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Liu J, Dong Y, Chen J, Jin Y, Qiu Y, Huang L. Corticosteroid in non-COVID-19 induced community-acquired pneumonia, a meta-analysis. Heart Lung 2024; 65:59-71. [PMID: 38432039 DOI: 10.1016/j.hrtlng.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/07/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Corticosteroid treatment in non-COVID-19 induced Community-acquired pneumonia (CAP) remains inconclusive. OBJECTIVES We aimed to assess the role of corticosteroid treatment in CAP. METHODS We conducted a comprehensive search of online databases, including PubMed, Embase, and Cochrane, to identify articles published from January 1, 2000, to May 5, 2023. Double-blind RCTs were selected. Two authors screened studies and extracted data. The evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS We analyzed data from 12 RCTs, involving 2446 patients. Corticosteroids therapy may reduce short-term mortality in patients with severe CAP (sCAP) and shorten the hospital length of stay in patients with CAP. Furthermore, corticosteroids treatment can decrease the risk of requiring mechanical ventilation, developing septic shock and multiple organ dysfunction syndrome (MODS). There were no significant differences between the corticosteroid and control groups concerning gastrointestinal bleeding and nosocomial infection. The use of corticosteroids could increase the risk of hyperglycemia. CONCLUSION Corticosteroid treatment for sCAP has the potential to provide benefits in reducing short-term mortality, but this conclusion necessitates more evidence. Besides, we found no evidence that strongly prevents us from using corticosteroids in patients with sCAP or those at risk of progressing to sCAP.
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Affiliation(s)
- Jian Liu
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Yongquan Dong
- Department of Respiratory Disease, YinZhou Second Hospital, Ningbo, Zhejiang, China
| | - Jia Chen
- Research Center for Healthcare Data Science, Zhejiang Lab, Hangzhou, Zhejiang, China
| | - Yuqing Jin
- Research Center for Healthcare Data Science, Zhejiang Lab, Hangzhou, Zhejiang, China
| | - Yunqing Qiu
- Zhejiang Provincial Key Laboratory for Drug Clinical Research and Evaluation, Department of Clinical Pharmacy, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingtong Huang
- Department of Critical Care Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Rello J, Allam C, Ruiz-Spinelli A, Jarraud S. Severe Legionnaires' disease. Ann Intensive Care 2024; 14:51. [PMID: 38565811 PMCID: PMC10987467 DOI: 10.1186/s13613-024-01252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Legionnaires' disease (LD) is a common but under-diagnosed cause of community-acquired pneumonia (CAP), although rapid detection of urine antigen testing (UAT) and advances in molecular testing have improved the diagnosis. LD entails intensive care unit (ICU) admission in almost one-third of cases, and the mortality rate ranges from 4% to 40%. This review aims to discuss recent advances in the study of this condition and to provide an update on the diagnosis, pathogenesis and management of severe LD. RESULTS The overall incidence of LD has increased worldwide in recent years due to the higher number of patients with risk factors, especially immunosuppression, and to improvements in diagnostic methods. Although LD is responsible for only around 5% of all-cause CAP, it is one of the three most common causes of CAP requiring ICU admission. Mortality in ICU patients, immunocompromised patients or patients with a nosocomial source of LD can reach 40% despite appropriate antimicrobial therapy. Regarding pathogenesis, no Legionella-specific virulence factors have been associated with severity; however, recent reports have found high pulmonary Legionella DNA loads, and impairments in immune response and lung microbiome in the most severe cases. The clinical picture includes severe lung injury requiring respiratory and/or hemodynamic support, extrapulmonary symptoms and non-specific laboratory findings. LD diagnostic methods have improved due to the broad use of UAT and the development of molecular methods allowing the detection of all Lp serogroups. Therapy is currently based on macrolides, quinolones, or a combination of the two, with prolonged treatment in severe cases. CONCLUSIONS Numerous factors influence the mortality rate of LD, such as ICU admission, the underlying immune status, and the nosocomial source of the infection. The host immune response (hyperinflammation and/or immunoparalysis) may also be associated with increased severity. Given that the incidence of LD is rising, studies on specific biomarkers of severity may be of great interest. Further assessments comparing different regimens and/or evaluating host-directed therapies are nowadays needed.
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Affiliation(s)
- Jordi Rello
- Global Health ECore, Vall d'Hebron Institut of Research (VHIR), Barcelona, Spain
- Formation Recherche Evaluation (FOREVA) Research Group, CHU Nîmes, Nîmes, France
| | - Camille Allam
- Institut des Agents Infectieux, Centre National de Référence des Légionelles, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Équipe Pathogenèse des Légionelles, Université Lyon, Inserm, U1111,Université Claude Bernard Lyon 1, CNRS, UMR5308,École Normale Supérieure de Lyon, Lyon, France
| | | | - Sophie Jarraud
- Institut des Agents Infectieux, Centre National de Référence des Légionelles, Hospices Civils de Lyon, Lyon, France.
- Centre International de Recherche en Infectiologie (CIRI), Équipe Pathogenèse des Légionelles, Université Lyon, Inserm, U1111,Université Claude Bernard Lyon 1, CNRS, UMR5308,École Normale Supérieure de Lyon, Lyon, France.
- Centre National de Reference des Légionelles, Institut des Agents Infectieux, Hospices Civils de Lyon, 103 Grande rue de la Croix Rousse, 69317, Lyon Cedex 04, France.
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Salluh JIF, Póvoa P, Beane A, Kalil A, Sendagire C, Sweeney DA, Pilcher D, Polverino E, Tacconelli E, Estenssoro E, Frat JP, Ramirez J, Reyes LF, Roca O, Nseir S, Nobre V, Lisboa T, Martin-Loeches I. Challenges for a broad international implementation of the current severe community-acquired pneumonia guidelines. Intensive Care Med 2024; 50:526-538. [PMID: 38546855 DOI: 10.1007/s00134-024-07381-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/29/2024] [Indexed: 04/16/2024]
Abstract
Severe community-acquired pneumonia (sCAP) remains one of the leading causes of admission to the intensive care unit, thus consuming a large share of resources and is associated with high mortality rates worldwide. The evidence generated by clinical studies in the last decade was translated into recommendations according to the first published guidelines focusing on severe community-acquired pneumonia. Despite the advances proposed by the present guidelines, several challenges preclude the prompt implementation of these diagnostic and therapeutic measures. The present article discusses the challenges for the broad implementation of the sCAP guidelines and proposes solutions when applicable.
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Affiliation(s)
- Jorge I F Salluh
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, RJ, Brazil.
- Postgraduate Program of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, UFRJ, Brazil.
