10.3390/pharmaceutics13091471] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Extraction procedures for mandibular third molars are performed all over the world every day. Local inflammation resulting from surgery, and the pain that patients experience, often make it impossible to take up daily life activities, such as work or sports. Growth and anti-inflammatory factors, located in the fibrin network, have a positive effect on tissue-healing processes and should also reduce local inflammation. Advanced platelet-rich fibrin (A-PRF) applied locally influences such processes as: angiogenesis, osteogenesis and collagenogenesis. It also affects mesenchymal cell lines and anti- and pro-inflammatory mediators. Due to the autologous origin of the material, their use in guide bone regeneration (GBR) is more and more widespread in dentistry. The results of previous studies indicate that the use of A-PRF in the treatment area significantly reduces postoperative pain, while the formation of edema is not affected. C-reactive protein (CRP), which is an acute phase protein, appears in the blood as a consequence of inflammation. Due to the dynamics of changes in concentration of CRP, it is a protein that is sufficiently sensitive and is used in studies to monitor the tissue healing process. The effect of A-PRF application on CRP concentrations, before and after surgery, has not been investigated yet. The study was conducted on 60 generally healthy patients. A faster decrease of CRP levels was shown in patients who used A-PRF after the procedure. Additionally, it accelerated healing and reduced the occurrence of a dry socket close to 0.
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Affiliation(s)
- Jacek M. Nowak
- Department of Dental Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.); (M.R.C.)
| | - Stanisław Surma
- Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (S.S.); (M.R.)
| | - Monika Romańczyk
- Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland; (S.S.); (M.R.)
| | - Andrzej Wojtowicz
- Department of Dental Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.); (M.R.C.)
| | - Krzysztof J. Filipiak
- Maria Sklodowska-Curie Medical Academy in Warsaw, Pałac Lubomirskich, 00-136 Warsaw, Poland;
| | - Maciej R. Czerniuk
- Department of Dental Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland; (A.W.); (M.R.C.)
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Hirai K, Tanaka A, Homma T, Kaneko K, Akimoto K, Suganuma H, Sato H, Kawahara T, Mikuni H, Ohta S, Kusumoto S, Suzuki S, Sagara H. Oral meal intake as a prognostic predictor of community-acquired pneumonia: A retrospective cohort study. J Infect Chemother 2020; 26:1186-1191. [PMID: 32703726 DOI: 10.1016/j.jiac.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The association between oral intake volume and prognosis has not been studied in hospitalized patients with community-acquired pneumonia (CAP). METHODS We retrospectively examined 503 hospitalized CAP patients to evaluate whether early-phase meal intake (EMI) (within the first 24 h after hospitalization) and maximum meal intake (MMI) (on the day during hospitalization) are useful prognostic predictors. RESULTS Of the 503 patients, 40 (8.0%) died within 30 days. Area under the curve (AUC) for prognosis was comparable between EMI, A-DROP, and serum albumin [EMI: 0.80, 95% confidence interval (CI) 0.75-0.84; A-DROP: 0.77, 95% CI 0.71-0.83; Serum albumin: 0.72, 95% CI 0.64-0.79]. Mortality rate was <1% in patients with EMI ≥ 50%. Univariate analysis showed that patients with EMI < 50% showed poor prognosis [odds ratio 53.4, 95% CI 7.2-392.2]. Multivariate analysis showed that EMI was an independent prognostic predictor [odds ratio 23.6, 95% CI 3.11-179.7]. AUC of MMI for prognosis was 0.94 (95% CI 0.91-0.96); mortality rate was <1% for patients who ingested ≥50% of meals on any day during hospitalization. We defined ingesting ≥50% of meals on any day during hospitalization as oral intake stability. Multivariate analyses revealed an association between oral intake stability and prognosis. Odds ratio of oral intake stability for prognosis was higher than that of conventional evaluations (vital sign and CRP level stability). Fewer days were required to reach oral intake stability than to reach vital sign and CRP level stability. CONCLUSIONS Oral intake is a simple, non-invasive, cost-free, and powerful prognostic predictor for patients with CAP.
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Affiliation(s)
- Kuniaki Hirai
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan.
| | - Akihiko Tanaka
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Keisuke Kaneko
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Kaho Akimoto
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Hiromitsu Suganuma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Hiroki Sato
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Tomoko Kawahara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Hatsuko Mikuni
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Shin Ohta
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Sojiro Kusumoto
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Shintaro Suzuki
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, Japan
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Ahn JM, Hwang SO, Moon JS, Lee SJ, Cha YS. Predictive Value of the Neutrophil-to-Lymphocyte Ratio for the Diagnosis of Pneumonia in Normothermic Dyspneic Patients with Chronic Heart Failure in the Emergency Department. J Emerg Med 2020; 58:892-901. [PMID: 32204997 DOI: 10.1016/j.jemermed.2020.01.001] [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: 08/01/2019] [Revised: 12/23/2019] [Accepted: 01/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Differentiating pneumonia from chronic heart failure (HF) in normothermic subjects in the emergency department (ED) is significantly difficult. OBJECTIVE This study aimed to evaluate the predictive value of the neutrophil-to-lymphocyte ratio (NLR) in establishing the diagnosis of pneumonia in normothermic subjects with chronic HF in the ED. METHODS This study included 523 adult dyspneic patients with chronic HF presenting in the ED. We categorized the selected patients into the nonpneumonia group (NPG) and the pneumonia group (PG), and the patients' serum white blood cell (WBC), neutrophil, and lymphocyte counts, NLR, and C-reactive protein (CRP) levels were measured upon arrival in the ED. Subsequently, we compared their predictive powers after performing a propensity score-matching (PSM) analysis. RESULTS The PG included 120 (22.9%) patients. After performing PSM, the mean NLR was significantly higher in the PG than in the NPG group (p < 0.001). According to the receiver operating characteristic area under the curve (AUC) analysis of inflammatory markers, the AUC of the NLR was significantly higher than that of WBCs, neutrophils, lymphocytes, and CRP. CONCLUSION The predictive value of the NLR was significantly higher than that of WBCs, neutrophils, lymphocytes, and CRP. Therefore, NLR may be a useful adjunctive marker to establish the early diagnosis of pneumonia in normothermic patients with chronic HF in the ED.
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Affiliation(s)
- Jung Mo Ahn
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jin Sil Moon
- Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok Jeong Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Sung Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
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Bachler M, Hell T, Schausberger L, Schlömmer C, Schäfer V, Liebensteiner M, Schäffler K, Schenk B, Fries D, Innerhofer P, Niederwanger C. Response patterns of routinely measured inflammatory and coagulatory parameters in sepsis. PeerJ 2019; 7:e7147. [PMID: 31275752 PMCID: PMC6590445 DOI: 10.7717/peerj.7147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Sepsis is characterized by a pro-inflammatory and pro-coagulatory shift which can induce life-threatening complications. Close monitoring and risk stratification of sepsis patients is crucial for proper treatment and consequently patient outcome. Therefore, this study focuses on the response patterns of inflammatory and coagulatory parameters used in clinical routines to estimate the course of sepsis. Methods A total of 1,110 patients diagnosed with sepsis were retrospectively analyzed to identify response patterns for risk stratification of routine parameters measured at the peak level of C-reactive protein. Cluster analysis was used and the differences in the patient characteristics and 28-day survival were assessed. Cox proportional hazards regression model for survival stratified by the clusters was performed. Results The analyses revealed the parameters to have five distinct response patterns. These clusters reflect the etiology as well as the course of sepsis associated with different mortalities. Here, impairment of the liver plays a crucial role in the ability to appropriately respond to sepsis. Of the routinely measured parameters, C-reactive protein and antithrombin seem to be unspecific for stratification of septic patients. Adjusted for the individual clusters, survival was associated with an increase in fibrinogen (p = 0.0042), platelets (p = 0.0003) and PT (p = 0.001) as well as a decrease in leukocytes (p = 0.034). Conclusions This study reveals that patients have distinct response patterns of inflammatory and coagulatory parameters depending on disease etiology. These patterns are associated with different mortalities although the patients have similar levels of C-reactive protein. Independently of the type of response, good coagulatory capacity seems to be crucial for patient survival.
