Gender differences in community-acquired pneumonia

Esculin alleviates lipopolysaccharide (LPS)-induced pneumonia by regulating the USP7/MAPK14 axis

Pneumonia is a serious and life-threatening lung inflammation with high morbidity and mortality. Accumulating evidence has suggested that esculin, a derivative of coumarin, possesses potent anti-inflammatory effects. This study is designed to explore the pharma role and underlying mechanism of esculin against lipopolysaccharides (LPS)-induced pneumonia. TC-1 cells were stimulated by LPS to mimic the inflammatory injury model in vitro. Cell viability, proliferation, and apoptosis were determined using MTT assay, 5-ethynyl-2'-deoxyuridine assay, and flow cytometry. Interleukin-1β and tumor necrosis factor α levels were analyzed using an enzyme-linked immunosorbent assay. Reactive oxygen species and superoxide dismutase were examined using special assay kits. Macrophage polarization was detected using flow cytometry. Mitogen-activated protein kinase 14 (MAPK14) level was detected by real-time quantitative polymerase chain reaction. MAPK14 and ubiquitin-specific protease 7 (USP7) protein levels were determined using western blot assay. After Ubibrowser database prediction, the interaction between USP7 and MAPK14 was verified using a Co-immunoprecipitation assay. The biological role of esculin was verified in LPS-challenged ALI mice in vivo. Here, we found that esculin significantly relieved LPS-induced TC-1 cell proliferation inhibition, and apoptosis, inflammatory response, oxidative stress, and M1-type macrophage polarization promotion. MAPK14 and USP7 expressions were enhanced in LPS-treated TC-1 cells, which was partly abolished by esculin treatment. Overexpressing MAPK14 attenuated the repression of esculin on LPS-triggered TC-1 cell injury. At the molecular level, USP7 interacted with MAPK14 and maintained its stability by removing ubiquitin. Moreover, esculin repressed the progression of pneumonia in vivo by regulating MAPK14. Taken together, esculin exposure could mitigate LPS-induced TC-1 cell injury partly by targeting the USP7/MAPK14 axis, providing a better understanding of the role of esculin in the anti-inflammatory therapeutics for pneumonia.

Relationships between human serum albumin levels and septic shock, in-hospital, and out-of-hospital mortality in elderly patients with pneumonia in different BMI ranges

OBJECTIVE

This retrospective cohort identified the association of human serum albumin (HSA) with adverse outcomes (septic shock, in-hospital and out-of-hospital mortality) in elderly hospitalized patients who have community-acquired pneumonia (CAP) and specific body mass index (BMI).

MATERIALS AND METHODS

This research included hospitalized CAP individuals (≥ 60 years) and was conducted at a teaching hospital in western China. All the patients were categorized into three populations based on two BMI cutoff values (18.5 kg/m2 and 24 kg/m2). The data was acquired from medical records, local government mortality databases, and telephone interviews. Binomial logistic regression analysis was used to explore the associations between low HSA and septic shock and in-hospital mortality, and Cox regression analysis was used to explore the association between low HSA and out-of-hospital mortality.

RESULTS

A total of 627 patients were included in the analysis of in-hospital death and septic shock, and 431 patients were included in the analysis of out-of-hospital death. The study showed that 120 elderly patients with CAP (19.14%) died in the hospital, while 141 patients (32.71%) died out of the hospital, and 93 patients (14.83%) developed septic shock. No differences in in-hospital and out-of-hospital mortality were observed for BMI values < 18.5 kg/m2 or BMI ≥ 24 kg/m2, regardless of whether HSA was ≥ 40 g/l or < 40 g/l. When 18.5 kg/m2 ≤ BMI < 24 kg/m2, patients with HSA < 40 g/l had both higher in-hospital and out-of-hospital mortality compared with those with HSA ≥ 40 g/l (in-hospital death: 26.13% vs. 11.46%, p < 0.001; out-of-hospital death: 46.15% vs. 19.17%, p < 0.001). No significant differences were observed in the incidence of septic shock between patients with HSA < 40 g/l and those with HSA ≥ 40 g/l either in the overall population or when the BMI values were divided according to the cutoff values of 18.5 kg/m2 and 24 kg/m2. After further logistic regression analysis and adjustment for potential confounders, the results showed that when 18.5 kg/m2 ≤ BMI < 24 kg/m2, elderly CAP patients with HSA < 40 g/l had a higher risk of in-hospital and out-of-hospital mortality compared with those with HSA ≥ 40 g/l (in-hospital death: HR = 1.964, 95%CI = 1.08-3.573; out-of-hospital death: HR = 2.841, 95%CI = 1.745-4.627).

CONCLUSIONS

HSA levels can predict the risk of in-hospital and out-of-hospital mortality in elderly patients with CAP and normal BMI values. However, HSA cannot predict the risk of septic shock in elderly patients hospitalized with CAP, irrespective of their BMI classification.

Factors associated with antibiotic resistance and survival analysis of severe pneumonia patients infected with Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa: A retrospective cohort study in Jakarta, Indonesia

Background

Antimicrobial resistance is one of the most significant challenges to global public health and the risk factors in severe pneumonia are constantly growing. Therefore, this study aimed to identify factors associated with antimicrobial resistance and conduct survival analysis of severe pneumonia patients with single and multiple pathogens in the National Referral Hospital, Jakarta, Indonesia.

Methods

A retrospective method was used, and secondary data were collected from severe pneumonia patients admitted to the intensive care unit at Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, from January 2016 to December 2022. Respiratory specimens were collected through bronchial washing. Furthermore, univariate and multivariate analyses were performed to analyze factors associated with antimicrobial resistance. Kaplan‒Meier survival curves were generated with the log-rank test to compare 30-day mortality between patients infected with single, dual, and multiple pathogens.

Results

The results showed that a total of 333 patients from 415 enrolled were analyzed. Klebsiella pneumoniae (35.4%), Acinetobacter baumannii (29.3%), and Pseudomonas aeruginosa (15.4%) were the most frequently isolated Gram-negative pathogens. Factors associated with resistance to aminoglycoside, carbapenem, and quinolone were sepsis, cerebrovascular disease, and ventilator-associated pneumonia, as indicated by p < 0.05. In addition, the Kaplan-Meier curves showed that multiple pathogens influenced the survival rate of severe pneumonia patients (p < 0.05).

Conclusions

Sepsis, cerebrovascular disease, and ventilator-associated pneumonia were associated with antimicrobial resistance in severe pneumonia patients. The survival rate of patients infected with multiple pathogens was low. This suggests the importance of further awareness regarding empirical antibiotic stewardship and mortality assessment in severe pneumonia patients.

Predictors of mortality in severe pneumonia patients: a systematic review and meta-analysis

BACKGROUND

Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment.

METHODS

Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle-Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis.