| | - Pedro Póvoa
- NOVA Medical School, CHRC, New University of Lisbon, Lisbon, Portugal
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, Odense University Hospital, University of Southern Denmark Centre for Clinical Epidemiology, Odense, Denmark
- Department of Intensive Care, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Abi Beane
- Pandemic Science Hub and Centre for Inflammation Research, University of Edinburgh, Edinburgh, UK
- NICS-MORU, Colombo, Sri Lanka
| | - Andre Kalil
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Cornelius Sendagire
- Anesthesia and Critical Care, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Daniel A Sweeney
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of California, La Jolla, San Diego, CA, USA
| | - David Pilcher
- Department of Intensive Care, Alfred Health, Commercial Road3004, Prahran, VIC, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation, Camberwell, Australia
| | - Eva Polverino
- Pneumology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, CIBERES, Barcelona, Spain
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos General San Martín, Servicio de Terapia Intensiva, Buenos Aires, Argentina
| | - Jean-Pierre Frat
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
- INSERM, CIC-1402, IS-ALIVE, Faculté de Médecine Et de Pharmacie de Poitiers, Université de Poitiers, Poitiers, France
| | - Julio Ramirez
- Norton Infectious Diseases Institute, Norton Healthcare, Louisville, KY, USA
- University of Louisville, Louisville, KY, USA
| | - Luis Felipe Reyes
- Unisabana Center for Translational Science, School of Medicine, Universidad de La Sabana, Chia, Colombia
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Oriol Roca
- Servei de Medicina Intensiva, Parc Taulí Hospital Universitari, Institut de Recerca Part Taulí - I3PT, Parc del Taulí 1, 08028, Sabadell, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Saad Nseir
- Centre de Réanimation, CHU de Lille, 59000, Lille, France
- Team Fungal Associated Invasive and Inflammatory Diseases, Lille Inflammation Research International Center, Université de Lille, INSERM U995, Lille, France
| | - Vandack Nobre
- Department of Internal Medicine, Medical School and University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thiago Lisboa
- Critical Care Department, Programa de Pós-Graduação em Ciencias Pneumologicas, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland
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Shang N, Li Q, Ji W, Liu H, Guo S. Acute muscle wasting is associated with poor prognosis in older adults with severe community-acquired pneumonia. Eur Geriatr Med 2024; 15:73-82. [PMID: 38060165 DOI: 10.1007/s41999-023-00895-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/30/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To investigate the impact of acute muscle wasting on 90-day mortality in older patients with severe pneumonia using ultrasound and chest computed tomography (CT). METHODS Quadriceps muscle layer thickness was measured via ultrasound on days 1, 7, and 14, and cross-sectional area of the erector spinae muscle was assessed using chest CT on days 1 and 14 in patients aged ≥ 65 years old. The primary outcome was all-cause 90-day mortality. Receiver operating characteristic curves were conducted for muscle loss to predict 90-day mortality. Cox proportional hazard models and Kaplan-Meier survival curves were employed to evaluate the association between muscle loss and 90-day mortality. RESULTS Sixty-two patients were enrolled with median age of 80.2 years, 29 (46.8%) were men and 28 (45.2%) patients died. Muscle mass measured using ultrasound and CT decreased significantly from baseline to day 14 in the non-survivor group. Muscle loss assessed by ultrasound (with minimum and maximum pressure) and CT independently predicted all-cause 90-day mortality (adjusted hazard ratios = 1.497, 1.400 and 1.082; P < 0.001, P = 0.002, and P = 0.004; respectively), and cutoff values of muscle loss were 0.34 cm, 0.11 cm and 4.92 cm2, correspondingly. A higher muscle loss had an increased risk of 90-day mortality. CONCLUSIONS Acute muscle wasting assessed by ultrasound and chest CT persisted for 14 days and was an independent predictor of adverse outcomes in older patients with severe pneumonia. A greater decline in muscle mass was associated with a higher 90-day mortality risk.
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Affiliation(s)
- Na Shang
- Department of Emergency Medicine, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Qiujing Li
- Department of Emergency Medicine, Capital Medical University, Beijing Shijitan Hospital, Beijing, 100038, China
| | - Wenqing Ji
- Department of Emergency Medicine, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Huizhen Liu
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Shubin Guo
- Department of Emergency Medicine, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, 100020, China.
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Li J, Wang Y, Zhao W, Yang T, Zhang Q, Yang H, Li X, Tong Z. Multi-omics analysis reveals overactive inflammation and dysregulated metabolism in severe community-acquired pneumonia patients. Respir Res 2024; 25:45. [PMID: 38243232 PMCID: PMC10797892 DOI: 10.1186/s12931-024-02669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Severe community-acquired pneumonia (S-CAP) is a public health threat, making it essential to identify novel biomarkers and investigate the underlying mechanisms of disease severity. METHODS Here, we profiled host responses to S-CAP through proteomics analysis of plasma samples from a cohort of S-CAP patients, non-severe (NS)-CAP patients, diseases controls (DCs), and healthy controls (HCs). Then, typical differentially expressed proteins were then validated by ELISA in an independent cohort. Metabolomics analysis was further performed on both the cohort 1 and cohort 2. Then, the proteomic and metabolomic signatures were compared between the adult and child cohorts to explore the characteristics of severe pneumonia patients. RESULTS There were clear differences between CAP patients and controls, as well as substantial differences between the S-CAP and NS-CAP. Pathway analysis of changes revealed excessive inflammation, suppressed immunity, and lipid metabolic disorders in S-CAP cases. Interestingly, comparing these signatures between the adult and child cohorts confirmed that overactive inflammation and dysregulated lipid metabolism were common features of S-CAP patients, independent of age. The change proportion of glycerophospholipids, glycerolipids, and sphingolipids were obviously different in the adult and child S-CAP cases. CONCLUSION The plasma multi-omics profiling revealed that excessive inflammation, suppressed humoral immunity, and disordered metabolism are involved in S-CAP pathogenesis.
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Affiliation(s)
- Jieqiong Li
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China.
| | - Yawen Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, China
| | - Weichao Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China
- Department of Respiratory Medicine, Strategic Support Force Medical Center, Beijing, China
| | - Tingyu Yang
- Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China
| | - Qianyu Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China
| | - Huqin Yang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China
| | - Xuyan Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China
| | - Zhaohui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, 8 Workers Stadium South Road, Chaoyang District, Beijing, China.
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Chen S, Jiang J, Su M, Chen P, Liu X, Lei W, Zhang S, Wu Q, Rong F, Li X, Zheng X, Xiao Q. A nomogram based on the expression level of angiopoietin-like 4 to predict the severity of community-acquired pneumonia. BMC Infect Dis 2023; 23:677. [PMID: 37821811 PMCID: PMC10568757 DOI: 10.1186/s12879-023-08648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The morbidity and mortality of community-acquired pneumonia (CAP) remain high among infectious diseases. It was reported that angiopoietin-like 4 (ANGPTL4) could be a diagnostic biomarker and a therapeutic target for pneumonia. This study aimed to develop a more objective, specific, accurate, and individualized scoring system to predict the severity of CAP. METHODS Totally, 31 non-severe community-acquired pneumonia (nsCAP) patients and 14 severe community-acquired pneumonia (sCAP) patients were enrolled in this study. The CURB-65 and pneumonia severity index (PSI) scores were calculated from the clinical data. Serum ANGPTL4 level was measured by enzyme-linked immunosorbent assay (ELISA). After screening factors by univariate analysis and receiver operating characteristic (ROC) curve analysis, multivariate logistic regression analysis of ANGPTL4 expression level and other risk factors was performed, and a nomogram was developed to predict the severity of CAP. This nomogram was further internally validated by bootstrap resampling with 1000 replications through the area under the ROC curve (AUC), the calibration curve, and the decision curve analysis (DCA). Finally, the prediction performance of the new nomogram model, CURB-65 score, and PSI score was compared by AUC, net reclassification index (NRI), and integrated discrimination improvement (IDI). RESULTS A nomogram for predicting the severity of CAP was developed using three factors (C-reactive protein (CRP), procalcitonin (PCT), and ANGPTL4). According to the internal validation, the nomogram showed a great discrimination capability with an AUC of 0.910. The Hosmer-Lemeshow test and the approximately fitting calibration curve suggested a satisfactory accuracy of prediction. The results of DCA exhibited a great net benefit. The AUC values of CURB-65 score, PSI score, and the new prediction model were 0.857, 0.912, and 0.940, respectively. NRI comparing the new model with CURB-65 score was found to be statistically significant (NRI = 0.834, P < 0.05). CONCLUSION A robust model for predicting the severity of CAP was developed based on the serum ANGPTL4 level. This may provide new insights into accurate assessment of the severity of CAP and its targeted therapy, particularly in the early-stage of the disease.
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Affiliation(s)
- Siqin Chen
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China
| | - Jia Jiang
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China
| | - Minhong Su
- Pulmonary and Critical Care Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Chen
- GMU-GIBH Joint School of Life Sciences, The Guangdong-Hong Kong-Macau Joint Laboratory for Cell Fate Regulation and Diseases, Guangzhou Medical University, Guangzhou, China
| | - Xiang Liu
- Departments of Hematology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Wei Lei
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China
| | - Shaofeng Zhang
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China
| | - Qiang Wu
- Department of Cardiology, National Clinical Research Center for Infectious Disease, State Key Discipline of Infectious Disease, Shenzhen Third People's Hospital, Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Fu Rong
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China
| | - Xi Li
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China
| | - Xiaobin Zheng
- Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-Sen University, 52 East Meihua Rd., Zhuhai, 519000, China.
| | - Qiang Xiao
- Pulmonary and Critical Care Medicine, Shunde Hospital, Southern Medical University, No.1, Jiazi Road, Lunjiao Street, Shunde District, Foshan, 528300, China.