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Affiliation(s)
- Mirjam Bachler
- University for Health Sciences, Medical Informatics and Technology, Institute for Sports Medicine, Alpine Medicine and Health Tourism, Hall, Austria
| | - Tobias Hell
- Department of Mathematics, Faculty of Mathematics, Computer Science and Physics, University of Innsbruck, Innsbruck, Austria
| | - Lukas Schausberger
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christine Schlömmer
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Volker Schäfer
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Marlies Liebensteiner
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Schäffler
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Schenk
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Dietmar Fries
- Department of General and Surgical Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Innerhofer
- Department of Anaesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Niederwanger
- Department of Pediatrics, Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
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Abstract
Pneumonia is a type of acute lower respiratory infection that is common and severe. The outcome of lower respiratory infection is determined by the degrees to which immunity is protective and inflammation is damaging. Intercellular and interorgan signaling networks coordinate these actions to fight infection and protect the tissue. Cells residing in the lung initiate and steer these responses, with additional immunity effectors recruited from the bloodstream. Responses of extrapulmonary tissues, including the liver, bone marrow, and others, are essential to resistance and resilience. Responses in the lung and extrapulmonary organs can also be counterproductive and drive acute and chronic comorbidities after respiratory infection. This review discusses cell-specific and organ-specific roles in the integrated physiological response to acute lung infection, and the mechanisms by which intercellular and interorgan signaling contribute to host defense and healthy respiratory physiology or to acute lung injury, chronic pulmonary disease, and adverse extrapulmonary sequelae. Pneumonia should no longer be perceived as simply an acute infection of the lung. Pneumonia susceptibility reflects ongoing and poorly understood chronic conditions, and pneumonia results in diverse and often persistent deleterious consequences for multiple physiological systems.
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Affiliation(s)
- Lee J Quinton
- Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts
| | - Allan J Walkey
- Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts
| | - Joseph P Mizgerd
- Pulmonary Center, Boston University School of Medicine , Boston, Massachusetts
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9
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Wichert A, Lukasewitz P, Häuser M, Bittersohl J, Lennartz H. ARDS in Fulminant Ornithosis and Treatment with Extracorporeal Lung Assist. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a 47-year-old male patient with fulminant ornithosis who developed severe respiratory failure leading to acute respiratory distress syndrome (ARDS) complicated by gastrointestinal, neurological and renal symptoms. ARDS was successfully treated by extracorporeal lung assist. As leukocytosis is typically absent in ornithosis, C-reactive protein, interleukin 6 and procalcitonin were used as infection parameters in order to monitor clinical development. The English-language literature on severe cases of ornithosis requiring respiratory support over the past 30 years is reviewed.
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Affiliation(s)
- A. Wichert
- Department of Anaesthesia and Intensive Care, Philipps-University of Marburg, Marburg - Germany
| | - P. Lukasewitz
- Department of Anaesthesia and Intensive Care, Philipps-University of Marburg, Marburg - Germany
| | - M. Häuser
- Department of Anaesthesia and Intensive Care, Philipps-University of Marburg, Marburg - Germany
| | - J. Bittersohl
- Department of Anaesthesia and Intensive Care, Philipps-University of Marburg, Marburg - Germany
| | - H. Lennartz
- Department of Anaesthesia and Intensive Care, Philipps-University of Marburg, Marburg - Germany
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Oh HK, Lee JY, Eo WK, Yoon SW, Han SN. Elevated Serum Vitamin B12 Levels as a Prognostic Factor for Survival Time in Metastatic Cancer Patients: A Retrospective Study. Nutr Cancer 2017; 70:37-44. [DOI: 10.1080/01635581.2018.1397711] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Hye Kyung Oh
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
- Department of Internal Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jee Young Lee
- Department of Internal Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Wan Kyu Eo
- Department of Hematology/Medical Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seong Woo Yoon
- Department of Internal Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Sung Nim Han
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
- Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Republic of Korea
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11
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Boyles TH, Brink A, Calligaro GL, Cohen C, Dheda K, Maartens G, Richards GA, van Zyl Smit R, Smith C, Wasserman S, Whitelaw AC, Feldman C. South African guideline for the management of community-acquired pneumonia in adults. J Thorac Dis 2017; 9:1469-1502. [PMID: 28740661 DOI: 10.21037/jtd.2017.05.31] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Tom H Boyles
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Adrian Brink
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa.,Ampath National Laboratory Services, Milpark Hospital, Johannesburg, South Africa
| | - Greg L Calligaro
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Cheryl Cohen
- Centre for Respiratory Disease and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Keertan Dheda
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Guy A Richards
- Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Richard van Zyl Smit
- Lung Infection and Immunity Unit, Division of Pulmonology and UCT Lung Institute, University of Cape Town, Cape Town, South Africa
| | | | - Sean Wasserman
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Andrew C Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa.,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Charles Feldman
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Jobs A, Simon R, de Waha S, Rogacev K, Katalinic A, Babaev V, Thiele H. Pneumonia and inflammation in acute decompensated heart failure: a registry-based analysis of 1939 patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 7:362-370. [DOI: 10.1177/2048872617700874] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The prognostic impact of pneumonia and signs of systemic inflammation in patients with acute decompensated heart failure (ADHF) has not been fully elucidated yet. The aim of the present study was thus to investigate the association of pneumonia and the inflammation surrogate C-reactive protein with all-cause mortality in patients admitted for ADHF. Methods: We analysed data of 1939 patients admitted for ADHF. Patients were dichotomised according to the presence or absence of pneumonia. The primary endpoint of all-cause mortality was determined by death registry linkage. Results: In total, 412 (21.2%) patients had concomitant pneumonia. Median C-reactive protein levels were higher in patients with compared to patients without pneumonia (24.9 versus 9.8 mg/l, respectively; P<0.001). All-cause mortality was significantly higher in patients with pneumonia ( P<0.001). In adjusted Cox regression models, pneumonia as well as C-reactive protein were independently associated with in-hospital mortality. Only C-reactive protein remained as independent predictor for long-term mortality. Conclusion: Pneumonia is relatively common in ADHF and a predictor for in-hospital mortality. However, inflammation in general seems to be more important than pneumonia itself for long-term prognosis. Compared to community-acquired pneumonia studies, C-reactive protein levels were rather low and therefore pneumonia might be over-diagnosed in ADHF patients.
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Affiliation(s)
- Alexander Jobs
- University Heart Center Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Ronja Simon
- University Heart Center Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, Germany
| | - Suzanne de Waha
- University Heart Center Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Kyrill Rogacev
- University Heart Center Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
| | | | - Valentin Babaev
- Institute for Cancer Epidemiology eV, University of Lübeck, Germany
| | - Holger Thiele
- University Heart Center Lübeck, Department of Cardiology, Angiology and Intensive Care Medicine, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany
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Lucena CM, Rovira M, Gabarrús A, Filella X, Martínez C, Domingo R, Torres A, Agustí C. The clinical value of biomarkers in respiratory complications in hematopoietic SCT. Bone Marrow Transplant 2016; 52:415-422. [PMID: 27797370 PMCID: PMC7094688 DOI: 10.1038/bmt.2016.280] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/20/2016] [Accepted: 06/24/2016] [Indexed: 11/24/2022]
Abstract
To determine the role of biomarkers in the clinical management of respiratory complications (RC) in hematopoietic stem cell transplantation (HSCT) recipients, we have prospectively evaluated a cohort of 175 patients followed-up for 1 year after HSCT. To avoid misinterpretation, we have excluded both unidentified respiratory infections (RI) and mixed RI. A total of 64 RC were included. Plasma levels of C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) were measured at diagnosis and on day 3 and 7. Different cytokines were evaluated in serum on the first day. No HSCT recipients without RC were included as a control group. Compared with RI, non-infectious RC showed a significant increase in CRP, proADM and interleukin 6 on day 0 (P=0.005; P=0.03 and P=0.04, respectively). When only RI were considered, we observed that bacterial–fungal PI showed higher levels of CRP (P=0.02), PCT (P=0.04) and proADM (P<0.01). Persistent low levels of proADM biomarkers suggest viral infection (specificity and positive predictive value 100%). Patients dying of RC had PCT and proADM levels higher than survivors (P=0.002 and P=0.03, respectively). In HSCT recipients biomarkers increase in both infectious and non-infectious RC. They may have utility in the assessment of the severity of RC and in suspecting a viral etiology.