RESULTS

In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P < 0.00001], male gender [odds ratio (OR) = 1.47, 95% CI (1.07, 2.02), P = 0.02], and risk of death from severe pneumonia. The comorbidity of neoplasm [OR = 3.37, 95% CI (1.07, 10.57), P = 0.04], besides the presence of complications such as diastolic hypotension [OR = 2.60, 95% CI (1.45, 4.67), P = 0.001], ALI/ARDS [OR = 3.63, 95% CI (1.78, 7.39), P = 0.0004], septic shock [OR = 9.43, 95% CI (4.39, 20.28), P < 0.00001], MOF [OR = 4.34, 95% CI (2.36, 7.95), P < 0.00001], acute kidney injury [OR = 2.45, 95% CI (1.14, 5.26), P = 0.02], and metabolic acidosis [OR = 5.88, 95% CI (1.51, 22.88), P = 0.01] were associated with significantly higher risk of death among patients with severe pneumonia. Those who died, compared with those who survived, differed on multiple biomarkers on admission including serum creatinine [Scr: + 67.77 mmol/L, 95% CI (47.21, 88.34), P < 0.00001], blood urea nitrogen [BUN: + 6.26 mmol/L, 95% CI (1.49, 11.03), P = 0.01], C-reactive protein [CRP: + 33.09 mg/L, 95% CI (3.01, 63.18), P = 0.03], leukopenia [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], sodium < 136 mEq/L [OR = 2.63, 95% CI (1.34, 5.18), P = 0.005], albumin [- 5.17 g/L, 95% CI (- 7.09, - 3.25), P < 0.00001], PaO2/FiO2 [- 55.05 mmHg, 95% CI (- 60.11, - 50.00), P < 0.00001], arterial blood PH [- 0.09, 95% CI (- 0.15, - 0.04), P = 0.0005], gram-negative microorganism [OR = 2.56, 95% CI (1.17, 5.62), P = 0.02], and multilobar or bilateral involvement [OR = 3.65, 95% CI (2.70, 4.93), P < 0.00001].

CONCLUSIONS

Older age and male gender might face a greater risk of death in severe pneumonia individuals. The mortality of severe pneumonia may also be significantly impacted by complications such diastolic hypotension, ALI/ARDS, septic shock, MOF, acute kidney injury, and metabolic acidosis, as well as the comorbidity of neoplasm, and laboratory indicators involving Scr, BUN, CRP, leukopenia, sodium, albumin, PaO2/FiO2, arterial blood PH, gram-negative microorganism, and multilobar or bilateral involvement.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Protocol Number: CRD 42023430684.

Diabetes and infection: review of the epidemiology, mechanisms and principles of treatment

An association between diabetes and infection has been recognised for many years, with infection being an important cause of death and morbidity in people with diabetes. The COVID-19 pandemic has re-kindled an interest in the complex relationship between diabetes and infection. Some infections occur almost exclusively in people with diabetes, often with high mortality rates without early diagnosis and treatment. However, more commonly, diabetes is a complicating factor in many infections. A reciprocal relationship occurs whereby certain infections and their treatments may also increase the risk of diabetes. People with diabetes have a 1.5- to 4-fold increased risk of infection. The risks are the most pronounced for kidney infection, osteomyelitis and foot infection, but are also increased for pneumonia, influenza, tuberculosis, skin infection and general sepsis. Outcomes from infection are worse in people with diabetes, with the most notable example being a twofold higher rate of death from COVID-19. Hyperglycaemia has deleterious effects on the immune response. Vascular insufficiency and neuropathy, together with altered skin, mucosal and gut microbial colonisation, contribute to the increased risk of infection. Vaccination is important in people with diabetes although the efficacy of certain immunisations may be compromised, particularly in the presence of hyperglycaemia. The principles of treatment largely follow those of the general population with certain notable exceptions.

Community-acquired pneumonia: use of clinical characteristics of acutely admitted patients for the development of a diagnostic model - a cross-sectional multicentre study

OBJECTIVES

This study aimed to describe the clinical characteristics of adults with suspected acute community-acquired pneumonia (CAP) on hospitalisation, evaluate their prediction performance for CAP and compare the performance of the model to the initial assessment of the physician.

DESIGN

Cross-sectional, multicentre study.

SETTING

The data originated from the INfectious DisEases in Emergency Departments study and were collected prospectively from patient interviews and medical records. The study included four Danish medical emergency departments (EDs) and was conducted between 1 March 2021 and 28 February 2022.

PARTICIPANTS

A total of 954 patients admitted with suspected infection were included in the study.

PRIMARY AND SECONDARY OUTCOME

The primary outcome was CAP diagnosis assessed by an expert panel.

RESULTS

According to expert evaluation, CAP had a 28% prevalence. 13 diagnostic predictors were identified using least absolute shrinkage and selection operator regression to build the prediction model: dyspnoea, expectoration, cough, common cold, malaise, chest pain, respiratory rate (>20 breaths/min), oxygen saturation (<96%), abnormal chest auscultation, leucocytes (<3.5×109/L or >8.8×109/L) and neutrophils (>7.5×109/L). C reactive protein (<20 mg/L) and having no previous event of CAP contributed negatively to the final model. The predictors yielded good prediction performance for CAP with an area under the receiver-operator characteristic curve (AUC) of 0.85 (CI 0.77 to 0.92). However, the initial diagnosis made by the ED physician performed better, with an AUC of 0.86 (CI 84% to 89%).

CONCLUSION

Typical respiratory symptoms combined with abnormal vital signs and elevated infection biomarkers were predictors for CAP on admission to an ED. The clinical value of the prediction model is questionable in our setting as it does not outperform the clinician's assessment. Further studies that add novel diagnostic tools and use imaging or serological markers are needed to improve a model that would help diagnose CAP in an ED setting more accurately.

TRIAL REGISTRATION NUMBER

NCT04681963.

Impacts of environmental factors on the aetiological diagnosis and disease severity of community-acquired pneumonia in China: a multicentre, hospital-based, observational study

Environmental exposures are known to be associated with pathogen transmission and immune impairment, but the association of exposures with aetiology and severity of community-acquired pneumonia (CAP) are unclear. A retrospective observational study was conducted at nine hospitals in eight provinces in China from 2014 to 2019. CAP patients were recruited according to inclusion criteria, and respiratory samples were screened for 33 respiratory pathogens using molecular test methods. Sociodemographic, environmental and clinical factors were used to analyze the association with pathogen detection and disease severity by logistic regression models combined with distributed lag nonlinear models. A total of 3323 CAP patients were included, with 709 (21.3%) having severe illness. 2064 (62.1%) patients were positive for at least one pathogen. More severe patients were found in positive group. After adjusting for confounders, particulate matter (PM) 2.5 and 8-h ozone (O3-8h) were significant association at specific lag periods with detection of influenza viruses and Klebsiella pneumoniae respectively. PM10 and carbon monoxide (CO) showed cumulative effect with severe CAP. Pollutants exposures, especially PM, O3-8h, and CO should be considered in pathogen detection and severity of CAP to improve the clinical aetiological and disease severity diagnosis.