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Shang N, Li Q, Liu H, Li J, Guo S. Erector spinae muscle-based nomogram for predicting in-hospital mortality among older patients with severe community-acquired pneumonia. BMC Pulm Med 2023; 23:346. [PMID: 37710218 PMCID: PMC10500910 DOI: 10.1186/s12890-023-02640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/07/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND No multivariable model incorporating erector spinae muscle (ESM) has been developed to predict clinical outcomes in older patients with severe community-acquired pneumonia (SCAP). This study aimed to construct a nomogram based on ESM to predict in-hospital mortality in patients with SCAP. METHODS Patients aged ≥ 65 years with SCAP were enrolled in this prospective observational study. Least absolute selection and shrinkage operator and multivariable logistic regression analyses were used to identify risk factors for in-hospital mortality. A nomogram prediction model was constructed. The predictive performance was evaluated using the concordance index (C-index), calibration curve, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis. RESULTS A total of 490 patients were included, and the in-hospital mortality rate was 36.1%. The nomogram included the following independent risk factors: mean arterial pressure, peripheral capillary oxygen saturation, Glasgow Coma Scale score (GCS), lactate, lactate dehydrogenase, blood urea nitrogen levels, and ESM cross-sectional area. Incorporating ESM into the base model with other risk factors significantly improved the C-index from 0.803 (95% confidence interval [CI], 0.761-0.845) to 0.836 (95% CI, 0.798-0.873), and these improvements were confirmed by category-free NRI and IDI. The ESM-based nomogram demonstrated a high level of discrimination, good calibration, and overall net benefits for predicting in-hospital mortality compared with the combination of confusion, urea, respiratory rate, blood pressure, and age ≥ 65 years (CURB-65), Pneumonia Severity Index (PSI), Acute Physiology and Chronic Health Evaluation II (APACHEII), and Sequential Organ Failure Assessment (SOFA). CONCLUSIONS The proposed ESM-based nomogram for predicting in-hospital mortality among older patients with SCAP may help physicians to promptly identify patients prone to adverse outcomes. TRIAL REGISTRATION This study was registered at www.chictr.org.cn (registration number Chi CTR-2300070377).
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Affiliation(s)
- Na Shang
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Qiujing Li
- Department of Emergency Medicine, Capital Medical University, Beijing Shijitan Hospital, Beijing, 100038, China
| | - Huizhen Liu
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Junyu Li
- Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center, Beijing, 100068, China
| | - Shubin Guo
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Beijing, 100020, China.
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Simon S, Rademacher J. [Antibiotic treatment of community-acquired and hospital-acquired pneumonia]. Med Klin Intensivmed Notfmed 2023; 118:454-463. [PMID: 37405418 DOI: 10.1007/s00063-023-01033-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 07/06/2023]
Abstract
Community-acquired and nosocomial bacterial pneumonia are among the most common infectious diseases in Germany. Knowledge of possible pathogens and therapeutic implications thereof are essential to be able to provide adequate, differentiated antimicrobial therapy with the appropriate drugs, form of application, dose, and duration. New diagnostics that include multiplex polymerase chain reaction, correct interpretation of the biomarker procalcitonin, and treatment of multidrug-resistant bacteria are becoming increasingly import.
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Affiliation(s)
- Susanne Simon
- Klinik für Pneumologie und Infektiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland.
| | - Jessica Rademacher
- Klinik für Pneumologie und Infektiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland
- German Center for Lung Research (DZL), Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH), Hannover, Deutschland
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9
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Pan J, Bu W, Guo T, Geng Z, Shao M. Development and validation of an in-hospital mortality risk prediction model for patients with severe community-acquired pneumonia in the intensive care unit. BMC Pulm Med 2023; 23:303. [PMID: 37592285 PMCID: PMC10436447 DOI: 10.1186/s12890-023-02567-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND A high mortality rate has always been observed in patients with severe community-acquired pneumonia (SCAP) admitted to the intensive care unit (ICU); however, there are few reported predictive models regarding the prognosis of this group of patients. This study aimed to screen for risk factors and assign a useful nomogram to predict mortality in these patients. METHODS As a developmental cohort, we used 455 patients with SCAP admitted to ICU. Logistic regression analyses were used to identify independent risk factors for death. A mortality prediction model was built based on statistically significant risk factors. Furthermore, the model was visualized using a nomogram. As a validation cohort, we used 88 patients with SCAP admitted to ICU of another hospital. The performance of the nomogram was evaluated by analysis of the area under the receiver operating characteristic (ROC) curve (AUC), calibration curve analysis, and decision curve analysis (DCA). RESULTS Lymphocytes, PaO2/FiO2, shock, and APACHE II score were independent risk factors for in-hospital mortality in the development cohort. External validation results showed a C-index of 0.903 (95% CI 0.838-0.968). The AUC of model for the development cohort was 0.85, which was better than APACHE II score 0.795 and SOFA score 0.69. The AUC for the validation cohort was 0.893, which was better than APACHE II score 0.746 and SOFA score 0.742. Calibration curves for both cohorts showed agreement between predicted and actual probabilities. The results of the DCA curves for both cohorts indicated that the model had a high clinical application in comparison to APACHE II and SOFA scoring systems. CONCLUSIONS We developed a predictive model based on lymphocytes, PaO2/FiO2, shock, and APACHE II scores to predict in-hospital mortality in patients with SCAP admitted to the ICU. The model has the potential to help physicians assess the prognosis of this group of patients.
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Affiliation(s)
- Jingjing Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Respiratory Intensive Care Unit, Anhui Chest Hospital, Hefei, China
| | - Wei Bu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tao Guo
- Center for Biomedical Imaging, University of Science and Technology of China, Hefei, China
| | - Zhi Geng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China.
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China.
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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10
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Tang X, Wang N, Liu G, Tan H, Li AM, Gao YQ, Yao MY, Wang N, Jing HD, Di QG, Chen L, Wang R, Li XY, Li Y, Yuan X, Zhao Y, Li Q, Tong ZH, Sun B. Psittacosis caused severe community-acquired pneumonia accompanied by acute hypoxic respiratory failure: a multicenter retrospective cohort study from China. BMC Infect Dis 2023; 23:532. [PMID: 37580698 PMCID: PMC10426048 DOI: 10.1186/s12879-023-08283-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/26/2023] [Indexed: 08/16/2023] Open
Abstract
INTRODUCTION Psittacosis can cause severe community-acquired pneumonia (CAP). The clinical manifestations of psittacosis range from subclinical to fulminant psittacosis with multi-organ failure. It is essential to summarize the clinical characteristic of patients with severe psittacosis accompanied by acute hypoxic respiratory failure (AHRF). METHODS This retrospective study included patients with severe psittacosis caused CAP accompanied by AHRF from 19 tertiary hospitals of China. We recorded the clinical data, antimicrobial therapy, respiratory support, complications, and outcomes. Chlamydia psittaci was detected on the basis of metagenomic next-generation sequencing performed on bronchoalveolar lavage fluid samples. Patient outcomes were compared between the treatment methods. RESULTS This study included 45 patients with severe CAP and AHRF caused by psittacosis from April 2018 to May 2021. The highest incidence of these infections was between September and April. There was a history of poultry contact in 64.4% of the patients. The median PaO2/FiO2 of the patients was 119.8 (interquartile range, 73.2 to 183.6) mmHg. Four of 45 patients (8.9%) died in the ICU, and the median ICU duration was 12 days (interquartile range, 8 to 21) days. There were no significant differences between patients treated with fluoroquinolone initially and continued after the diagnosis, fluoroquinolone initially followed by tetracycline, and fluoroquinolone combined with tetracycline. CONCLUSION Psittacosis caused severe CAP seems not rare, especially in the patients with the history of exposure to poultry or birds. Empirical treatment that covers atypical pathogens may benefit such patients, which fluoroquinolones might be considered as an alternative.