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Affiliation(s)
- C M Lucena
- Department of Pneumology, Hospital Clínic i Provincial, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
| | - M Rovira
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,HSCT Unit, Department of Hematology, Hospital Clínic I Provincial, Barcelona, Spain
| | - A Gabarrús
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - X Filella
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Biochemistry and Molecular Genetics, Hospital Clínic i Provincial, Barcelona, Spain
| | - C Martínez
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,HSCT Unit, Department of Hematology, Hospital Clínic I Provincial, Barcelona, Spain
| | - R Domingo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Torres
- Department of Pneumology, Hospital Clínic i Provincial, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - C Agustí
- Department of Pneumology, Hospital Clínic i Provincial, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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The Usefulness of the Delta Neutrophil Index for Predicting Superimposed Pneumonia in Patients with Acute Decompensated Heart Failure in the Emergency Department. PLoS One 2016; 11:e0163461. [PMID: 27682424 PMCID: PMC5040249 DOI: 10.1371/journal.pone.0163461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/08/2016] [Indexed: 01/11/2023] Open
Abstract
Background Although respiratory infections, such as pneumonia, have long been recognized as precipitators of exacerbation in patients with acute decompensated heart failure (ADHF), identifying signs of concomitant pneumonia in ADHF is a clinical diagnostic challenge. We evaluated the predictive value of the delta neutrophil index (DNI), a new indicator for immature granulocytes, for diagnosing superimposed pneumonia in patients presenting with ADHF in the emergency department (ED). Methods This was a retrospective and observational study of consecutive patients (>18 years old) diagnosed with an ADHF in the ED over a 7-month period. Patients were categorized into either the ADHF group or the ADHF with pneumonia group. DNI, serum white blood cell (WBC), C-reactive protein (CRP), and β-natriuretic peptide (BNP) were measured upon ED arrival. Results The ADHF with pneumonia group included 30 patients (20.4%). Median initial DNI, WBC, and CRP were significantly higher in the ADHF with pneumonia group [0% vs. 1.8%, p<0.001, 8,200 cells/mL vs. 10,470 cells/mL, p<0.001, and 0.56 mg/dL vs. 6.10 mg/dL, p<0.001]. Multiple logistic regression analyses showed that only initial DNI significantly predicted the presence of superimposed pneumonia in patients with ADHF. In the receiver operating characteristic curves for initial DNI, WBC, and CRP for differentiating superimposed pneumonia in ADHF patients, the area under curve (AUC) of DNI (0.916 [95% confidence interval 0.859–0.955]) was good. AUC of DNI was significantly higher than AUC of CRP and WBC [0.828 and 0.715] (DNI vs. CRP, p = 0.047 and DNI vs. WBC, p<0.001). Conclusions Initial DNI, which was measured upon ED arrival, was significantly higher in the ADHF with pneumonia group than in the ADHF group. The initial DNI’s ability of prediction for ADHF with superimposed pneumonia in the ED was good and it was better than those of serum WBC and CRP. Therefore, DNI may serve as a convenient and useful marker for early diagnosis of superimposed pneumonia in patients with ADHF in the ED.
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Ruiz-González A, Utrillo L, Bielsa S, Falguera M, Porcel JM. The Diagnostic Value of Serum C-Reactive Protein for Identifying Pneumonia in Hospitalized Patients with Acute Respiratory Symptoms. J Biomark 2016; 2016:2198745. [PMID: 27610265 PMCID: PMC5004021 DOI: 10.1155/2016/2198745] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/25/2016] [Indexed: 01/06/2023] Open
Abstract
Background. The clinical diagnosis of pneumonia is sometimes difficult since chest radiographs are often indeterminate. In this study, we aimed to assess whether serum C-reactive protein (CRP) could assist in identifying patients with pneumonia. Methods. For one winter, all consecutive patients with acute respiratory symptoms admitted to the emergency ward of a single center were prospectively enrolled. In addition to chest radiographs, basic laboratory tests, and microbiology, serum levels of CRP were measured at entry. Results. A total of 923 (62.3%) of 1473 patients hospitalized for acute respiratory symptoms were included. Subjects with a final diagnosis of pneumonia had higher serum CRP levels (median 187 mg/L) than those with exacerbations of chronic obstructive pulmonary disease (63 mg/L) or acute bronchitis (54 mg/L, p < 0.01). CRP was accurate in identifying pneumonia (area under the curve 0.84, 95% CI 0.82-0.87). The multilevel likelihood ratio (LR) for intervals of CRP provided useful information on the posttest probability of having pneumonia. CRP intervals above 200 mg/L were associated with LR+ > 5, for which pneumonia is likely, whereas CRP intervals below 75 mg/L were associated with LR < 0.2, for which pneumonia is unlikely. Conclusion. Serum CRP may be a useful addition for diagnosing pneumonia in hospitalized patients with acute respiratory symptoms.
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Affiliation(s)
- Agustín Ruiz-González
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida Foundation Dr. Pifarré (IRBLleida), 25198 Lleida, Spain
| | - Laia Utrillo
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida Foundation Dr. Pifarré (IRBLleida), 25198 Lleida, Spain
| | - Silvia Bielsa
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida Foundation Dr. Pifarré (IRBLleida), 25198 Lleida, Spain
| | - Miquel Falguera
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida Foundation Dr. Pifarré (IRBLleida), 25198 Lleida, Spain
| | - José M. Porcel
- Department of Internal Medicine, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida Foundation Dr. Pifarré (IRBLleida), 25198 Lleida, Spain
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Serum C-Reactive Protein in Children with Liver Disease and Ascites. HEPATITIS MONTHLY 2016. [DOI: 10.5812/hepatmon.56087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Kalvandi G, Honar N, Geramizadeh B, Ataollahi M, Rahmani A, Javaherizadeh H. Serum C-Reactive Protein in Children with Liver Disease and Ascites. HEPATITIS MONTHLY 2016; 16:e38973. [PMID: 27795726 PMCID: PMC5070613 DOI: 10.5812/hepatmon.38973] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 06/10/2016] [Accepted: 07/05/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The diagnosis of peritonitis as a complication of cirrhosis is an important clinical problem. OBJECTIVES The aim of this study was to evaluate serum C-reactive protein levels as a diagnostic factor for spontaneous bacterial peritonitis (SBP) in child patients with liver disease. METHODS In this study, 150 children diagnosed with liver disease and ascites upon admission to Nemazee Teaching Hospital (Shiraz, Iran) were examined. Patients were divided into spontaneous bacterial peritonitis and sterile ascetic fluid groups according to the PMN count ≥ 250/mm3 in the ascetic fluids. Routine laboratory tests were conducted and quantitative C-reactive protein (CRP) levels were measured for all of the patients. Accuracy, sensitivity, and specificity of CRP was evaluated for diagnosis of SBP. RESULTS Of 150 cirrhotic patients, 109 patients presented without SBP (52.29% male, mean age: 5.02 ± 4.49 years) and 41 patients presented with SBP (51.21% male, mean age: 4.71 years). Cell counts, protein levels, albumin levels, and lactate dehydrogenize (LDH) levels of the ascetic fluid and serum samples in the SBP group were higher than the rates for those without SBP (P < 0.05(. The mean ± SD of CRP in the SBP group (36.89 ± 23.43) increased significantly compared to the rate among those without SBP (21.59 ± 15.43, P = 0.001). The percentages for sensitivity and specificity of CRP, the diagnosis of SBP based on the PMN count ≥ 250/mm3, and cultured ascites were 69.23%, 90.25%, 88.43%, and 84.32%, respectively. The areas under the curve of CRP for SBP based on the PMN count ≥ 250/mm3 and cultured ascites was 0.94 (CI 95%: 0.90 to 0.96) and 0.85 (CI 95%: 0.84 to 0.92), respectively (P < 0.001). CONCLUSIONS Our study showed that CRP is a marker with high sensitivity and specificity for the diagnosis of SBP in cirrhotic children.
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Affiliation(s)
- Gholamreza Kalvandi
- Department of Pediatrics, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Naser Honar
- Department of Pediatric Gastroenterology, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Bita Geramizadeh
- Department of Pathology, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Maryam Ataollahi
- Department of Pediatric Gastroenterology, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Asghar Rahmani
- Student Research Committee, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Hazhir Javaherizadeh
- Nursing Research Center in Chronic Diseases and Department of Pediatric Gastroenterology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran
- Corresponding Author: Hazhir Javaherizadeh, Nursing Research Center in Chronic Diseases and Department of Pediatric Gastroenterology, Ahvaz Jundishapur University of Medical Sciences, Abuzar Children’s Hospital, Ahvaz, IR Iran, E-mail: ,
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Kaddah S, Ahmed S. Lifestyle associated diseases and risk of pulmonary hypertension in patients with idiopathic pulmonary fibrosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Sambursky R, Shapiro N. Evaluation of a combined MxA and CRP point-of-care immunoassay to identify viral and/or bacterial immune response in patients with acute febrile respiratory infection. Eur Clin Respir J 2015; 2:28245. [PMID: 26672961 PMCID: PMC4676840 DOI: 10.3402/ecrj.v2.28245] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 09/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background Challenges in the clinical differentiation of viral and/or bacterial respiratory infection lead to the misappropriation of antibiotics and increased healthcare costs. A tool to facilitate rapid and accurate point-of-care (POC) differentiation is needed. Methods and findings A prospective, single center, blinded, observational clinical trial was conducted at Beth Israel Deaconess Medical Center from December 2012 to August 2013 to determine the accuracy of a POC immunoassay to identify a clinically significant immune response to viral and/or bacterial infection. Sixty patients with acute febrile respiratory infection (19 pharyngitis and 41 lower respiratory tract infection [LRTI]) were enrolled. Participants provided fingerstick blood for immunoassay testing (myxovirus A [MxA] and c-reactive protein [CRP]) and four oropharyngeal samples for viral PCR and routine bacterial cell culture. A venous blood sample was collected. An ELISA was used to measure CRP and MxA. Paired serological testing was used to confirm atypical bacteria. A urine sample was provided for Streptococcus and Legionella antigen testing. Patients with suspected LRTI had sputum and blood cultures, chest X-ray, and WBC count measured. Viral infection was confirmed if oropharyngeal PCR was positive for viral pathogens. Bacterial infection was confirmed in positive throat or sputum cultures. Elevated immunoglobulin M antibodies or twofold increase in IgG antibodies between acute and convalescent phase indicated atypical bacteria. Positive Streptococcus or Legionella urine antigen assays also confirmed bacterial infection. The immunoassay correctly categorized subjects as 92% (22/24) negative, 80% (16/20) with bacterial infection, and 70% (7/10) with viral infection. Conclusions The interplay between an MxA value and a semi-quantitative CRP value can aid in the differentiation of infectious etiology. In isolation, neither MxA nor CRP alone is sensitive or specific. However, the pattern of results in a rapid immunoassay provides a sensitive and specific method to differentiate acute febrile respiratory infections. This diagnostic information may help reduce antibiotic misuse and resistance and lower healthcare costs.