The aging lung: microenvironment, mechanisms, and diseases

With the development of global social economy and the deepening of the aging population, diseases related to aging have received increasing attention. The pathogenesis of many respiratory diseases remains unclear, and lung aging is an independent risk factor for respiratory diseases. The aging mechanism of the lung may be involved in the occurrence and development of respiratory diseases. Aging-induced immune, oxidative stress, inflammation, and telomere changes can directly induce and promote the occurrence and development of lung aging. Meanwhile, the occurrence of lung aging also further aggravates the immune stress and inflammatory response of respiratory diseases; the two mutually affect each other and promote the development of respiratory diseases. Explaining the mechanism and treatment direction of these respiratory diseases from the perspective of lung aging will be a new idea and research field. This review summarizes the changes in pulmonary microenvironment, metabolic mechanisms, and the progression of respiratory diseases associated with aging.

Tau and Aβ42 in lavage fluid of pneumonia patients are associated with end-organ dysfunction: A prospective exploratory study

BACKGROUND

Bacterial pneumonia and sepsis are both common causes of end-organ dysfunction, especially in immunocompromised and critically ill patients. Pre-clinical data demonstrate that bacterial pneumonia and sepsis elicit the production of cytotoxic tau and amyloids from pulmonary endothelial cells, which cause lung and brain injury in naïve animal subjects, independent of the primary infection. The contribution of infection-elicited cytotoxic tau and amyloids to end-organ dysfunction has not been examined in the clinical setting. We hypothesized that cytotoxic tau and amyloids are present in the bronchoalveolar lavage fluid of critically ill patients with bacterial pneumonia and that these tau/amyloids are associated with end-organ dysfunction.

METHODS

Bacterial culture-positive and culture-negative mechanically ventilated patients were recruited into a prospective, exploratory observational study. Levels of tau and Aβ42 in, and cytotoxicity of, the bronchoalveolar lavage fluid were measured. Cytotoxic tau and amyloid concentrations were examined in comparison with patient clinical characteristics, including measures of end-organ dysfunction.

RESULTS

Tau and Aβ42 were increased in culture-positive patients (n = 49) compared to culture-negative patients (n = 50), independent of the causative bacterial organism. The mean age of patients was 52.1 ± 16.72 years old in the culture-positive group and 52.78 ± 18.18 years old in the culture-negative group. Males comprised 65.3% of the culture-positive group and 56% of the culture-negative group. Caucasian culture-positive patients had increased tau, boiled tau, and Aβ42 compared to both Caucasian and minority culture-negative patients. The increase in cytotoxins was most evident in males of all ages, and their presence was associated with end-organ dysfunction.

CONCLUSIONS

Bacterial infection promotes the generation of cytotoxic tau and Aβ42 within the lung, and these cytotoxins contribute to end-organ dysfunction among critically ill patients. This work illuminates an unappreciated mechanism of injury in critical illness.

Hospitalization, case fatality, comorbidities, and isolated pathogens of adult inpatients with pneumonia from 2013 to 2022: a real-world study in Guangzhou, China

BACKGROUND

In the context of increasing population aging, ongoing drug-resistant pathogens and the COVID-19 epidemic, the changes in the epidemiological and clinical characteristics of patients with pneumonia remain unclear. This study aimed to assess the trends in hospitalization, case fatality, comorbidities, and isolated pathogens of pneumonia-related adult inpatients in Guangzhou during the last decade.

METHODS

We retrospectively enrolled hospitalized adults who had doctor-diagnosed pneumonia in the First Affiliated Hospital of Guangzhou Medical University from January 1, 2013 to December 31, 2022. A natural language processing system was applied to automatically extract the clinical data from electronic health records. We evaluated the proportion of pneumonia-related hospitalizations in total hospitalizations, pneumonia-related in-hospital case fatality, comorbidities, and species of isolated pathogens during the last decade. Binary logistic regression analysis was used to assess predictors for patients with prolonged length of stay (LOS).

RESULTS

A total of 38,870 cases were finally included in this study, with 70% males, median age of 64 (53, 73) years and median LOS of 7.9 (5.1, 12.8) days. Although the number of pneumonia-related hospitalizations showed an upward trend, the proportion of pneumonia-related hospitalizations decreased from 199.6 per 1000 inpatients in 2013 to 123.4 per 1000 in 2021, and the case fatality decreased from 50.2 per 1000 in 2013 to 23.9 per 1000 in 2022 (all P < 0.05). The most common comorbidities were chronic obstructive pulmonary disease, lung malignancy, cardiovascular diseases and diabetes. The most common pathogens were Pseudomonas aeruginosa, Candida albicans, Acinetobacter baumannii, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Staphylococcus aureus. Glucocorticoid use during hospitalization (Odd Ratio [OR] = 1.86, 95% Confidence Interval (CI): 1.14-3.06), immunosuppressant use during hospitalization (OR = 1.99, 1.14-3.46), ICU admission (OR = 16.23, 95%CI: 11.25-23.83), receiving mechanical ventilation (OR = 3.58, 95%CI: 2.60-4.97), presence of other underlying diseases (OR = 1.54, 95%CI: 1.15-2.06), and elevated procalcitonin (OR = 1.61, 95%CI: 1.19-2.19) were identified as independent predictors for prolonged LOS.

CONCLUSION

The proportion of pneumonia-related hospitalizations and the in-hospital case fatality showed downward trends during the last decade. Pneumonia inpatients were often complicated by chronic underlying diseases and isolated with gram-negative bacteria. ICU admission was a significant predictor for prolonged LOS in pneumonia inpatients.

Gender differences in unplanned hospital admission: A population-based approach

Gender inequities are present not only in the health status of individuals but also in access to health services. Unplanned hospitalizations can indicate dysfunction in health systems by detecting unmet health problems prior to the health care needs of a person, while planned hospitalizations indicate effective management by the system. Thus, we aim to analyze the association between sex and the probability of unplanned or planned hospitalization for different diseases. A cross-sectional retrospective study was performed with data regarding the 700 447 hospitalizations at all registered centers in the Basque Country from 2016 to 2018. Adjusted odds ratios were carried out to determine the association between sex and admission circumstances for each diagnostic category. Results showed that women had higher odds ratio for unplanned hospitalization for various diseases of the circulatory system and inguinal hernia among others, while men had a higher odds ratio for diseases such as neoplasms, metabolic diseases, and multiple sclerosis. The differences by sex indicate that the odds applied to the circumstance of hospitalization is a sensitive indicator and potentially applicable for detecting diseases likely to generate gender-based inequalities.

A multicenter prospective study of comprehensive metagenomic and transcriptomic signatures for predicting outcomes of patients with severe community-acquired pneumonia

BACKGROUND

Severe community-acquired pneumonia (SCAP) results in high mortality as well as massive economic burden worldwide, yet limited knowledge of the bio-signatures related to prognosis has hindered the improvement of clinical outcomes. Pathogen, microbes and host are three vital elements in inflammations and infections. This study aims to discover the specific and sensitive biomarkers to predict outcomes of SCAP patients.