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Affiliation(s)
- Xiao Tang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Na Wang
- Department of Pulmonary and critical care medicine, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Department Pulmonary and critical care medical center, Xinqiao hospital, Army Medical University, the Chinese People's Liberation Army Respiratory Disease Institute, Chongqing, China
| | - Hai Tan
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, Ningxia Hui Autonomous Region, Xi Ning, China
| | - Ai-Min Li
- Respiratory and Critical Care Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yan-Qiu Gao
- Respiratory Intensive Care Unit, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan Province, China
| | - Meng-Ying Yao
- Department of Respiratory Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Na Wang
- Department of Pulmonary, The first hospital of Fangshan district, Beijing, China
| | - Hui-Dan Jing
- Department of Intensive Care Unit, Daping Hospital, Army Medical University, Chongqing, China
| | - Qing-Guo Di
- Department of Pulmonary and Critical Care Medicine, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Liang Chen
- Department of Respiratory and Critical Care Medicine, Beijing Jingmei Group General Hospital, Beijing, China
| | - Rui Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xu-Yan Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xue Yuan
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yu Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qi Li
- Department Pulmonary and critical care medical center, Xinqiao hospital, Army Medical University, the Chinese People's Liberation Army Respiratory Disease Institute, Chongqing, China.
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Huang D, He D, Yao R, Wang W, He Q, Wu Z, Shi Y, Liang Z. Association of admission lactate with mortality in adult patients with severe community-acquired pneumonia. Am J Emerg Med 2023; 65:87-94. [PMID: 36592566 DOI: 10.1016/j.ajem.2022.12.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/05/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The present study was conducted to investigate the association of admission lactate with mortality in severe community-acquired pneumonia (SCAP). METHODS We performed a retrospective, observational, cohort study on adult SCAP patients admitted to intensive care unit (ICU) in West China Hospital of Sichuan University between December 2011 and December 2018. The primary outcome was hospital mortality. Univariate and then multivariate analysis were performed to identify independent risk factors for hospital mortality. The association of admission lactate categories with hospital mortality was examined in three logistic regression models and Kaplan-Meier plots. We also applied restricted cubic splines to estimate the potential non-linear associations. RESULTS In total, 2275 SCAP patients were included. Admission lactate remained a significant factor for mortality after multivariate regression (OR: 1.085; 95% CI: 1.033,1.141; by continuous variable). After lactate was categorized into quartiles and the confounders were fully adjusted, compared with the quartile 1, ORs (95% CIs) of hospital mortality for quartile 2, quartile 3 and quartile 4 were 1.001 (0.759-1.321), 1.153 (0.877-1.516) and 1.593 (1.202-2.109), respectively (P for trend =0.001). Survival curves indicated that elevated lactate was associated with poor prognosis (P < 0.001). Moreover, this association was non-linear, indicating that increased lactate has the most notable impact on mortality within the range of 1.5 to 4 mmol/L (P non-linear: 0.029 for hospital mortality; 0.004 for ICU mortality). CONCLUSION Elevated admission lactate has a significant, independent, and potentially non-linear association with increased mortality in SCAP patients.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dingxiu He
- Department of Emergency Medicine, The People's Hospital of Deyang, Deyang, Sichuan, China
| | - Rong Yao
- Department of Emergency Medicine, Emergency Medical Laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiao He
- Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenru Wu
- Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yujun Shi
- Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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12
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Gong K, Xu J, Tang J. Diagnostic and Prognostic Value of Deregulated Circulating Long Non-coding RNA TUG1 in Elderly Patients with Severe Pneumonia. Inflammation 2023; 46:313-321. [PMID: 36104517 DOI: 10.1007/s10753-022-01735-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/15/2022] [Accepted: 08/26/2022] [Indexed: 11/05/2022]
Abstract
To investigate the expression pattern of long non-coding RNA TUG1 in elderly patients with severe community-acquired pneumonia (sCAP) and evaluate its diagnostic and prognostic value for sCAP. Serum TUG1 levels were detected in 130 sCAP patients and 122 healthy volunteers via qRT-PCR method. The receiver operating characteristic (ROC) curve and k-M plot were drawn for the diagnostic and prognostic value evaluation. A diminished trend of TUG1 was detected in the serum of sCAP cases, and negatively correlated with the concentration of TNF-α, CRP, suPAR and sTREM-1. Among the 130 cases, 30 cases died from sCAP within 30 days after admission. Serum TUG1 had the diagnostic value for 30-day mortality prediction with the AUC of 0.823. In the non-survival group, more cases had old age, high CURB score and PSI score. K-M plot demonstrated that cases with low TUG1 levels showed poor survival than those carrying high TUG1 levels. Serum TUG1 was an independent risk factor for death in elderly patients with sCAP within 30 days after admission. Serum TUG1 was at low expression in sCAP patients, and it had the predictive value for the clinical prognosis of elderly sCAP patients.
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Affiliation(s)
- Kai Gong
- Department of Respiratory Medicine, Wu-Jin Hospital Affiliated to Jiangsu University, Wu-Jin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Chang Zhou, Jiangsu, 213017, China
| | - Jiao Xu
- Department of Respiratory Medicine, Wu-Jin Hospital Affiliated to Jiangsu University, Wu-Jin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Chang Zhou, Jiangsu, 213017, China
| | - Jianlei Tang
- Department of Intensive Care Unit, Wu-Jin Hospital Affiliated to Jiangsu University, Wu-Jin Clinical College of Xuzhou Medical University, No. 2 Yongning North Road, Chang Zhou, Jiangsu, 213017, China.
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13
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Zhang C, He H, Chen X, Wei T, Yang C, Bi J, Tang X, Liu J, Zhang D, Chen C, Song Y, Miao C. The prediction of lymphocyte count and neutrophil count on the efficacy of Xuebijing adjuvant treatment for severe community-acquired pneumonia: A post hoc analysis of a randomized controlled trial. Phytomedicine 2023; 110:154614. [PMID: 36587417 DOI: 10.1016/j.phymed.2022.154614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/09/2022] [Accepted: 12/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Adjuvant Xuebijing therapy exhibited a protective effect on severe community-acquired pneumonia (SCAP) in previous studies. Blood inflammatory biomarkers related to the disease subtype and severity of SCAP might be associated with the effects of Xuebijing on clinical outcomes of SCAP. PURPOSE To investigate whether neutrophils or lymphocytes are a useful biomarker of the therapeutic effect of Xuebijing on mortality and inflammation damage index. STUDY DESIGN A post hoc analysis of a randomized, placebo-controlled and double-blinded clinical trial of Xuebijing in patients with SCAP (Clinical Trial Registration: ChiCTR-TRC-13003534). METHODS We compared 28-day mortality (primary outcome) and four clinical scores (secondary outcome), including pneumonia severity index (PSI) score, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation II (APACHE II) score, and systemic inflammatory response syndrome (SIRS) score, according to the baseline strata of neutrophil count and lymphocyte count. RESULTS A total of 675 patients were included in the analyses, of which 334 received Xuebijing and 341 received the placebo. Xuebijing was more effective in SCAP patients with higher lymphocyte counts and lower neutrophil counts. In the lymphocyte-dominated inflammation (LDI) subgroup, defined as neutrophil count <13 × 109 cells/l and lymphocyte count ≥0.65 × 109 cells/l, Xuebijing reduced 28-day mortality by 15% while mortality of the neutrophil-dominated inflammation (NDI) subgroup decreased by 4.7% (p = 0.050). There was also greater improvement in the PSI, SOFA, APACHE II, and SIRS scores following Xuebijing treatment in the LDI subgroup compared with the NDI subgroup. CONCLUSIONS Xuebijing treatment shows stronger protective effects in SCAP patients with higher lymphocyte and lower neutrophil counts. Our findings may facilitate the selection of the most appropriate treatments for individual patients with SCAP, including who will receive Xuebijing injections.