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Sensitive detection of C-reactive protein in serum by immunoprecipitation–microchip capillary gel electrophoresis. Anal Biochem 2015; 478:102-6. [DOI: 10.1016/j.ab.2015.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 03/01/2015] [Accepted: 03/06/2015] [Indexed: 11/22/2022]
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Predictors of mortality for nursing home-acquired pneumonia: a systematic review. BIOMED RESEARCH INTERNATIONAL 2015; 2015:285983. [PMID: 25821793 PMCID: PMC4363502 DOI: 10.1155/2015/285983] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/12/2015] [Accepted: 02/16/2015] [Indexed: 12/18/2022]
Abstract
Background. Current risk stratification tools, primarily used for CAP, are suboptimal in predicting nursing home acquired pneumonia (NHAP) outcome and mortality. We conducted a systematic review to evaluate current evidence on the usefulness of proposed predictors of NHAP mortality. Methods. PubMed (MEDLINE), EMBASE, and CINAHL databases were searched for articles published in English between January 1978 and January 2014. The literature search elicited a total of 666 references; 580 were excluded and 20 articles met the inclusion criteria for the final analysis. Results. More studies supported the Pneumonia Severity Index (PSI) as a superior predictor of NHAP severity. Fewer studies suggested CURB-65 and SOAR (especially for the need of ICU care) as useful predictors for NHAP mortality. There is weak evidence for biomarkers like C-reactive protein and copeptin as prognostic tools. Conclusion. The evidence supports the use of PSI as the best available indicator while CURB-65 may be an alternative prognostic indicator for NHAP mortality. Overall, due to the paucity of information, biomarkers may not be as effective in this role. Larger prospective studies are needed to establish the most effective predictor(s) or combination scheme to help clinicians in decision-making related to NHAP mortality.
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Predictive value of C-reactive protein in critically ill patients who develop acute lung injury. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2014.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Haubitz S, Mueller B, Schuetz P. Streamlining antibiotic therapy with procalcitonin protocols: consensus and controversies. Expert Rev Respir Med 2014; 7:145-57. [DOI: 10.1586/ers.13.6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Andreassen SL, Liaaen ED, Stenfors N, Henriksen AH. Impact of pneumonia on hospitalizations due to acute exacerbations of COPD. CLINICAL RESPIRATORY JOURNAL 2013; 8:93-9. [PMID: 23889911 DOI: 10.1111/crj.12043] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/12/2013] [Accepted: 07/09/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Pneumonia is often diagnosed among patients hospitalized with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). The aims of this study were to find the proportion of patients with pneumonia among admissions due to AECOPD and whether pneumonia has impact on the length of stay (LOS), usage of non-invasive ventilation (NIV) or the in-hospital mortality. METHODS Retrospectively, all hospitalizations in 2005 due to AECOPD in the Departments of Internal and Respiratory Medicine in one Swedish and two Norwegian hospitals were analyzed. A total of 1144 admittances (731 patients) were identified from patient administrative systems. Pneumonic AECOPD (pAECOPD) was defined as pneumonic infiltrates on chest X-ray and C-reactive protein (CRP) value of ≥40 mg/L, and non-pneumonic AECOPD (npAECOPD) was defined as no pneumonic infiltrate on X-ray and CRP value of <40 at admittance. RESULTS In admissions with pAECOPD (n = 237), LOS was increased (median 9 days vs 5 days, P < 0.001) and usage of NIV was more frequent (18.1% vs 12.5%, P = 0.04), but no significant increase in the in-hospital mortality (3.8% vs 3.6%) was found compared to admissions with npAECOPD. A higher proportion of those with COPD GOLD stage I-II had pAECOPD compared to those with COPD GOLD stage III-IV (28.2% vs 18.7%, P = 0.001). CONCLUSIONS In-hospital morbidity, but not mortality, was increased among admissions with pAECOPD compared to npAECOPD. This may, in part, be explained by the extensive treatment with antibiotics and NIV in patients with pAECOPD.
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Affiliation(s)
- Siw Lillevik Andreassen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
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Evaluation of B-type natriuretic peptide in patients with community acquired pneumonia. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kim SH, Chung JH, Lee JC, Park YH, Joe JH, Hwang HJ. Carboxy-terminal provasopressin may predict prognosis in nursing home acquired pneumonia. Clin Chim Acta 2013; 421:226-9. [PMID: 23454473 DOI: 10.1016/j.cca.2013.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 02/21/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study compares biomarker (including procalcitonin, pro-ANP, and copeptin) levels to pneumonia severity scores to predict 30-day mortality in NHAP (nursing home acquired pneumonia) patients. METHODS Seventy three patients aged ≥ 65 y, admitted to general hospitals and who fulfilled the definition of NHAP were included in the study. Data collected at admission included age, gender, nursing home admission, coexisting illness, symptoms and clinical parameters (blood pressure, pulse rate, respiratory rate and status). Additional data collected included laboratory results, radiographic findings and outcome variables. Severity of pneumonia was evaluated using a prediction rule calculated by CURB-65 criteria (confusion, urea nitrogen, respiratory rate, blood pressure, age>65 y). RESULTS After adjustment for age, sex and CURB-65, copeptin (OR=5.60, 95% confidence interval (CI)=1.20-26.24) was associated with 30-day mortality in NHAP patients, while procalcitonin and pro-ANP were not. The areas under the receiver operating characteristic curves (AUCs) for CURB-65, in predicting mortality were 0.685 [95% CI 0.559-0.811], whereas copeptin showed slightly superior accuracy with an AUC of 0.698 (95% CI 0.568-0.827). CONCLUSIONS Among 3 biomakers, copeptin was the strongest predictor of 30-day mortality from NHAP. The pathophysiologic and clinical implications of this finding require further investigation.
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Affiliation(s)
- Sang-Hwan Kim
- Kwandong University College of Medicine, Gangneung-si, Gangwon-do 210-701, Republic of Korea
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Cheng CW, Chien MH, Su SC, Yang SF. New markers in pneumonia. Clin Chim Acta 2013; 419:19-25. [PMID: 23384502 PMCID: PMC7094281 DOI: 10.1016/j.cca.2013.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/01/2013] [Accepted: 01/12/2013] [Indexed: 01/07/2023]
Abstract
Pneumonia is one of the most common causes of death from infectious diseases worldwide, and the most common fatal infection acquired in hospitals. Despite advances in prevention strategies, such as antibiotic therapies and intensive care, significant improvement in the mortality rate is still lacking. This high mortality is largely due to the limitations in current clinical practices and laboratory tests, which delay the timing of adequate antibiotic therapy. In recent years, many indicators (biomarkers) are present in scenarios where infectious pathogens invade into the body. These biomarkers, as reflected in specific biological responses to infections, have been reported to demonstrate the ability to facilitate the diagnosis, risk stratification, and management of pneumonia. This review provides a schematic overview of these new potential biomarkers based on the categories of (1) microorganisms and their derivatives, (2) inflammation mediators, (3) inflammation response proteins, and (4) stress-sensing proteins. In addition, approaches to identifying new biomarkers are also briefly introduced. Although no current biomarker can solely achieve a definitive diagnosis, many of them can be complemented, rather than replaced outright, in routine clinical practices to improve decision-making processes regarding pneumonia.