METHODS

In this study, we applied a combined metagenomic and transcriptomic screening approach to clinical specimens gathered from 275 SCAP patients of a multicentre, prospective study.

FINDINGS

We found that 30-day mortality might be independent of pathogen category or microbial diversity, while significant difference in host gene expression pattern presented between 30-day mortality group and the survival group. Twelve outcome-related clinical characteristics were identified in our study. The underlying host response was evaluated and enrichment of genes related to cell activation, immune modulation, inflammatory and metabolism were identified. Notably, omics data, clinical features and parameters were integrated to develop a model with six signatures for predicting 30-day mortality, showing an AUC of 0.953 (95% CI: 0.92-0.98).

INTERPRETATION

In summary, our study linked clinical characteristics and underlying multi-omics bio-signatures to the differential outcomes of patients with SCAP. The establishment of a comprehensive predictive model will be helpful for future improvement of treatment strategies and prognosis with SCAP.

FUNDING

National Natural Science Foundation of China (No. 82161138018), Shanghai Municipal Key Clinical Specialty (shslczdzk02202), Shanghai Top-Priority Clinical Key Disciplines Construction Project (2017ZZ02014), Shanghai Key Laboratory of Emergency Prevention, Diagnosis and Treatment of Respiratory Infectious Diseases (20dz2261100).

Fall of viral and bacterial pneumonia hospitalizations following COVID-19 pandemic mitigation strategies: a central Italian Region retrospective study

Community-Acquired Pneumonia (CAP) represents one of the first causes of hospitalization and death in the elderly all over the world and weighs heavily on public health system. Since the beginning of the COVID-19 (CoronaVirus Disease-19) pandemic, everybody's behavior was forced to change, as the result of a global lockdown strategy and the obligation of using personal protection equipment (PPE). We aimed to evaluate how the mitigation strategies adopted to fight SARS-CoV-2 (Severe Acute Respiratory Coronavirus Syndrome 2) infection have influenced hospitalizations due to CAP in two different Local Health Boards (LHBs) of central Italy. We considered two main periods of observation: before and after the national start of lockdown, in two Abruzzo's LHBs. We analyzed 19,558 hospital discharge records of bacterial and viral CAP. Excluding SARS-CoV2 infection, a significant decrease in CAP hospitalizations was observed. Through the analysis of Diagnosis Related Group (DRG) values, we highlighted a significant saving of founds for the Regional Health Service. The enactment of social distancing measures to contain COVID-19 spread, brought down admissions for bacterial and viral pneumonia. Our study emphasizes that costs for hospitalizations due to CAP could be drastically reduced by mask wearing and social distancing.

Sex and gender differences in community-acquired pneumonia

Awareness of the influence of sex ands gender on the natural history of several diseases is increasing. Community-acquired pneumonia (CAP) is the most common acute respiratory disease, and it is associated with both morbidity and mortality across all age groups. Although a role for sex- and gender-based differences in the development and associated complications of CAP has been postulated, there is currently high uncertainty on the actual contribution of these factors in the epidemiology and clinical course of CAP. More evidence has been produced on the topic during the last decades, and sex- and gender-based differences have also been extensively studied in COVID-19 patients since the beginning of the SARS-CoV-2 pandemic. This review aims to provide an extensive outlook of the role of sex and gender in the epidemiology, pathogenesis, treatment, and outcomes of patients with CAP, and on the future research scenarios, with also a specific focus on COVID-19.

Community‐acquired pneumonia and its predictors of mortality in rural southwestern Nigeria: A‐five year retrospective observational study

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Majority of people in sub-Sahara Africa reside in rural areas.

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Many hospitals in rural and sub-urban centres do not have adequate personnel and infrastructures.

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There are limited dataoncommunity-acquired pneumonia and its predictors of mortality and were largely restricted to urban and suburban centres.

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The results of the present study would guide the stakeholders on how to reduce community- acquired pneumonia mortality in rural centres.

Introduction

The predictors of community-acquired pneumonia (CAP) mortality are important outcome measures in epidemiological studies and clinical trials. There is an observed paucity of data regarding the predictors of mortality of CAP in Nigeria. Few studies from the urban centres have been reported in the literature, with none from the rural centres. The objective of this study is to ascertain the clinical presentations, risk factors, and predictors of mortality among patients admitted for CAP in rural Southwestern Nigeria.

Methods

A retrospective observational study using a data form and a standardised questionnaire reviewed the 176 patients admitted to Southwestern Nigeria hospital between January 2015 and December 2019. The data were analysed using SPSS Version 22.0. The results were presented in descriptive and tabular formats.

Results

A total of 176 patients were studied. Their mean age was 53.3±16.8 years. There were more males, 112 (63.6%), than females. The most common clinical presentations were cough, fever and sputum expectoration. The case fatality rate was 9.1% and its predictors were older aged patients [Adjusted Odds Ration (AOR), 4.135: 95% Confidence Interval (CI) (1.389-12.315); p =0.005], hypoxia [AOR, 11.118: 95% CI (2.607-47.405); p<0.001], tobacco smoking [AOR, 3.632: 95% CI (1.459-9.039); p=0.008], chronic obstructive pulmonary disease (COPD) [AOR, 10.111: 95%CI (2.370-43.139); p <0.001], and human immunodeficiency virus (HIV) [AOR, 9.444: 95% CI (4.304-20.725), p<0.001].

Conclusion

The case -fatality rate was 9.1%, and its predictors were older age patients, patients with hypoxia, tobacco smoking, COPD, and HIV. This study strengthens the argument on the higher prevalence of CAP and its mortality in rural Southwestern Nigeria. The findings may provide an impetus for prospective research on these outcomes.

Analysis of the association between atrial fibrillation with in-hospital mortality in people admitted for community-acquired pneumonia through an observational, nation-wide, sex-stratified study

We aimed to analyze the influence of atrial fibrillation (AF) prior to hospital admission (“prevalent”) and AF diagnosed during hospital admission (“incident”) on in-hospital mortality (IHM) in women and men admitted for community-acquired pneumonia (CAP) in Spain (2016–2019). We used the Spanish Register of Specialized Care‐Basic Minimum Database. We analyzed 519,750 cases of CAP in people ≥ 18 years (213,631 women (41.1%)), out of which people with prevalent AF represented 23.75% (N = 123,440), whereas people with incident AF constituted 0.60% (N = 3154). Versus no AF, crude IHM was significantly higher for prevalent AF (15.24% vs. 11.40%, p < 0.001) and for incident AF (23.84% vs. 12.24%, p < 0.001). After propensity score marching, IHM in women and men with prevalent AF neared IHM in women and men with no AF (15.72% vs. 15.52%, p = 0.425; and 14.90% vs. 14.99%, p = 0.631, respectively), but IHM in women and men with incident AF was higher than IHM in women and men with no AF (24.37% vs. 13.36%, p < 0.001; and 23.94% vs. 14.04%, p < 0.001, respectively). Male sex was associated with a higher IHM in people with prevalent AF (OR 1.06; 95% CI 1.02–1–10), but not in people with incident AF (OR 0.93; 95% CI 0.77–1–13). AF diagnosed during hospital admission was associated with a higher IHM, irrespectively of sex.