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Affiliation(s)
- Cuiping Zhang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hong He
- Department of Anesthesiology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, No.270 Dongan Road, Shanghai 200032, China
| | - Xiaoyan Chen
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Tianchang Wei
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Chen Yang
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR, China
| | - Jing Bi
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Xinjun Tang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jie Liu
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Donghui Zhang
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Cuicui Chen
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yuanlin Song
- Shanghai Key Laboratory of Lung Inflammation and Injury, Department of Pulmonary and Critical care Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China; Shanghai Institute of Infectious Disease and Biosecurity, Shanghai 200032, China.
| | - Changhong Miao
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Zhu Q, Zhou J, Li F, Shi P, Lu Y, Lin X, Yuan L, Zhuo Z, Shen J. Nasopharyngeal aspirates in children with severe community-acquired pneumonia collected within 3 days before bronchoscopy can partially reflect the pathogens in bronchoalveolar lavage fluids. BMC Infect Dis 2022; 22:814. [PMID: 36319953 PMCID: PMC9623994 DOI: 10.1186/s12879-022-07749-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 09/17/2022] [Accepted: 09/23/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There is little evidence about consistency between nasopharyngeal and pulmonary pathogens in children with severe pneumonia. This study aims to compare the difference of pathogens between nasopharyngeal aspirates (NPAs) collected before bronchoscopy and bronchoalveolar lavage fluids (BALFs) in children with severe community-acquired pneumonia (SCAP). METHODS NPAs and BALFs were collected form pediatric SCAP cases hospitalized from January 2018 to March 2019. NPAs were colleced within 3 days before bronchoscopy. Samples were detected by direct immunofluorescence assay (DFA) for seven respiratory viruses and by routine bacterial culture in the clinical microbiology laboratory. Respiratory syncytial virus (RSV), Adenovirus (ADV), Influenza virus types A, B (IV-A and IV-B), Parainfluenza virus 1-3 (PIV1-3) were detected with a commercial assay. The virological and bacteriological detention results of NPAs were compared with the results of BALFs. RESULTS In total 204 cases with mean age of 3.4 ± 2.8 years (IQR, 1 month-14 years) were included in the study. Both NPA and BALF were collected from those cases. The positive rates of pathogen in NPAs and BALFs were 25.0% (51/204) and 36.7% (75/204), respectively (x2 = 6.614, P = 0.010). Respiratory viruses were found in 16.1% (33/204) from NPAs and 32.3% (66/204) from BALFs (x2 = 14.524, P < 0.001). RSV and ADV were the two most frequent detected viruses in NPAs and BALFs. High consistentcy of pathogens between NPAs and BALFs was observed, and 96.9% (32/33) viruses detected in NPAs were also found in BALFs. While bacteria were isolated from 12.7% (26/204) and 10.7% (22/204) of the two kinds of samples, respectively (x2 = 0.378, P = 0.539). In addition, Haemophilus influenzae (HI) was the dominant germ in both samples. CONCLUSION The DFA method used to detect seven respiratory viruses from NPAs collected within 3 days before bronchoscopy can partially reflect the pathogens in the lungs in children with SCAP.
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Affiliation(s)
- Qiguo Zhu
- Xiamen Children's Hospital, Xiamen Branch of children's Hospital of Fudan University, 361006, Xia Men, China
| | - Junli Zhou
- Xiamen Children's Hospital, Xiamen Branch of children's Hospital of Fudan University, 361006, Xia Men, China
| | - Fei Li
- Infectious Disease Department, Children's Hospital of Fudan University, National Children's Medical Center, 201102, Shanghai, China
| | - Peng Shi
- Statistics and data management center, Children's Hospital of Fudan University, National Children's Medical Center, 201102, Shanghai, China
| | - Yi Lu
- Xiamen Children's Hospital, Xiamen Branch of children's Hospital of Fudan University, 361006, Xia Men, China
| | - Xiaoliang Lin
- Xiamen Children's Hospital, Xiamen Branch of children's Hospital of Fudan University, 361006, Xia Men, China
| | - Lin Yuan
- Xiamen Children's Hospital, Xiamen Branch of children's Hospital of Fudan University, 361006, Xia Men, China
| | - Zhiqiang Zhuo
- Xiamen Children's Hospital, Xiamen Branch of children's Hospital of Fudan University, 361006, Xia Men, China
| | - Jun Shen
- Infectious Disease Department, Children's Hospital of Fudan University, National Children's Medical Center, 201102, Shanghai, China.
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Hong S, Wang H, Liu J, Qiao L. Effects of different doses of methylprednisolone on clinical outcomes in patients with severe community-acquired pneumonia: a study protocol for a randomized controlled trial. Trials 2022; 23:423. [PMID: 35598005 PMCID: PMC9123754 DOI: 10.1186/s13063-022-06404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background The specific use of methylprednisolone in severe community-acquired pneumonia (SCAP) has not yet formed a consensus. It is not clear whether the clinical efficacy of methylprednisolone in SCAP is dose-dependent, and how to balance the best efficacy with the least complications. The aim of this study is to evaluate the efficacy and safety of different doses of methylprednisolone in the adjuvant treatment for patients with SCAP. Methods/design This is a prospective, randomized, double-blind, parallel group, placebo-controlled trial to evaluate the efficacy and safety of different doses of methylprednisolone in the adjuvant treatment for patients with SCAP. Patients with diagnosed SCAP are randomized to the following four groups at a 1:1:1:1 ratio: group 1 (control group)—standard ICU patient care+100ml of normal saline once a day for 5 days; group 2—standard ICU patient care+40mg of methylprednisolone (dissolved in normal saline with a final volume of 100ml) once a day for 5 days; group 3—standard ICU patient care+80mg of methylprednisolone (dissolved in normal saline with a final volume of 100ml) once a day for 5 days; and group 4—standard ICU patient care+120mg of methylprednisolone (dissolved in normal saline with a final volume of 100ml) once a day for 5 days. The primary outcome is PaO2/FiO2 ratio at day 5 following randomization. The secondary outcomes are 28-day mortality, ventilator-free days at 28 days, mechanical ventilation duration at 28 days, endotracheal intubation rate, time for temperature recovery, duration of vasopressors use, serum CRP and interleukin-6 level at day 5 following randomization, hospital stay, frequency of nosocomial infections, gastrointestinal hemorrhage, and hyperglycemia. Discussion The results of our study may find the optimal dose of glucocorticoid in the adjuvant treatment of SCAP and provide evidence-based proof for clinicians to treat patients with SCAP. Since coronavirus disease 2019 (COVID-19) also belongs to community-acquired pneumonia, perhaps the results of our study will help to determine the appropriate dose of methylprednisolone in COVID-19 treatment. Trial registration Chinese Clinical Trial Registry ChiCTR2100045056. Registered on 4 April 2021.
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Affiliation(s)
- Shukun Hong
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China.
| | - Hongye Wang
- Department of Obstetrics and Gynecology, Shengli Oilfield Central Hospital, Dongying, China
| | - Jian Liu
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China
| | - Lujun Qiao
- Department of Intensive Care Unit, Shengli Oilfield Central Hospital, Dongying, China.