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Affiliation(s)
- Chao-Wen Cheng
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Fujisaki R, Yamaoka T, Yamamura M, Kawakami S, Ono Y, Miyazawa Y, Teramoto T, Nishiya H. Usefulness of gram-stained sputum obtained just after administration of antimicrobial agents as the earliest therapeutic indicator for evaluating the effectiveness of empiric therapy in community-acquired pneumonia caused by pneumococcus or Moraxella catarrhalis. J Infect Chemother 2012; 19:517-23. [PMID: 23073648 DOI: 10.1007/s10156-012-0475-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
We present here three cases in which morphological changes and/or a decreased number of Streptococcus pneumoniae or Moraxella catarrhalis could be observed in gram-stained sputum obtained just after the first administration of an antimicrobial agent. Case 1 was a 53-year-old man with pneumonia caused by gram-positive diplococcus, identified as S. pneumoniae, who was administered 2 g of ampicillin over a period of 1 h. Gram-stained sputum showed smaller or gram-negative pneumococci at the completion of administration of the agent, a decreased number of cocci at 1 h after administration, and almost no cocci at 12 h after the completion of administration. Case 2 was a 72-year-old woman with pneumonia caused by diplococcus, identified as S. pneumoniae, who was administered 2 g of ampicillin over a period of 1 h. Gram-stained sputum showed weakly stained, small cocci at the completion of administration of the agent and few cocci at 1 h after the completion of administration. Case 3 was a 58-year-old woman with pneumonia caused by a gram-negative diplococcus, identified as Moraxella catarrhalis, who was administered 1 g of cefotaxime over a period of 30 min. Gram-stained sputum showed few extracellular cocci and some intracellular cocci inside neutrophils 1 h after administration and no cocci 2 h after the completion of administration. These three cases showed that gram-stained sputum obtained just after and/or 1 h after administration of the first antimicrobial agent were suitable as the quickest therapeutic indicator of the effectiveness of empiric therapy, with the effectiveness of the agent being shown much earlier than with markers such as the white blood cell count and C-reactive protein level.
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Affiliation(s)
- Ryuichi Fujisaki
- Department of Internal Medicine, Teikyo University School of Medicine, Kaga 2-11-1, Itabashi-ku, Tokyo, 173-8605, Japan
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The association between self-reported symptoms of recent airway infection and CRP values in a general population. Inflammation 2012; 35:1015-22. [PMID: 22089980 PMCID: PMC3332358 DOI: 10.1007/s10753-011-9405-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
C-reactive protein (CRP) is a much used biomarker for respiratory tract infection; however, the influence of airway infection on the CRP level in the general population has not been well described. The study aimed to evaluate the impact of recent symptoms of airway infection on the CRP level and how the predictive power of other known CRP predictors is influenced by taking respiratory symptoms into account. A total of 6,325 participants, aged 38-87 years, in the Tromsø Study, a repeated population-based survey, were examined with questionnaires, measurements of height and weight, spirometry, and high-sensitivity CRP analyses. The mean CRP value was 2.86 mg/L, and the geometric mean was 1.51 mg/L. Geometric means above 2.0 mg/L were found in the subgroups with the following characteristics: self-reported COPD, diabetes, recent symptoms of airway infection, forced expiratory volume in 1 s (FEV1) <80% predicted, body mass index (BMI) ≥30, and subjects treated with inhaled or oral corticosteroids. Among the subjects who reported recent airway infection, 10.5% had a CRP value of ≥10 mg/L, compared to 3.3% among the remaining participants. By multivariate analysis, BMI was the strongest independent predictor of the CRP level, followed by recent airway infection, FEV1% predicted, age, and current smoking. The study clearly demonstrates that a report of recent symptoms of airway infection strongly predicts the CRP level in the population. Such symptoms were shared rather equally between subgroups with increased CRP level, and the risk of being an important confounder in epidemiological studies is probably low. In the clinical setting, care should be taken when using the CRP level as a guide for medical prevention of chronic diseases.
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Ugajin M, Yamaki K, Iwamura N, Yagi T, Asano T. Blood urea nitrogen to serum albumin ratio independently predicts mortality and severity of community-acquired pneumonia. Int J Gen Med 2012; 5:583-9. [PMID: 22866010 PMCID: PMC3410717 DOI: 10.2147/ijgm.s33628] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Early studies of community-acquired pneumonia showed that nonsurvivors had higher blood urea nitrogen levels and lower serum albumin levels than survivors. Therefore, elevation of the blood urea nitrogen to serum albumin (B/A) ratio may identify patients with community-acquired pneumonia who are becoming critically ill. This study investigated the correlation between commonly used laboratory markers, in particular the B/A ratio, and clinical outcomes of community-acquired pneumonia. Methods This observational study was performed in consecutive patients with community-acquired pneumonia admitted to our hospital over a period of one year. Blood counts, commonly used laboratory markers, microbiological tests, and calculation of Pneumonia Severity Index (PSI) and CURB-65 were done on admission. The endpoints were mortality within 28 days of admission and requirement for intensive care. Results One hundred and seventy-five patients with community-acquired pneumonia were enrolled. Nineteen patients died within 28 days of admission and 29 patients required intensive care. Using multivariate analysis, independent factors associated with mortality were the requirement for intensive care (odds ratio [OR] 14.96, 95% confidence interval [CI] 3.73–60.03, P < 0.001), PSI class (OR 3.55, 95% CI 1.08–11.66, P = 0.037), and B/A ratio (OR 1.10, 95% CI 1.01–1.20, P = 0.037). Similarly, independent factors associated with need for intensive care were PSI class (OR 5.35, 95% CI 1.90–15.06, P = 0.002), CURB-65 (OR 2.37, 95% CI 1.26–4.45, P = 0.007), and B/A ratio (OR 1.27, 95% CI 1.09–1.47, P = 0.002). Conclusion The B/A ratio is a simple but independent predictor of mortality and severity of community-acquired pneumonia.
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Affiliation(s)
- Motoi Ugajin
- Department of Respiratory Medicine, Ichinomiya-Nishi Hospital, Ichinomiya City, Aichi Prefecture, Japan
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Blasi F, Bocchino M, Di Marco F, Richeldi L, Aliberti S. The role of biomarkers in low respiratory tract infections. Eur J Intern Med 2012; 23:429-35. [PMID: 22726371 DOI: 10.1016/j.ejim.2012.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Low respiratory tract infections (LRTI) represent the leading infectious cause of death worldwide and account for substantial use of healthcare resources. Physicians must adopt practices focused on improving outcomes and serum biomarker can help them in the management of patients with LRTI. Several studies have been carried out or are currently ongoing to evaluate the role of various biomarkers for the differential diagnosis, definition of prognosis, treatment and duration of antibiotic therapy in respiratory infections. The objective of this position paper of the Italian Society of Respiratory Diseases (SIMER) is to provide evidence-based recommendations for the use of biomarkers in routine clinical practice in the management of adult patients with LRTI. These guidelines capture the use of biomarkers both outside and inside the hospital, focused on community-acquired pneumonia, acute exacerbations of chronic obstructive pulmonary disease, hospital-acquired and ventilator-acquired pneumonia.
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Affiliation(s)
- Francesco Blasi
- Dipartimento Toraco-Polmonare e Cardio-Circolatorio, University of Milan, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy.
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Chalmers JD, Rutherford J. Can we use severity assessment tools to increase outpatient management of community-acquired pneumonia? Eur J Intern Med 2012; 23:398-406. [PMID: 22726367 DOI: 10.1016/j.ejim.2011.10.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/02/2011] [Accepted: 10/03/2011] [Indexed: 02/08/2023]
Abstract
Outpatient management of community-acquired pneumonia (CAP) has several potential advantages, including significant cost-savings, a reduction in hospital-acquired infections and increased patient satisfaction. Despite the benefits, it is often difficult to identify which patients may be managed in the community without compromising patient safety. CAP severity scores, such as the pneumonia severity index (PSI) and the British Thoracic Society CURB65/CRB65 scores are designed to identify groups of patients at low risk of mortality who may be suitable for outpatient care. This review discusses the strengths and weaknesses of severity scores for use in determining site of care for patients with pneumonia. Use of the PSI in emergency departments has been shown to increase the proportion of patients treated in the community without increasing patient mortality or hospital readmissions. The CURB65 and CRB65 scores are less complex alternatives to the PSI that have been shown to perform similarly for prediction of 30-day mortality. All 3 scores identify populations at low risk of mortality who may be eligible for outpatient care. Nevertheless, a number of factors not included in severity scores may prevent discharge of these patients, including social factors, co-morbidities and severity markers not captured by severity scores. The limitations of severity scores are discussed along with recent attempts to improve predictive tools, with the development of new biomarkers and alternative scoring systems.
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Affiliation(s)
- James D Chalmers
- MRC Centre for Inflammation Research, Queens Medical Research Centre, University of Edinburgh, Edinburgh, UK.