Nomogram for predicting in-hospital mortality of nonagenarians with community-acquired pneumonia

AIM

Nonagenarians with community-acquired pneumonia (CAP) have a high mortality rate; however, appropriate tools for reliable severity assessment in this population are lacking. The current study aimed to evaluate the risk factors and establish a nomogram to predict in-hospital mortality of nonagenarians with CAP.

METHODS

In total, 304 patients aged ≥90 years who were admitted with CAP to Jiangsu Provincial People's Hospital and Jiangsu Provincial Hospital of Chinese Medicine between 2014 and 2020 were retrospectively analyzed. Clinical information, laboratory imaging results and pathogen detection were retrieved. Significant variables independently associated with CAP were identified by a logistic regression model, and a nomogram prediction model was constructed. The nomogram was compared with the widely used assessments: CURB-65, PSI and National Early Warning Score (NEWS) scores.

RESULTS

Univariate and multivariate logistic regression analyses identified gender, blood urea nitrogen, C-reactive protein-to-albumin ratio, Charlson Comorbidity Index and systemic immune inflammation index as independent factors that affect the prognosis. We created a nomogram for CAP based on these risk factors. The nomogram had a bootstrapped concordance index of 0.796 and was well-calibrated in the decision analysis curve range of 0.1-0.98. The area under the curve was 0.796 (95% CI: 0.74-0.85), significantly higher than for CURB-65, PSI and NEWS scores (P < 0.05).

CONCLUSIONS

Our nomogram model can predict the outcome of hospitalized nonagenarians with CAP and guide clinicians to provide better treatment, leading to improved prognosis and reduced mortality. Geriatr Gerontol Int 2022; 22: 635-641.

Mouse Liver B Cells Phagocytose Streptococcus pneumoniae and Initiate Immune Responses against Their Antigens

Recent studies have revealed that mammalian B cells ingest particulate Ags, such as bacteria, although little is known about the effect of this function on acquired immunity. We investigated the role of bacterium-phagocytosing B cells in acquired host immune responses. Cultured mouse liver B cells substantially phagocytosed serum-opsonized Streptococcus pneumoniae and produced IgM. On adoptive transfer of liver B cells that phagocytose S. pneumoniae labeled with pHrodo Red succinimidyl ester, recipient mice showed elevated plasma levels of IgG specific for bacterial Ags. In particular, the levels of IgG2a and IgG2b specific for pneumococcal surface protein A, as well as IgG3 for pneumococcal polysaccharide, were markedly increased compared with total IgG specific for each Ag. When phagocytic liver B cells were cultured with spleen CD4⁺ T cells obtained from mice primed with heat-killed S. pneumoniae 7 d before, they induced IL-2 production and proliferation of the CD4⁺ T cells, along with Th1 cytokine production. However, they induced neither the CD4⁺ T cell production of IL-21, a suggested marker promoting B cell proliferation and differentiation, nor the expression of genes important for somatic hypermutation or isotype switching; such responses were particularly evident when splenic B cells merely capturing S. pneumoniae without processing them were cultured with spleen CD4⁺ T cells. These findings suggest that phagocytic liver B cells may be involved in acquired immune responses by presenting derivative peptides to CD4⁺ T cells without their own somatic hypermutation or isotype switching.

Host protease activity classifies pneumonia etiology

Community-acquired pneumonia (CAP) has been brought to the forefront of global health priorities due to the COVID-19 pandemic. However, classification of viral versus bacterial pneumonia etiology remains a significant clinical challenge. To this end, we have engineered a panel of activity-based nanosensors that detect the dysregulated activity of pulmonary host proteases implicated in the response to pneumonia-causing pathogens and produce a urinary readout of disease. The nanosensor targets were selected based on a human protease transcriptomic signature for pneumonia etiology generated from 33 unique publicly available study cohorts. Five mouse models of bacterial or viral CAP were developed to assess the ability of the nanosensors to produce etiology-specific urinary signatures. Machine learning algorithms were used to train diagnostic classifiers that could distinguish infected mice from healthy controls and differentiate those with bacterial versus viral pneumonia with high accuracy. This proof-of-concept diagnostic approach demonstrates a way to distinguish pneumonia etiology based solely on the host proteolytic response to infection.

Health Problems among Forcibly Displaced Myanmar Nationals (FDMNs) admitted to the Medicine ward of Cox's Bazar Medical College Hospital

Background

Forcibly Displaced Myanmar Nationals (FDMNs) or Rohingya refugees are one of the vulnerable groups suffering from different kinds of health problems but have been less reported yet. Therefore, the study was designed to delineate the health problems among FDMNs admitted to Cox's Bazar Medical College Hospital.

Methods

This hospital-based cross-sectional study was conducted at the Medicine ward, Cox's Bazar Medical College Hospital, for a six-month period following approval. Rohingya refugees who were admitted during the study period were approached for inclusion. Informed written consent was ensured prior to participation. A structured questionnaire was used during data collection. Collected information was recorded in case record form. A total of 290 subjects were interviewed. Analysis was performed using the statistical package for social science (SPSS) version 20.

Results

The mean age of the participants was 48.76 ± 18.67 years (range: 16–91), with a clear male predominance (60.7%). Family size ranged 6–8. All of the participants reported at least one of the illnesses. Of all, 29.66% patients had disease of the respiratory system, and 26.9% had disease of the gastrointestinal and hepatobiliary system. Accidental injury or injury due to electrocution or thin falls or snake bites was present in 10.4% of the cases. Among the single most common diseases, COPD (20%) was the most frequently observed, and the rest of them were chronic liver disease (13.1%), pulmonary TB (5.5%), ischemic stroke (5.5%), CAP (4.1%), acute coronary syndrome (3.4%), thalassaemia (3.4%) and hepatocellular carcinoma (3.4%). Among the top 6 diagnosed diseases, PTB was more common in elderly individuals (p = 0.29). The disease pattern was similar across the sexes among the refugees except community acquisition pneumonia (CAP), which was commonly observed among males (p = .004). Considering different age groups, genitourinary problems were more common in males aged >60 years, and rheumatology and musculoskeletal problems were equally affected in females aged between 40 and 60 years.

Conclusion

COPD, CLD and CAP were the most prevalent diseases in FDMN patients who attended the Medicine ward of Cox's Bazar Medical College Hospital. Further exploration is warranted before any policy making and comprehensive plan.