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16
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Guo K, Cai W, Chen Y, Shi Y, Xu Z, Chen C. Skeletal muscle depletion predicts death in severe community-acquired pneumonia patients entering ICU. Heart Lung 2021; 52:71-75. [PMID: 34902778 DOI: 10.1016/j.hrtlng.2021.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/16/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sarcopenia, or skeletal muscle depletion, was common in the elderly and often led to a poor prognosis of diseases. The area of the psoas muscle in abdominal computed tomography (CT) is the most common used for diagnosing sarcopenia. However, patients with pneumonia routinely only undergo chest CT. OBJECTIVES This study aimed to determine whether paraspinal muscle area (PMA) obtained by chest CT can predict death for community-acquired pneumonia (SCAP) patients entering intensive care unit (ICU). METHODS This study enrolled 208 SCAP patients admitted to ICU after undergoing chest CT. PMA, paraspinal muscle radiodensity (PMD), and lean paraspinal muscle area (LPMA) were calculated on chest CT images. The main outcome was mortality during hospitalization. Logistic regression, receiver operating characteristic (ROC) curve, and Kaplan-Meier curves were used to evaluate forecasting effectiveness. RESULTS The primary outcome occurred in 76 (36.53%) patients. In multivariate logistic regression, PMA, lactic dehydrogenase (LDH), invasive mechanical ventilation (IMV), red blood cell (RBC) and age≥ 65 years were independent risk factors predicting death during hospitalization (adjusted Odds Ratio [OR]: 0.886, 1.002, 3.178, 0.612 and 2.003, respectively). The area under curve (AUC) of PMA to predict death was 0.720 (P< 0.001). During hospitalization, the median survival time of high-PMA (51.00 days) and low-PMA groups (20.00 days) was statistically significant (P< 0.001). CONCLUSION Lower PMA was associated with an increased risk of death for SCAP patients admitted to the ICU. In other words, PMA may help early identify adverse prognosis of SCAP patients admitted to ICU.
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Affiliation(s)
- Kun Guo
- Department of Pneumology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang province, China
| | - Weimin Cai
- Department of Gastroenterology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang province, China
| | - Yongxian Chen
- Department of Pneumology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang province, China
| | - Yubo Shi
- Department of Pneumology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang province, China
| | - Zhixiao Xu
- Department of Pneumology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang province, China
| | - Chengshui Chen
- Department of Pneumology, the First Affiliated Hospital of Wenzhou Medical University, Zhejiang province, China.
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Huang D, He D, Gong L, Wang W, Yang L, Zhang Z, Shi Y, Liang Z. Clinical characteristics and risk factors associated with mortality in patients with severe community-acquired pneumonia and type 2 diabetes mellitus. Crit Care 2021; 25:419. [PMID: 34876193 PMCID: PMC8650350 DOI: 10.1186/s13054-021-03841-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/24/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The present study was performed to investigate the impacts of type 2 diabetes mellitus (T2DM) on severe community-acquired pneumonia (SCAP) and to develop a novel prediction model for mortality in SCAP patients with T2DM. METHODS This was a retrospective observational study conducted in consecutive adult patients with SCAP admitted to the intensive care unit (ICU) of West China Hospital, Sichuan University, China, between September 2011 and September 2019. The primary outcome was hospital mortality. A propensity score matching (PSM) analysis model with a 1:2 ratio was used for the comparisons of clinical characteristics and outcomes between T2DM and nondiabetic patients. The independent risk factors were identified via univariate and then multivariable logistic regression analysis and were then used to establish a nomogram. RESULTS In total, 1262 SCAP patients with T2DM and 2524 matched patients without T2DM were included after PSM. Patients with T2DM had longer ICU length of stay (LOS) (13 vs. 12 days, P = 0.016) and higher 14-day mortality (15% vs. 10.8%, P < 0.001), 30-day mortality (25.7% vs. 22.7%, P = 0.046), ICU mortality (30.8% vs. 26.5%, P = 0.005), and hospital mortality (35.2% vs. 31.0%, P = 0.009) than those without T2DM. In SCAP patients with T2DM, the independent risk factors for hospital mortality were increased numbers of comorbidities and diabetes-related complications; elevated C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), brain natriuretic peptide (BNP) and blood lactate; as well as decreased blood pressure on admission. The nomogram had a C index of 0.907 (95% CI: 0.888, 0.927) in the training set and 0.873 (95% CI: 0.836, 0.911) in the testing set, which was superior to the pneumonia severity index (PSI, AUC: 0.809, 95% CI: 0.785, 0.833). The calibration curve and decision curve analysis (DCA) also demonstrated its accuracy and applicability. CONCLUSIONS SCAP patients with T2DM had worse clinical outcomes than nondiabetic patients. The nomogram has good predictive performance for hospital mortality and might be generally applied after more external validations.
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Affiliation(s)
- Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Dingxiu He
- Department of Emergency Medicine, The People's Hospital of Deyang, Deyang, Sichuan, China
| | - Linjing Gong
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.,Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Wen Wang
- Chinese Evidence-Based Medicine Center and CREAT Group, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Yang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yujun Shi
- Institute of Clinical Pathology, Key Laboratory of Transplant Engineering and Immunology, NHC, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Bellut H, Porcher R, Varon E, Asfar P, Le Tulzo Y, Megarbane B, Mathonnet A, Dugard A, Veinstein A, Ouchenir K, Siami S, Reignier J, Galbois A, Cousson J, Preau S, Baldesi O, Rigaud JP, Souweine B, Misset B, Jacobs F, Dewavrin F, Mira JP, Bedos JP. Comparison of prognostic factors between bacteraemic and non-bacteraemic critically ill immunocompetent patients in community-acquired severe pneumococcal pneumonia: a STREPTOGENE sub-study. Ann Intensive Care 2021; 11:148. [PMID: 34689255 PMCID: PMC8542522 DOI: 10.1186/s13613-021-00936-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background The presence of bacteraemia in pneumococcal pneumonia in critically ill patients does not appear to be a strong independent prognostic factor in the existing literature. However, there may be a specific pattern of factors associated with mortality for ICU patients with bacteraemic pneumococcal community-acquired pneumonia (CAP). We aimed to compare the factors associated with mortality, according to the presence of bacteraemia or not on admission, for patients hospitalised in intensive care for severe pneumococcal CAP. Methods This was a post hoc analysis of data from the prospective, observational, multicentre STREPTOGENE study in immunocompetent Caucasian adults admitted to intensive care in France between 2008 and 2012 for pneumococcal CAP. Patients were divided into two groups based on initial blood culture (positive vs. negative) for Streptococcus pneumoniae. The primary outcome was hospital mortality, which was compared between the two groups using odds ratios according to predefined variables to search for a prognostic interaction present in bacterial patients but not non-bacteraemic patients. Potential differences in the distribution of serotypes between the two groups were assessed. The prognostic consequences of the presence or not of initial bi-antibiotic therapy were assessed, specifically in bacteraemic patients. Results Among 614 included patients, 274 had a blood culture positive for S. pneumoniae at admission and 340 did not. The baseline difference between the groups was more frequent leukopaenia (26% vs. 14%, p = 0.0002) and less frequent pre-hospital antibiotic therapy (10% vs. 16.3%, p = 0.024) for the bacteraemic patients. Hospital mortality was not significantly different between the two groups (p = 0.11). We did not observe any prognostic factors specific to the bacteraemic patient population, as the statistical comparison of the odds ratios, as an indication of the association between the predefined prognostic parameters and mortality, showed them to be similar for the two groups. Bacteraemic patients more often had invasive serotypes but less often serotypes associated with high case fatality rates (p = 0.003). The antibiotic regimens were similar for the two groups. There was no difference in mortality for patients in either group given a beta-lactam alone vs. a beta-lactam combined with a macrolide or fluoroquinolone. Conclusion Bacteraemia had no influence on the mortality of immunocompetent Caucasian adults admitted to intensive care for severe pneumococcal CAP, regardless of the profile of the associated prognostic factors. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00936-z.