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Kasamatsu Y, Yamaguchi T, Kawaguchi T, Tanaka N, Oka H, Nakamura T, Yamagami K, Yoshioka K, Imanishi M. Usefulness of a semi-quantitative procalcitonin test and the A-DROP Japanese prognostic scale for predicting mortality among adults hospitalized with community-acquired pneumonia. Respirology 2012; 17:330-6. [PMID: 22059525 DOI: 10.1111/j.1440-1843.2011.02101.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The solid-phase immunoassay, semi-quantitative procalcitonin (PCT) test (B R A H M S PCT-Q) can be used to rapidly categorize PCT levels into four grades. However, the usefulness of this kit for determining the prognosis of adult patients with community-acquired pneumonia (CAP) is unclear. METHODS A prospective study was conducted in two Japanese hospitals to evaluate the usefulness of this PCT test in determining the prognosis of adult patients with CAP. The accuracy of the age, dehydration, respiratory failure, orientation disturbance, pressure (A-DROP) scale proposed by the Japanese Respiratory Society for prediction of mortality due to CAP was also investigated. Hospitalized CAP patients (n = 226) were enrolled in the study. Comprehensive examinations were performed to determine PCT and CRP concentrations, disease severity based on the A-DROP, pneumonia severity index (PSI) and confusion, urea, respiratory rate, blood pressure, age ≥65 (CURB-65) scales and the causative pathogens. The usefulness of the biomarkers and prognostic scales for predicting each outcome were then examined. RESULTS Twenty of the 170 eligible patients died. PCT levels were strongly positively correlated with PSI (ρ = 0.56, P < 0.0001), A-DROP (ρ = 0.61, P < 0.0001) and CURB-65 scores (ρ = 0.58, P < 0.0001). The areas under the receiver operating characteristic curves (95% CI) for prediction of survival, for CRP, PCT, A-DROP, CURB-65, and PSI were 0.54 (0.42-0.67), 0.80 (0.70-0.90), 0.88 (0.82-0.94), 0.88 (0.82-0.94), and 0.89 (0.85-0.94), respectively. The 30-day mortality among patients who were PCT-positive (≥0.5 ng/mL) was significantly higher than that among PCT-negative patients (log-rank test, P < 0.001). CONCLUSIONS The semi-quantitative PCT test and the A-DROP scale were found to be useful for predicting mortality in adult patients with CAP.
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Affiliation(s)
- Yu Kasamatsu
- Department of Respiratory Medicine, Matsushita Memorial Hospital, Japan.
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Plasma C-reactive protein levels are associated with mortality in elderly with acute lung injury. J Crit Care 2011; 27:524.e1-6. [PMID: 22176804 DOI: 10.1016/j.jcrc.2011.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 10/13/2011] [Accepted: 10/14/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE The plasma C-reactive protein (CRP) level is considered to be a predictor of severity in both hospital- and community-acquired pneumonias, whereas recent reports have shown that higher CRP levels lead to better outcomes in patients with acute lung injury (ALI). To explain this discrepancy, we evaluated the relationship among plasma CRP levels, etiology, affectors of CRP production, and mortality in patients with ALI. MATERIALS AND METHODS This was a case-control study of 76 consecutive patients with ALI. The plasma CRP levels had been measured in all of the patients within 1 hour of visiting an emergency department. The associations between the plasma CRP levels and 60-day mortality were analyzed after adjusting for the causes of ALI, disease severity, the patients' age, use of corticosteroids, and presence of hepatic failure. RESULTS The CRP levels and patients' ages were strongly related to the mortality (adjusted hazard ratio, 1.005 [P = .007] and 1.059 [P = .011], respectively), whereas the etiology of ALI did not affect the mortality (adjusted hazard ratio, 0.789 [P = .530]) in the Cox proportional hazard models. CONCLUSIONS The plasma CRP level may be a predictor of mortality in elderly patients with ALI.
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Arinzon Z, Peisakh A, Schrire S, Berner Y. C-reactive protein (CRP): An important diagnostic and prognostic tool in nursing-home-associated pneumonia. Arch Gerontol Geriatr 2011; 53:364-9. [DOI: 10.1016/j.archger.2011.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 11/17/2022]
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Lacoma A, Rodríguez N, Prat C, Ruiz-Manzano J, Andreo F, Ramírez A, Bas A, Pérez M, Ausina V, Domínguez J. Usefulness of consecutive biomarkers measurement in the management of community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2011; 31:825-33. [PMID: 21870054 DOI: 10.1007/s10096-011-1381-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 08/03/2011] [Indexed: 02/05/2023]
Abstract
The aim of this study was to investigate whether procalcitonin (PCT), neopterin, C-reactive protein (CRP), and mid regional pro-atrial natriuretic peptide (MR-proANP) levels at admission and during the clinical course can be useful for the management of patients with pneumonia. The study population consisted of 75 patients with clinical and radiological diagnosis of pneumonia. Serum samples were collected at admission and during hospitalization. Complications were defined as intensive care unit (ICU) admission or death. The levels of PCT were significantly higher in pneumonia of definite bacterial origin in comparison to probable bacterial or unknown origin. The PCT levels were higher in pneumococcal pneumonia. The PCT and MR-proANP levels increased significantly according to the Pneumonia Severity Index (PSI). All biomarkers levels are higher in patients developing complications and who were dying. The serial levels of MR-proANP remain significantly elevated in patients developing complications and in patients classified in PSI and CURB-65 risk groups. In patients not developing complications, there is a significant decrease in the PCT levels. PCT can be useful for identifying pneumonia etiology. PCT and MR-proANP levels correlate with pneumonia severity rules. PCT and MR-proANP serial measurements can be useful for predicting short-term prognosis. Systemic biomarkers can provide additional information regarding clinical evolution, because these are dynamic and can be measured daily.
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Affiliation(s)
- A Lacoma
- Servei de Microbiologia, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Carretera del Canyet s/n, 08916, Barcelona, Spain
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Komiya K, Ishii H, Teramoto S, Takahashi O, Eshima N, Yamaguchi O, Ebi N, Murakami J, Yamamoto H, Kadota JI. Diagnostic utility of C-reactive protein combined with brain natriuretic peptide in acute pulmonary edema: a cross sectional study. Respir Res 2011; 12:83. [PMID: 21696613 PMCID: PMC3136418 DOI: 10.1186/1465-9921-12-83] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 06/22/2011] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Discriminating acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) from cardiogenic pulmonary edema (CPE) using the plasma level of brain natriuretic peptide (BNP) alone remains controversial. The aim of this study was to determine the diagnostic utility of combination measurements of BNP and C-reactive protein (CRP) in critically ill patients with pulmonary edema. METHODS This was a cross-sectional study. BNP and CRP data from 147 patients who presented to the emergency department due to acute respiratory failure with bilateral pulmonary infiltrates were analyzed. RESULTS There were 53 patients with ALI/ARDS, 71 with CPE, and 23 with mixed edema. Median BNP and CRP levels were 202 (interquartile range 95-439) pg/mL and 119 (62-165) mg/L in ALI/ARDS, and 691 (416-1,194) pg/mL (p < 0.001) and 8 (2-42) mg/L (p < 0.001) in CPE. BNP or CRP alone offered good discriminatory performance (C-statistics 0.831 and 0.887), but the combination offered greater one [C-statistics 0.931 (p < 0.001 versus BNP) (p = 0.030 versus CRP)]. In multiple logistic-regression, BNP and CRP were independent predictors for the diagnosis after adjusting for other variables. CONCLUSIONS Measurement of CRP is useful as well as that of BNP for distinguishing ALI/ARDS from CPE. Furthermore, a combination of BNP and CRP can provide higher accuracy for the diagnosis.