Mortality due to respiratory infections: an alert study before COVID-19 pandemic

Objective

Respiratory tract infections remain a common problem in clinical practice with high morbidity and mortality worldwide. In Portugal, pneumonia was the third leading death cause in 2018. Due to COVID-19 pandemic, there is a growing concern about the burden of respiratory diseases and preventable risk factors. The present study started before the pandemic and its aim was to determine the occurrence of pneumonia/bronchopneumonia in a postmortem series and to characterize its circumstantial context.

Methods

A retrospective anatomopathological study was performed on cases with acute pneumonia/bronchopneumonia at the Medicolegal Portuguese Institute (2011-2017).

Results

In an autopsy series of 737 patients, 521 were male and 675 presented comorbidities. The mean age was 63.87 ± 19.8 years. The most common acquisition site was community (65.1%), as natural death (65.5%). Concerning the manner of death, most cases (48.0%) were sudden deaths, followed by accidents (29.2%). A statistically significant association was observed between the medicolegal etiology and the place of infection acquisition, with higher prevalence of natural obitus (91.0%) in community-acquired pneumonia/bronchopneumonia versus higher prevalence of violent obitus in hospital-acquired pneumonia/bronchopneumonia (82.1%) (p < 0.001).

Conclusions

Forensic anatomopathological postmortem data may contribute to better understand community and hospital pulmonary infections.

52-year follow-up of a birth cohort reveals a high pneumonia incidence among young men

Background

Knowledge of pneumonia incidence and risk factors in adults is mainly based on clinical studies of selected patient data and registers with ageing populations. Prospective population-based investigations, such as birth cohort studies, are needed to understand pneumonia incidence and risk factors among young and working-age populations.

Methods

Northern Finland Birth Cohort (NFBC) 1966 data (n=6750) were analysed for pneumonia incidence and risk factors. Incidence analysis was replicated using data from an independent NFBC 1986 cohort (n=9207). Pneumonia in relation to chronic conditions and lifestyle factors was analysed.

Results

A peak with a maximum of 227 pneumonia episodes per 10 000 among men between the ages of 19 and 21 years was found in two independent cohorts. Pneumonia was associated with male sex (relative risk 1.72, 95% CI 1.45-2.04; p<0.001), low educational level (relative risk 2.30, 95% CI 1.72-3.09; p<0.001), smoking (relative risk 1.55, 95% CI 1.31-1.84; p<0.001), asthma (relative risk 2.19, 95% CI 1.73-2.75; p<0.001), cardiovascular diseases (relative risk 2.50, 95% CI 2.04-3.07; p=0.001), kidney diseases (relative risk 4.14, 95% CI 2.81-6.10; p<0.001), rheumatoid arthritis (relative risk 2.69, 95% CI 1.80-4.01; p<0.001), psoriasis (relative risk 2.91, 95% CI 1.92-4.41; p<0.001) and type II diabetes (relative risk 1.80, 95% CI 1.34-2.42; p<0.001). Men with excessive alcohol consumption at age 31 years were at risk of future pneumonia (relative risk 2.40, 95% CI 1.58-3.64; p<0.001).

Conclusions

Birth cohort data can reveal novel high-risk subpopulations, such as young males. Our study provides understanding of pneumonia incidence and risk factors among young and working age populations.

The Influence of Atrial Fibrillation on In-Hospital Mortality in People with Hospital-Acquired Pneumonia: An Observational, Sex-Stratified Study

(1) Background: The study aimed to analyze the influence of atrial fibrillation (AF) prior to hospital admission (“prevalent”) and new-onset AF diagnosed during hospital admission (“incident”) on in-hospital mortality (IHM) in women and men who developed hospital-acquired pneumonia (HAP) in Spain (2016−2019). (2) Methods: We used the Spanish Register of Specialized Care-Basic Minimum Database. (3) Results: We analyzed 38,814 cases of HAP (34.6% women; 13.5% ventilator-associated). Prevalent AF was coded in 19.9% (n = 7742), and incident AF in 5.5% (n = 2136) of HAP. Crude IHM was significantly higher for prevalent AF (34.22% vs. 27.35%, p < 0.001) and for incident AF (35.81% vs. 28.31%, p < 0.001) compared to no AF. After propensity score matching, IHM among women and men with prevalent AF was higher than among women and men with no AF (among women, 32.89% vs. 30.11%, p = 0.021; among men, 35.05% vs. 32.46%, p = 0.008). Similarly, IHM among women and men with incident AF was higher than among women and men with no AF (among women, 36.23% vs. 29.90%, p = 0.013; among men, 35.62% vs. 30.47%; p = 0.003). Sex was associated with a higher IHM only in people with incident AF (for female, OR = 1.21; 95% CI: 1.01−1.57). (4) Conclusions: Both prevalent and incident AF were associated with higher IHM in people who developed HAP. Female sex was associated with a higher IHM in incident AF.

Outcomes and Predictors of Severe Hyperoxemia in Patients Receiving Mechanical Ventilation: A Single-Center Cohort Study

RATIONALE

Supplemental oxygen is among the most commonly administered therapies in intensive care units. High supplemental oxygen exposure has been associated with harm in observational human studies and animal models. Yet no consensus exists regarding which dose and duration of high oxygen constitutes harmful hyperoxemia, and little is known regarding the clinical factors that predict potentially injurious exposure.

OBJECTIVES

To determine the level and duration of arterial oxygen (PaO2) associated with mortality among mechanically ventilated patients, and to identify the clinical factors that predict this exposure.

METHODS

We performed a retrospective cohort study of patients who received invasive mechanical ventilation at a single academic institution in 2017 and 2018. We used a generalized additive model to visualize the relationship between the measured PaO2 via arterial blood gases (ABGs) and 30-day mortality. We used multivariable logistic regression to identify patient- and hospital-level factors that predict exposure to harmful hyperoxemia.

RESULTS

We analyzed 2,133 patients with 33,310 ABGs obtained during mechanical ventilation. We identified a U-shaped relationship between PaO2 and mortality, where PaO2 was positively correlated with mortality above a threshold of 200 mmHg. 1,184 patients (55.5%) had at least one PaO2 level above this threshold. If patients spent an entire day exposed to PaO2 > 200 mmHg, they had 2.19 (95% CI 1.33 - 3.60, p = 0.002) greater odds of 30-day mortality in an adjusted analysis. Any exposure to severe hyperoxemia (PaO2 > 200 mmHg), was associated with mortality (OR 1.29, 95% CI 1.04 - 1.59, p = 0.021). The strongest clinical predictor of severe hyperoxemia exposure was the identity of the ICU in which mechanical ventilation was delivered.

CONCLUSIONS

Exposure to high arterial oxygen concentrations is common among mechanically ventilated patients, and the dose and duration of PaO2 ≥ 200 mmHg is associated with mortality. Severe hyperoxemia is highly variable across ICUs, and is far more common in clinical practice than in recent randomized trials of oxygen targeting strategies. Efforts to minimize this common and injurious exposure level are needed.