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Affiliation(s)
- Hugo Bellut
- Réanimation Médico‑Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France.
| | - Raphael Porcher
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS‑UMR1153), Inserm, Centre d'épidémiologie clinique, Centre Equator France, Hôpital Hôtel-Dieu, Université Paris Descartes, 75004, Paris, France
| | - Emmanuelle Varon
- Laboratoire de Microbiologie, Centre National de Référence des Pneumocoques, AP-HP Hôpital Européen Georges-Pompidou, 75908, Paris Cedex 15, France.,Centre National de Référence des Pneumocoques, Centre Hospitalier Interrcommunal de Créteil, 94000, Créteil, France
| | - Pierre Asfar
- Réanimation Médicale, CHU Angers, 49933, Angers Cedex 9, France
| | | | - Bruno Megarbane
- Réanimation Médicale et Toxicologique, Hôpital Lariboisière, 75010, Paris, France
| | - Armelle Mathonnet
- Réanimation Polyvalente, Hôpital de La Source, 45067, Orléans Cedex 2, France
| | - Anthony Dugard
- Réanimation Polyvalente, CHU Dupuytren, 87042, Limoges, France
| | - Anne Veinstein
- Réanimation, CHU Jean Bernard, 86021, Poitiers Cedex, France
| | - Kader Ouchenir
- Réanimation, Hôpital Louis Pasteur, 28018, Chartres Cedex, France
| | - Shidasp Siami
- Réanimation Polyvalente, CH Sud Essonne, 91152, Etampes Cedex 02, France
| | - Jean Reignier
- Réanimation Médicale, CHU Nantes, 44093, Nantes Cedex 1, France
| | - Arnaud Galbois
- Réanimation Médicale, Hôpital St Antoine, 75012, Paris, France
| | - Joël Cousson
- Réanimation Polyvalente, Hôpital Robert Debré, 51092, Reims Cedex, France
| | - Sébastien Preau
- Réanimation, Hôpital A. Calmette, 59037, Lille Cedex, France
| | - Olivier Baldesi
- Réanimation, CH du Pays d'Aix, 13616, Aix En Provence, France
| | | | - Bertrand Souweine
- Réanimation Médicale, CHU Gabriel Montpied, 63000, Clermont Ferrand, France
| | - Benoit Misset
- Réanimation, Hôpital Saint Joseph, 75014, Paris, France
| | - Frederic Jacobs
- Réanimation Médicale, Hôpital Antoine Béclère, 92140, Clamart, France
| | | | - Jean-Paul Mira
- Réanimation Médicale, Hôpital Cochin, 75679, Paris Cedex 14, France
| | - Jean-Pierre Bedos
- Réanimation Médico‑Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France
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Zhang J, Ma K, Wang X, Jiang Y, Zhao S, Ou J, Lan W, Guan W, Wu X, Zheng H, Yang B, Wan C, Zhao W, Wu J, Zhang Q. Desmoglein 2 (DSG2) Is A Receptor of Human Adenovirus Type 55 Causing Adult Severe Community-Acquired Pneumonia. Virol Sin 2021; 36:1400-1410. [PMID: 34224109 DOI: 10.1007/s12250-021-00414-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/06/2021] [Indexed: 11/30/2022] Open
Abstract
Human adenovirus type 55 (HAdV-B55) is a re-emergent acute respiratory disease pathogen that causes adult community-acquired pneumonia (CAP). Previous studies have shown that the receptor of HAdV-B14, which genome is highly similar with HAdV-B55, is human Desmoglein 2 (DSG2). However, whether the receptor of HAdV-B55 is DSG2 is undetermined because there are three amino acid mutations in the fiber gene between HAdV-B14 and HAdV-B55. Here, firstly we found the 3T3 cells, a mouse embryo fibroblast rodent cell line which does not express human DSG2, were able to be infected by HAdV-B55 after transfected with pcDNA3.1-DSG2, while normal 3T3 cells were still unsusceptible to HAdV-B55 infection. Next, A549 cells with hDSG2 knock-down by siRNA were hard to be infected by HAdV-B3/-B14/-B55, while the control siRNA group was still able to be infected by all these types of HAdVs. Finally, immunofluorescence confocal microscopy indicated visually that Cy3-conjugated HAdV-B55 viruses entered A549 cells by binding to DSG2 protein. Therefore, DSG2 is a major receptor of HAdV-B55 causing adult CAP. Our finding is important for better understanding of interactions between adenoviruses and host cells and may shed light on the development of new drugs that can interfere with these processes as well as for the development of potent prophylactic vaccines.
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Affiliation(s)
- Jing Zhang
- Guangdong Provincial Key Laboratory of Virology, Institute of Medical Microbiology, Jinan University, Guangzhou, 510632, China.,Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Kui Ma
- Guangdong Provincial Key Laboratory of Virology, Institute of Medical Microbiology, Jinan University, Guangzhou, 510632, China
| | - Xiangyu Wang
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Yinbo Jiang
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Shan Zhao
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Junxian Ou
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Wendong Lan
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Wenyi Guan
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Xiaowei Wu
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Heping Zheng
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Bin Yang
- Guangdong Provincial Dermatology Hospital, Southern Medical University, Guangzhou, 510091, China
| | - Chengsong Wan
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Wei Zhao
- Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Jianguo Wu
- Guangdong Provincial Key Laboratory of Virology, Institute of Medical Microbiology, Jinan University, Guangzhou, 510632, China.
| | - Qiwei Zhang
- Guangdong Provincial Key Laboratory of Virology, Institute of Medical Microbiology, Jinan University, Guangzhou, 510632, China. .,Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China.
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20
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Zeng Q, Tang T, Huang B, Bu S, Xiao Y, Dai Y, Wei Z, Huang L, Jiang S. rs1840680 single nucleotide polymorphism in Pentraxin 3: a potential protective biomarker of severe community-acquired pneumonia. J Int Med Res 2021; 49:3000605211010621. [PMID: 33906523 PMCID: PMC8111280 DOI: 10.1177/03000605211010621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective Single nucleotide polymorphisms (SNPs) of pentraxin 3 (PTX3) are associated with various outcomes of lung infections. This study aimed to analyze the relationship between PTX3 polymorphisms and the severity of community-acquired pneumonia (CAP). Methods This is a retrospective case-control study comprising 43 patients with severe CAP (SCAP) and 97 patients with non-severe CAP. Three SNPs in the PTX3 gene (rs2305619, rs3816527, and rs1840680) from peripheral blood samples were genotyped by real-time polymerase chain reaction. The association between each SNP and the CAP severity was analyzed by logistic regression analysis. Results We found that the rs1840680 polymorphism was significantly associated with CAP clinical severity. However, no such association was observed for the genotypes and allele frequencies of rs2305619 or rs3816527. The PTX3 rs1840680 AG genotype was an independent factor for a lower risk of SCAP after multivariate logistic regression analysis. Male sex and coronary heart disease were associated with an increased risk of SCAP. Conclusions The PTX3 rs1840680 AG genotype was found to be associated with a lower risk of SCAP, and may serve as a potential protective biomarker to help clinical judgment and management.
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Affiliation(s)
- Qiaojun Zeng
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Tiantian Tang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Biru Huang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shiyi Bu
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yingqi Xiao
- Department of Respiratory Medicine, Tungwah Hospital of Sun Yat-sen University, Dongguan, China
| | - Yumeng Dai
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zixin Wei
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Linjie Huang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.,Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, Guangdong, China
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21
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Chen L, Miao C, Chen Y, Han X, Lin Z, Ye H, Wang C, Zhang H, Li J, Tang Q, Dong Y, Bai M, Zhu Y, Liu G. Age-specific risk factors of severe pneumonia among pediatric patients hospitalized with community-acquired pneumonia. Ital J Pediatr 2021; 47:100. [PMID: 33892752 DOI: 10.1186/s13052-021-01042-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Risk factors that predispose the development of severe community-acquired pneumonia (CAP) among pediatric CAP patients of different age ranges are yet to be identified. METHODS We retrospectively analyzed pediatric in-patients (< 6 years old) diagnosed with CAP in our hospital. We subdivided patients into four age groups (< 6 months, 6 months-1 year, 1-2 years, and 2-6 years). Their medical records, including demographic information, clinical features, laboratory findings, and chest radiographic reports, were reviewed and collected for further analysis. Univariate logistic regression analysis and stepwise regression analysis were applied to identify risk factors associated with severe CAP and ICU admission for overall patients and age-stratified subgroups. RESULTS A total of 20,174 cases were initially included. Among them, 3309 (16.40%) cases were identified as severe CAP, and 2824 (14.00%) cases required ICU admission. Potential risk factors for severe CAP and ICU admission identified by univariate analysis included younger age, rural residency, premature birth, low birth weight (LBW), formula feeding, congenital heart disease (CHD), history of pneumonia or neonatal jaundice, patients with other health issues, certain symptoms (manifesting wheezing, dyspnea, cyanosis, but have no cough or fever), abnormal laboratory findings (abnormal levels of white blood cells, albumin, and C-reactive protein and RSV infection), and chest X-ray (odds ratio [OR] > 1 for all). CHD, low albumin, proteinuria, abnormal chest x-ray were independent risks factors across different age groups, whereas birth or feeding history, history of pneumonia, cyanosis or dyspnea on admission, and RSV infection were independent risk factors for only younger kids (< 1 year), and wheezing was an independent risk factor only for older children (2-5 years old). CONCLUSIONS Risk factors predicting disease severity among children hospitalized with CAP vary with age. Risk factor stratification of pediatric CAP based on age-specific risk factors can better guide clinical practice. TRIAL REGISTRATION This study has been registered in China, with the registration number being ChiCTR2000033019 .