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Affiliation(s)
- Kosaku Komiya
- Department of Internal Medicine 2, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu (879-5593), Japan
| | - Hiroshi Ishii
- Department of Internal Medicine 2, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu (879-5593), Japan
| | - Shinji Teramoto
- Department of Respiratory Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Hitachinaka Education and Research Center, 20-1 Ishikawa, Hitachinaka (317-0077), Japan
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's Life Science Institute, 10-1 Akashi-machi, Chuo (104-0044), Japan
| | - Nobuoki Eshima
- Department of Biostatistics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu (879-5593), Japan
| | - Ou Yamaguchi
- Departments of Respiratory Medicine, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka (820-0018), Japan
| | - Noriyuki Ebi
- Departments of Respiratory Medicine, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka (820-0018), Japan
| | - Junji Murakami
- Department of Radiology, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka (820-0018), Japan
| | - Hidehiko Yamamoto
- Departments of Respiratory Medicine, Aso Iizuka Hospital, 3-83 Yoshio-machi, Iizuka (820-0018), Japan
| | - Jun-ichi Kadota
- Department of Internal Medicine 2, Oita University Faculty of Medicine, 1-1 Idaigaoka, Yufu (879-5593), Japan
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Bafadhel M, Clark TW, Reid C, Medina MJ, Batham S, Barer MR, Nicholson KG, Brightling CE. Procalcitonin and C-reactive protein in hospitalized adult patients with community-acquired pneumonia or exacerbation of asthma or COPD. Chest 2011; 139:1410-1418. [PMID: 21030489 PMCID: PMC3109646 DOI: 10.1378/chest.10-1747] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 09/25/2010] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antibiotic overuse in respiratory illness is common and is associated with drug resistance and hospital-acquired infection. Biomarkers that can identify bacterial infections may reduce antibiotic prescription. We aimed to compare the usefulness of the biomarkers procalcitonin and C-reactive protein (CRP) in patients with pneumonia or exacerbations of asthma or COPD. METHODS Patients with a diagnosis of community-acquired pneumonia or exacerbation of asthma or COPD were recruited during the winter months of 2006 to 2008. Demographics, clinical data, and blood samples were collected. Procalcitonin and CRP concentrations were measured from available sera. RESULTS Sixty-two patients with pneumonia, 96 with asthma, and 161 with COPD were studied. Serum procalcitonin and CRP concentrations were strongly correlated (Spearman rank correlation coefficient [rs] = 0.56, P < .001). Patients with pneumonia had increased procalcitonin and CRP levels (median [interquartile range] 1.27 ng/mL [2.36], 191 mg/L [159]) compared with those with asthma (0.03 ng/mL [0.04], 9 mg/L [21]) and COPD (0.05 ng/mL [0.06], 16 mg/L [34]). The area under the receiver operating characteristic curve (95% CI) for distinguishing between patients with pneumonia (antibiotics required) and exacerbations of asthma (antibiotics not required), for procalcitonin and CRP was 0.93 (0.88-0.98) and 0.96 (0.93-1.00). A CRP value > 48 mg/L had a sensitivity of 91% (95% CI, 80%-97%) and specificity of 93% (95% CI, 86%-98%) for identifying patients with pneumonia. CONCLUSIONS Procalcitonin and CRP levels can both independently distinguish pneumonia from exacerbations of asthma. CRP levels could be used to guide antibiotic therapy and reduce antibiotic overuse in hospitalized patients with acute respiratory illness.
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Affiliation(s)
- Mona Bafadhel
- Institute for Lung Health, University of Leicester, Leicester, England; Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, England
| | - Tristan W Clark
- Department of Infectious Disease, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Carlene Reid
- Institute for Lung Health, University of Leicester, Leicester, England
| | - Marie-Jo Medina
- Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, England
| | - Sally Batham
- Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, England; Department of Infectious Disease, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Michael R Barer
- Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, England
| | - Karl G Nicholson
- Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, England; Department of Infectious Disease, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Christopher E Brightling
- Institute for Lung Health, University of Leicester, Leicester, England; Department of Infection, Immunity, and Inflammation, University of Leicester, Leicester, England.
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Bui H, Vargas F, Gruson D, Hilbert G. Où traiter une pneumopathie aiguë communautaire : évaluation de la sévérité ? Rev Mal Respir 2011; 28:240-53. [DOI: 10.1016/j.rmr.2010.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 08/04/2010] [Indexed: 10/18/2022]
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Mooiweer E, Luijk B, Bonten MJM, Ekkelenkamp MB. C-Reactive protein levels but not CRP dynamics predict mortality in patients with pneumococcal pneumonia. J Infect 2011; 62:314-6. [PMID: 21281676 DOI: 10.1016/j.jinf.2011.01.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 01/22/2011] [Indexed: 11/28/2022]
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Abstract
SummaryThe incidence of pneumonia is higher in older than younger people, due to both an increase in factors facilitating entry of infectious agents into the lungs, and attenuated functioning of the immune system. Classic features of presentation of pneumonia may be absent. The most common signs of pneumonia in old age are tachypnoea and tachycardia. Aetiology is established in only 50% of older patients. The empirical treatment of community-aquired pneumonia (CAP) should be aimed at its most common cause,Streptococcus pneumoniae. The empirical treatment of health care-associated pneumonia (HCAP) should be targeted at Gram-negative agents. Choice of antibiotic must include consideration of potential drug interactions.
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Brar NK, Niederman MS. Management of community-acquired pneumonia: a review and update. Ther Adv Respir Dis 2010; 5:61-78. [PMID: 20935033 DOI: 10.1177/1753465810381518] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, affecting approximately 5.6 million patients annually in the USA, where the annual cost exceeds US$12 billion. Optimal management should be based on knowledge of the most likely etiologic pathogens for each patient, based on an assessment of specific risk factors. It is also essential to assess severity of illness, to determine the appropriate site of care, and to order appropriate diagnostic testing. New developments in CAP management have focused on recognizing newly identified pathogens, such as methicillin-resistant Staphylococcus aureus and novel H1N1 influenza, understanding when to utilize new microbiological diagnostic techniques, and how to use biomarkers to direct the appropriate utilization of antibiotics and to define the duration of therapy. This paper reviews recent advances in our knowledge about the diagnosis and optimal management of CAP.
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Affiliation(s)
- Navdeep K Brar
- Department of Pulmonary, Critical Care and Sleep Medicine, Winthrop University Hospital, Mineola, NY 11501, USA
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Zimmerman O, Rogowski O, Aviram G, Mizrahi M, Zeltser D, Justo D, Dahan E, Arad R, Touvia O, Tau L, Tarabeia J, Berliner S, Paran Y. C-reactive protein serum levels as an early predictor of outcome in patients with pandemic H1N1 influenza A virus infection. BMC Infect Dis 2010; 10:288. [PMID: 20920320 PMCID: PMC2959060 DOI: 10.1186/1471-2334-10-288] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 10/04/2010] [Indexed: 12/27/2022] Open
Abstract
Background Data for predicting which patients with pandemic influenza A (H1N1) infection are likely to run a complicated course are sparse. We retrospectively studied whether the admission serum C-reactive protein (CRP) levels can serve as a predictor of illness severity. Methods Included were all consecutive adult patients who presented to the emergency department (ED) between May-December, 2009 with a flu-like illness, a confirmed diagnosis of pandemic influenza A (H1N1) infection and a serum CRP level measured within 24 hours of presentation. Patients with a proven additional concurrent acute illness (e.g., bacteremia) were excluded. We used the ROC curve analysis, Kaplan-Meier curves and the Cox proportional hazard model to evaluate the predictive ability of CRP as a prognostic factor. Results Seventeen (9%) of the 191 enrolled patients were admitted to the intensive care unit (ICU), of whom eight (4%) required mechanical ventilation and three (2%) died. The median admission serum CRP levels were significantly higher among patients who required subsequent ICU care and mechanical ventilation than among patients who did not (123 mg/L and 112 mg/L vs. 40 mg/L, p < .001 and 43 mg/L, p = .017, respectively). A Cox proportional hazard model identified admission serum CRP levels and auscultatory findings over the lungs as independent prognostic factors for ICU admission. Admission serum CRP levels were the only independent prognostic factor for mechanical ventilation. Thirty days after presenting to the ED, none of the patients with admission serum CRP level <28 mg/L (lower tertile) required either ICU admission or mechanical ventilation. At the same time point, 19% of the patients with admission serum CRP level ≥70 mg/L (upper tertile) needed to be admitted to the ICU and 8% of the same upper tertile group required mechanical ventilation. The differences in the rates between the lower vs. upper tertile groups were significant (Log-Rank p < .001 for ICU and p < .024 for mechanical ventilation). Conclusions In our study group, serum CRP levels obtained in the early ED admission stage from patients presenting with pandemic H1N1 influenza A infection were found to serve as a useful gauge for predicting disease course and assisting in patient management.
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Affiliation(s)
- Ofer Zimmerman
- Department of Internal Medicine D, Tel-Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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44
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Quinton LJ, Mizgerd JP. NF-κB and STAT3 signaling hubs for lung innate immunity. Cell Tissue Res 2010; 343:153-65. [PMID: 20872151 DOI: 10.1007/s00441-010-1044-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 08/17/2010] [Indexed: 01/05/2023]
Abstract
Innate immune responses to lung pathogens involve the coordinated expression of myriad affector and effector molecules of innate immunity, which must be induced and appropriately regulated in response to diverse stimuli generated by microbes or the infected host. Many intercellular and intracellular signaling pathways are involved, but we propose NF-κB and STAT3 transcription factors to be especially important signaling hubs for integrating these pathways to orchestrate effective host defense without excessive inflammatory injury.