Effects of bronchoalveolar lavage on Mycoplasma Pneumoniae pneumonia: A propensity score matched-cohort study

BACKGROUND

The purpose of this study was to evaluate the efficacy and safety of BAL in treating MPP.

METHODS

From January 2013 to January 2019, 1,689 pediatric patients with MPP were analyzed retrospectively. Patients were subdivided into BAL group and non-BAL group according to whether they received BAL treatment within seven days after admission. The propensity score matching method matched patients' baseline characteristics (1:1). The primary outcomes were hospital stays and the cure rate. Secondary outcomes included mortality, co-infection, repeat hospitalization within 30 days, and total cost of treatment.

RESULTS

After matching, 524 patients (BAL: 262; control: 262) were recorded. The BAL group had significantly shorter hospital stays (OR: 0.5, 95% CI: 0.4-0.7). Meanwhile, BAL did not significantly modify the cost, co-infection rate, and mortality. In subgroup analyses, the group with BAL intervention within three days had a significantly shorter hospital stay (OR: 0.4, 95% CI: 0.3-0.5) compared with the group with BAL intervention three days after admission.

CONCLUSIONS

Early BAL intervention is a better treatment than conventional drug therapy alone, and no significant complications were seen in this study. BAL intervention has an excellent clinical benefit. The earlier the intervention, the better the effect.

Community-Acquired Pneumonia among Patients with COPD in Spain from 2016 to 2019. Cohort Study Assessing Sex Differences in the Incidence and Outcomes Using Hospital Discharge Data

Background: To describe and analyze the incidence and hospital outcomes of patients admitted with community-acquired pneumonia (CAP) according to Chronic Obstructive Pulmonary Disease (COPD) status and sex in Spanish hospitals from 2016 to 2019. Methods: We conducted a cohort study using national hospital discharge data of all patients ≥40 years with CAP. Results: A total of 500,833 patients (59.0% men) was identified. Incidence of CAP increased over time. Age-adjusted incidence was 4.42-times higher in COPD patients. In-hospital mortality (IHM) was lower in men and women with COPD than in those without COPD (14.41% vs. 10.70% in men; 11.12% vs. 8.58%. in women; p < 0.001). The risk of dying in hospital increased with age, presence of several comorbidities (excluding T2DM that was a protective factor), and need for mechanical ventilation (non-invasive and invasive) during admission, irrespective of sex. Over time, the IHM decreased significantly in men and women with COPD. Men with COPD were significantly more likely to die in hospital than were COPD women (OR 1.13; 95% CI 1.07–1.21). Conclusions: Incidence of CAP was higher among subjects with COPD, although the effect of COPD was higher in men than in women. By contrast, IHM was lower in COPD patients, but men with COPD were significantly more likely to die in hospital than were COPD women.

Incidence, Outcomes and Sex-Related Disparities in Pneumonia: A Matched-Pair Analysis with Data from Spanish Hospitals (2016-2019)

(1) Background: the purpose of this study is to analyze the incidence and in-hospital mortality (IHM) of community-acquired pneumonia (CAP) needing hospital admission and hospital-acquired pneumonia (HAP) in Spain (2016–2019). (2) Methods: using the Spanish Register of Specialized Care-Basic Minimum Database, we estimated the incidence of CAP and HAP. We matched each woman with a man with an identical age, according to comorbidities. (3) Results: we analyzed 518,838 cases of CAP and 38,705 cases of HAP, and 5192 ventilator-associated HAPs (13.4%). The incidence of CAP increased over time in both men (from 384.5 to 449.8 cases/105 population) and women (from 244.9 to 301.2 cases/105 population). Men showed a 47% higher adjusted incidence of CAP than women. The incidence of HAP increased over time in both men (from 302.3 to 342.2 cases/105 population) and women (from 139.2 to 167.6 cases/105 population). Men showed a 98% higher adjusted incidence of HAP than women. IHM was higher in men admitted for CAP than in women (12.9% vs. 12.2%; p < 0.001), but not in men who developed HAP (28.9% vs. 28.0%; p = 0.107). Men admitted for CAP (OR: 1.13; 95% CI: 1.10–1.15) and men who developed HAP (OR: 1.05; 95% CI: 1.01–1.10) had higher IHM than women. (4) Conclusions: men had higher incidence rates of CAP and HAP than women. Men admitted for CAP and men who developed HAP had higher IHM than women.

Sex-Related Disparities in the Incidence and Outcomes of Community-Acquired Pneumonia among Type 2 Diabetes Patients: A Propensity Score-Matching Analysis Using the Spanish National Hospital Discharge Database for the Period 2016-2019

(1) Background: To analyze incidence, clinical characteristics, procedures, and in-hospital outcomes among patients hospitalized with community-acquired pneumonia (CAP) according to the presence of T2DM in Spain (2016-2019) and to assess the role of gender among those with T2DM. (2) Methods: Using the Spanish National Hospital Discharge Database, we estimated hospitalized CAP incidence. Propensity score matching was used to compare population subgroups. (3) Results: CAP was coded in 520,723 patients, of whom 140,410 (26.96%) had T2DM. The hospitalized CAP incidence was higher in patients with T2DM (both sexes) (IRR 4.25; 95% CI 4.23-4.28). The hospitalized CAP incidence was higher in men with T2DM than in women with T2DM (IRR 1.46; 95% CI 1.45-1.47). The hospitalized CAP incidence among T2DM patients increased over time; however, the in-hospital mortality (IHM) decreased between 2016 and 2019. IHM was higher among non-T2DM men and women than matched T2DM men and women (14.23% and 14.22% vs. 12.13% and 12.91%; all p < 0.001, respectively), After adjusting for confounders, men with T2DM had a 6% higher mortality risk than women (OR 1.06; 95% CI 1.02-1.1). (4) Conclusions: T2DM is associated with a higher hospitalized CAP incidence and is increasing overtime. Patients hospitalized with CAP and T2DM have lower IHM. Male sex is a significant risk factor for mortality after CAP among T2DM patients.

Pneumonia

Pneumonia is a common acute respiratory infection that affects the alveoli and distal airways; it is a major health problem and associated with high morbidity and short-term and long-term mortality in all age groups worldwide. Pneumonia is broadly divided into community-acquired pneumonia or hospital-acquired pneumonia. A large variety of microorganisms can cause pneumonia, including bacteria, respiratory viruses and fungi, and there are great geographical variations in their prevalence. Pneumonia occurs more commonly in susceptible individuals, including children of <5 years of age and older adults with prior chronic conditions. Development of the disease largely depends on the host immune response, with pathogen characteristics having a less prominent role. Individuals with pneumonia often present with respiratory and systemic symptoms, and diagnosis is based on both clinical presentation and radiological findings. It is crucial to identify the causative pathogens, as delayed and inadequate antimicrobial therapy can lead to poor outcomes. New antibiotic and non-antibiotic therapies, in addition to rapid and accurate diagnostic tests that can detect pathogens and antibiotic resistance will improve the management of pneumonia.

Analysis of causes of death in patients with implanted defibrillators

AIMS

Implantable cardioverter defibrillators (ICDs) are used for primary or secondary prevention of sudden cardiac death. We sought to clarify prognosis and causes of death after ICD implantation.

METHODS AND RESULTS

A total of 2743 patients with ICDs implanted during 1990-2020 were analyzed. Median age was 68.5 (59.6-74.6) years; 21% women, median left ventricular ejection fraction (LVEF) was 30 (23-35), 52% had an ischemic etiology and 77% had a primary preventive indication. Mortality rate after 10 years was 22, 44, 55, and 72% in the 1st, 2nd, 3rd, and 4^th age quartile, respectively. The calculated median sex and age adjusted loss of life years compared to the average German population was 9.7 (6.1-14.0) years. Prognosis was independently related to sex, age, LVEF, and glomerular filtration rate. 713 out of 852 deaths could be classified to a specific cause. Congestive heart failure (CHF) accounted for death in 214 (30%) and sudden death (SD) for 144 patients (20%). Postmortem interrogation of devices in 74 patients revealed VT/VF in 39 and no episodes in 35 patients. Cancer was identified as the cause of death in 121 patients (17% of cases), of which 36 were bronchial carcinomas. 73 (10%) of patients died due to infection. 67 patients (9%) died within 24 h of procedures. Compared to other causes, significantly more life years were lost associated with procedures and SD: 9.3 (5.7-12.9) versus 12.1 (7.4-15.2) and 11.9 (7.6-17.8) years.

CONCLUSION

Life expectancy of ICD patients is lower than for the general population. Mortality is predominantly due to CHF, but there is still a considerable rate of SD. The occurrence of cancers, most importantly bronchial carcinomas, and infections, warrants protective measures. Some deaths during procedures are possibly preventable. Patients with ICDs comprise a vulnerable cohort, and treatment has to be optimized in many directions to improve prognosis.

Gender differences in incidence and in-hospital outcomes of community-acquired, ventilator-associated and nonventilator hospital-acquired pneumonia in Spain

AIMS

We aim to compare the incidence and in-hospital outcomes of community-acquired pneumonia (CAP), ventilator-associated pneumonia (VAP) and nonventilator hospital-acquired pneumonia (NV-HAP) according to gender.

METHODS

This was a retrospective observational epidemiological study using the Spanish National Hospital Discharge Database for the years 2016 and 2017.

RESULTS

Of 277 785 hospital admissions, CAP was identified in 257 455 (41.04% females), VAP was identified in 3261 (30.42% females) and NV-HAP was identified in 17 069 (36.58% females). The incidence of all types of pneumonia was higher amongst males (CAP: incidence rate ratio [IRR] 1.05, 95% CI 1.03-1.06; VAP: IRR 1.36, 95% CI 1.26-1.46; and NV-HAP: IRR 1.16, 95% CI 1.14-1.18). The crude in-hospital mortality (IHM) rate for CAP was 11.44% in females and 11.80% in males (P = .005); for VAP IHM, the rate was approximately 35% in patients of both genders and for NV-HAP IHM, the rate was 23.97% for females and 26.40% for males (P < .001). After multivariable adjustment, in patients of both genders, older age and comorbidities were factors associated with IHM in the three types of pneumonia analysed. Female gender was a risk factor for IHM after VAP (OR 1.24; 95% CI 1.06-1.44), and no gender differences were found for CAP or NV-HAP.

CONCLUSIONS

Our findings show a difference between females and males, with females presenting a lower incidence of all types of pneumonia. However, female gender was a risk factor for IHM after VAP.

Validation and Comparison of Six Risk Scores for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

Aims: Very few of the risk scores to predict infection in ST-segment elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) have been validated, and reports on their differences. We aimed to validate and compare the discriminatory value of different risk scores for infection.

Methods: A total of 2,260 eligible patients with STEMI undergoing PCI from January 2010 to May 2018 were enrolled. Six risk scores were investigated: age, serum creatinine, or glomerular filtration rate, and ejection fraction (ACEF or AGEF) score; Canada Acute Coronary Syndrome (CACS) risk score; CHADS₂ score; Global Registry for Acute Coronary Events (GRACE) score; and Mehran score conceived for contrast induced nephropathy. The primary endpoint was infection during hospitalization.

Results: Except CHADS₂ score (AUC, 0.682; 95%CI, 0.652–0.712), the other risk scores showed good discrimination for predicting infection. All risk scores but CACS risk score (calibration slope, 0.77; 95%CI, 0.18–1.35) showed best calibration for infection. The risks scores also showed good discrimination for in-hospital major adverse clinical events (MACE) (AUC range, 0.700–0.786), except for CHADS₂ score. All six risk scores showed best calibration for in-hospital MACE. Subgroup analysis demonstrated similar results.

Conclusions: The ACEF, AGEF, CACS, GRACE, and Mehran scores showed a good discrimination and calibration for predicting infection and MACE.

Increased Risk of Autopsy-Proven Pneumonia with Sex, Season and Neurodegenerative Disease

There has been a markedly renewed interest in factors associated with pneumonia, a leading cause of death worldwide, due to its frequent concurrence with pandemics of influenza and Covid-19 disease. Reported predisposing factors to both bacterial pneumonia and pandemic viral lower respiratory infections are wintertime occurrence, older age, obesity, pre-existing cardiopulmonary conditions and diabetes. Also implicated are age-related neurodegenerative diseases that cause parkinsonism and dementia. We investigated the prevalence of autopsy-proven pneumonia in the Arizona Study of Aging and Neurodegenerative Disorders (AZSAND), a longitudinal clinicopathological study, between the years 2006 and 2019 and before the beginning of the Covid-19 pandemic. Of 691 subjects dying at advanced ages (mean 83.4), pneumonia was diagnosed postmortem in 343 (49.6%). There were 185 subjects without dementia or parkinsonism while clinicopathological diagnoses for the other subjects included 319 with Alzheimer's disease dementia, 127 with idiopathic Parkinson's disease, 72 with dementia with Lewy bodies, 49 with progressive supranuclear palsy and 78 with vascular dementia. Subjects with one or more of these neurodegenerative diseases all had higher pneumonia rates, ranging between 50 and 61%, as compared to those without dementia or parkinsonism (40%). In multivariable logistic regression models, male sex and a non-summer death both had independent contributions (ORs of 1.67 and 1.53) towards the presence of pneumonia at autopsy while the absence of parkinsonism or dementia was a significant negative predictor of pneumonia (OR 0.54). Male sex, dementia and parkinsonism may also be risk factors for Covid-19 pneumonia. The apolipoprotein E4 allele, as well as obesity, chronic obstructive pulmonary disease, diabetes, hypertension, congestive heart failure, cardiomegaly and cigarette smoking history, were not significantly associated with pneumonia, in contradistinction to what has been reported for Covid-19 disease.