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Affiliation(s)
- Lee J Quinton
- The Pulmonary Center, Boston University School of Medicine, 72 E. Concord Street, Boston, MA 02118, USA
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45
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Schuetz P, Albrich W, Christ-Crain M, Chastre J, Mueller B. Procalcitonin for guidance of antibiotic therapy. Expert Rev Anti Infect Ther 2010; 8:575-87. [PMID: 20455686 DOI: 10.1586/eri.10.25] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Procalcitonin is a surrogate biomarker for estimating the likelihood of a bacterial infection. Procalcitonin-guided initiation and termination of antibiotic therapy is a novel approach utilized to reduce antibiotic overuse. This is essential to decrease the risk of side effects and emerging bacterial multiresistance. Interpretation of procalcitonin levels must always comprise the clinical setting and knowledge about assay characteristics. Only highly sensitive procalcitonin assays should be used in clinical practice and cut-off ranges must be adapted to the disease and setting. Highly sensitive procalcitonin measurements, embedded in diagnosis-specific clinical algorithms, have been shown to markedly reduce the overuse of antibiotic therapy without increasing risk to patients in 11 randomized controlled trials including over 3500 patients from different European countries. In primary care and emergency department patients with mild and mostly viral respiratory infections (acute bronchitis), the initial prescription of antibiotics was reduced by 30-80%. In hospitalized and more severely ill patients with community-acquired pneumonia and sepsis, the main effect was a reduction of the duration of antibiotic courses by 25-65%. This review aims to provide physicians with an overview of the strengths and limitations of procalcitonin guidance for antibiotic therapy when used in different clinical settings and in patients with different underlying infections.
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Bewick T, Lim WS. Diagnosis of community-acquired pneumonia in adults. Expert Rev Respir Med 2010; 3:153-64. [PMID: 20477309 DOI: 10.1586/ers.09.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Community-acquired pneumonia (CAP) is a common presentation to both primary and secondary care, representing approximately 5% of the acute medical intake in the UK. Treatment is often based on an empirical approach, using broad-spectrum antibiotic regimens, with which the majority of patients will achieve clinical cure. However, in cases of severe CAP, initial treatment failure or severe comorbidity, a more rigorous diagnostic approach is required. This review assesses the evidence base behind the common diagnostic methods for CAP, and presents the case for a rapid and accurate microbiological and radiological diagnosis in improving management and outcomes of this common condition.
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Affiliation(s)
- Thomas Bewick
- Nottingham University Hospitals NHS Trust, David Evans Building, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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47
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Abstract
IMPORTANCE OF THE FIELD Community-acquired pneumonia (CAP) is a common and potentially life-threatening illness that continues to be a major medical problem. Among infectious diseases, CAP is the leading cause of death in the world and is associated with a substantial economic burden to health are systems around the globe. AREAS COVERED IN THIS REVIEW Recently identified clinical and biochemical tools promise to improve the assessment of CAP severity. Various prognostic scoring systems and predictive biomarkers have been proposed as tools to aid clinicians in key management decisions. This review provides a summary of current evidence about the use of prognostic scoring systems and biomarkers in the management of patients presenting with CAP. According to the existing guidelines, until more accurate and rapid diagnostic methods are available, the initial treatment for most patients with CAP will remain empirical. Some novel antibiotic and nonantibiotic therapies have recently been tested; some empirical antimicrobial regimens are still being debated. This review summarizes the recent advances in the field of therapy and novel approaches. We searched PubMed for English-language references published from 1997 to 2009 using combinations of the following terms: 'community acquired pneumonia', 'community acquired bacterial pneumonia', 'therapy', 'antibiotics', 'antimicrobials', 'prognostic scoring systems', 'biomarkers', 'diagnostic testing', 'guidelines' 'etiological diagnosis'. WHAT THE READER WILL GAIN A thorough description about recent advances in the field of therapy and novel approaches of CAP, as well as a summary of current evidence about the use of prognostic scoring systems and biomarkers in the management of patients presenting with CAP, is presented. TAKE HOME MESSAGE Recent developments have made significant contributions to the management of CAP patients. However, various hot topics remain open and urgently require prospective studies in order to optimize the outcomes of CAP.
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Affiliation(s)
- Stavros Anevlavis
- Department of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Medical School, Alexandroupolis 68100, Greece
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48
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Poll GH, Betz SK, Miller CA. Identification of clinical markers of specific language impairment in adults. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2010; 53:414-429. [PMID: 20360465 DOI: 10.1044/1092-4388(2009/08-0016)] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE To investigate the usefulness of 3 tasks known to be effective diagnostic clinical markers of specific language impairment (SLI) in children: (a) nonword repetition, (b) sentence repetition, and (c) grammaticality judgments of finiteness marking. METHOD Two groups of young adults, 13 with SLI and 18 with typical language, completed 3 experimental tasks: (a) nonword repetition, (b) sentence repetition, and (c) grammaticality judgments of sentences that were either correct or contained an omitted finiteness marker, an overt agreement error, or an omitted progressive -ing. Analyses included receiver operating characteristic curve analyses and computation of likelihood ratios associated with the use of each task as a clinical marker for SLI, as well as development of a logistic regression model that used multiple tasks as predictors. RESULTS Each marker task significantly contributed to classification of adults as affected or unaffected by SLI, with moderate positive and negative likelihood ratios. A combination of the 3 marker tasks was the best predictor of affectedness status with moderate to large likelihood ratios. CONCLUSIONS The results suggest that SLI persists into adulthood and that effective clinical markers of this disorder are similar to those used to identify SLI in children. Refinement of these tasks to increase their likelihood ratios will improve their usefulness in diagnosing SLI in adults.
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Affiliation(s)
- Gerard H Poll
- The Pennsylvania State University, University Park, PA 16802, USA.
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Marcos V, Latzin P, Hector A, Sonanini S, Hoffmann F, Lacher M, Koller B, Bufler P, Nicolai T, Hartl D, Griese M. Expression, regulation and clinical significance of soluble and membrane CD14 receptors in pediatric inflammatory lung diseases. Respir Res 2010; 11:32. [PMID: 20302606 PMCID: PMC2845564 DOI: 10.1186/1465-9921-11-32] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 03/19/2010] [Indexed: 11/11/2022] Open
Abstract
Background Inflammatory lung diseases are a major morbidity factor in children. Therefore, novel strategies for early detection of inflammatory lung diseases are of high interest. Bacterial lipopolysaccharide (LPS) is recognized via Toll-like receptors and CD14. CD14 exists as a soluble (sCD14) and membrane-associated (mCD14) protein, present on the surface of leukocytes. Previous studies suggest sCD14 as potential marker for inflammatory diseases, but their potential role in pediatric lung diseases remained elusive. Therefore, we examined the expression, regulation and significance of sCD14 and mCD14 in pediatric lung diseases. Methods sCD14 levels were quantified in serum and bronchoalveolar lavage fluid (BALF) of children with infective (pneumonia, cystic fibrosis, CF) and non-infective (asthma) inflammatory lung diseases and healthy control subjects by ELISA. Membrane CD14 expression levels on monocytes in peripheral blood and on alveolar macrophages in BALF were quantified by flow cytometry. In vitro studies were performed to investigate which factors regulate sCD14 release and mCD14 expression. Results sCD14 serum levels were specifically increased in serum of children with pneumonia compared to CF, asthma and control subjects. In vitro, CpG induced the release of sCD14 levels in a protease-independent manner, whereas LPS-mediated mCD14 shedding was prevented by serine protease inhibition. Conclusions This study demonstrates for the first time the expression, regulation and clinical significance of soluble and membrane CD14 receptors in pediatric inflammatory lung diseases and suggests sCD14 as potential marker for pneumonia in children.
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Affiliation(s)
- Veronica Marcos
- Children's Hospital of the Ludwig-Maximilians-University, Munich, Germany.
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50
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Koseoglu Z, Ozkan OV, Semerci E, Aslan A, Yetim I, Ucar E, Kuvandik G, Temiz M, Borazan A. The relationship between mortality and inflammation in patients with gastrointestinal bleeding. J Int Med Res 2010; 37:1508-14. [PMID: 19930858 DOI: 10.1177/147323000903700528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to investigate the association between mortality and inflammation in patients who were admitted to the emergency room with gastrointestinal bleeding. Patients (n = 96) managed at two medical centres were included in the study. Initial levels of serum C-reactive protein (CRP), haemoglobin and albumin, and leucocyte and thrombocyte counts for 28 patients who died were compared with those for the 68 patients who survived and were successfully discharged. The data were analysed using the chi(2)-test. Serum levels of CRP and leucocyte counts were significantly higher, and albumin and haemoglobin were significantly lower in patients who died compared with patients who survived. The increased levels of serum CRP and leucocyte counts, and decreased levels of albumin and haemoglobin were found to be independent risk factors for mortality. It is concluded that increased serum CRP levels and leucocyte counts combined with decreased albumin and haemoglobin levels on admission to the emergency room may be used as predictive factors of mortality in patients with gastrointestinal bleeding.
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Affiliation(s)
- Zikret Koseoglu
- Department of Emergency Medicine, Adana Numune Education and Research Hospital, Adana, Turkey.
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