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Tsai D, Chiong F, Secombe P, Hnin KM, Stewart P, Goud R, Woodman R, Lipman J, Roberts J, Hewagama S. Epidemiology and Microbiology of Severe Community-Acquired Pneumonia in Central Australia: A Retrospective Study. Intern Med J 2020; 52:1048-1056. [PMID: 33342052 DOI: 10.1111/imj.15171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/13/2020] [Accepted: 12/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) has high mortality and morbidity. AIMS To describe the epidemiology and microbiology of SCAP in Central Australia. METHODS A retrospective epidemiological study describing the characteristics, incidence rates (IR) and microbiological aetiology of SCAP in Central Australia. Adult patients admitted to Alice Springs Hospital Intensive Care Unit (ICU) between 2011-2014 that fitted the IDSA/ATS definition of SCAP were included. Medical records were reviewed and compared between Indigenous and non-Indigenous patients. Primary outcomes were incidence rate and microbiological aetiology of SCAP. Secondary outcomes were 30-day mortality, and ICU and hospital length of stay (LoS). RESULTS A total of 185 patents were included (156 Indigenous, 29 non-Indigenous). The overall SCAP IR per 1000 person-years was 3.24 (3.75 Indigenous and 1.87 non-Indigenous) with an IR difference of 2.71 after adjustment (p<0.001). Those aged ≥50 had an IR 74.8% higher than those younger. Male IR was 50% higher than females. There was a significant difference between Indigenous and non-Indigenous groups for age (48 vs. 64 years), but not for 30-day mortality (7.7% vs. 10.3%), ICU LoS (4.8 vs. 4.6 days) and hospital LoS (10.9 vs. 15.1 days), respectively. Likely causative pathogen(s) were identified in 117 patients; Streptococcus pneumoniae was the most common pathogen (28.2%), followed by Haemophilus influenzae (19.7%), Influenza A/B (16.2%) and Staphylococcus aureus (14.5%). CONCLUSION A high incidence of SCAP was observed in Central Australia, disproportionately affecting the Indigenous population. Prevention strategies are imperative, as well as early identification of SCAP and appropriate empiric antibiotic regimens. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Danny Tsai
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Centre for Remote Health, Flinders NT, Flinders University, Alice Springs, NT, Australia.,Pharmacy Department, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Fabian Chiong
- Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia.,Department of Infectious Diseases, University Hospital Geelong, Geelong, VIC, Australia
| | - Paul Secombe
- Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, NT, Australia
| | | | - Penny Stewart
- Department of Intensive Care Medicine, Alice Springs Hospital, Alice Springs, NT, Australia
| | - Rajendra Goud
- Department of Intensive Care Medicine, Cairns Base Hospital, Cairns, QLD, Australia
| | - Richard Woodman
- School of Bioinformatics, Flinders University, Adelaide, SA, Australia
| | - Jeffrey Lipman
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Jason Roberts
- University of Queensland Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Intensive Care Medicine, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Centre for Translational Anti-infective Pharmacodynamics, School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Departments of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Saliya Hewagama
- Department of Medicine, Alice Springs Hospital, Alice Springs, NT, Australia.,Department of Infectious Diseases, The Northern Hospital, Epping, Melbourne, VIC, Australia
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23
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Wu X, Li Y, Zhang M, Li M, Zhang R, Lu X, Gao W, Li Q, Xia Y, Pan P, Li Q. Etiology of Severe Community-Acquired Pneumonia in Adults Based on Metagenomic Next-Generation Sequencing: A Prospective Multicenter Study. Infect Dis Ther 2020; 9:1003-1015. [PMID: 33170499 PMCID: PMC7652912 DOI: 10.1007/s40121-020-00353-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/03/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid (BALF) has the potential to improve the pathogen identification in severe community-acquired pneumonia (SCAP). METHODS In this 1.5-year, multicenter, prospective study, we investigated the usefulness of mNGS of BALF for identifying pathogens of SCAP in hospitalized adults, comparing it with other laboratory methods. RESULTS Of 329 SCAP adults, a microbial etiology was established in 304 cases (92.4%). The overall microbial yield was 90.3% for mNGS versus 39.5% for other methods (P < 0.05). The most frequently detected pathogens in immunocompetent patients were Streptococcus pneumoniae (14.8%), rhinovirus (9.8%), Haemophilus influenzae (9.1%), Staphylococcus aureus (8.7%), and Chlamydia psittaci (8.0%), while in immunocompromised patients they were Pneumocystis jirovecii (44.6%), Klebsiella pneumoniae (18.5%), Streptococcus pneumoniae (15.4%), Haemophilus influenzae (13.8%), and Pseudomonas aeruginosa (13.8%). Notably, novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified from two patients solely by mNGS in January 2020; uncommon pathogens including Orientia tsutsugamushi and Nocardia otitidiscaviarum were identified from one patient, respectively. Furthermore, mixed infections were detected in 56.8% of the patients. CONCLUSIONS A high microbial detection rate was achieved in SCAP adults using mNGS testing of BALF. The most frequently detected pathogens of SCAP differed between immunocompetent and immunocompromised patients. mNGS testing may be an powerful tool for early identification of potential pathogens for SCAP to initiate a precise antimicrobial therapy.
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Affiliation(s)
- Xiaodong Wu
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yuanyuan Li
- Department of Respiratory Medicine (Department of Respiratory and Critical Care Medicine), National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha, China
| | - Ming Zhang
- Department of Respiratory and Critical Care Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Miaomiao Li
- Department of Respiratory and Critical Care Medicine, Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rong Zhang
- Department of Respiratory and Critical Care Medicine, Changhai Hospital, the Second Military Medical University, Shanghai, China
| | - Xin Lu
- Department of Respiratory and Critical Care Medicine, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Gao
- Department of Respiratory and Critical Care Medicine, Second Clinical Medical College (Shenzhen People's Hospital), Jinan University, Shenzhen, China
| | - Qin Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Xia
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| | - Pinhua Pan
- Department of Respiratory Medicine (Department of Respiratory and Critical Care Medicine), National Key Clinical Specialty, Xiangya Hospital, Central South University, Changsha, China.
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, Tongji University, Shanghai, China.
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Tang J, Luo J, Huang Z, Xu J, Liao J, Zhan H, Xiong Y, Luo H, Jiang Y, Zeng Q. Admission IL-32 concentration predicts severity and mortality of severe community-acquired pneumonia independently of etiology. Clin Chim Acta 2020; 510:647-53. [PMID: 32860786 DOI: 10.1016/j.cca.2020.08.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is a critical disorder with high morbidity and mortality, usually manifested as acute respiratory failure and septic shock generally caused by exaggerated systemic inflammation. Interleukin-32 (IL-32), a pro-inflammatory cytokine, has been reported involved in various infectious diseases. We investigated the efficacy of the plasma IL-32 as a biomarker for evaluating the severity and clinical outcomes in SCAP patients. METHODS A total of 124 adult immunocompetent SCAP patients and 87 healthy controls were enrolled in this observational, prospective cohort study. RESULTS We found that PBMCs IL-32 mRNA and plasma IL-32 concentrations on admission of SCAP patients were significantly higher than healthy controls. Plasma IL-32 concentrations closely correlated with increasing severity scores, the need for vasopressor support or invasive mechanical ventilation but not with the etiology. The area under the curve (AUC) for predicting 30-day mortality using IL-32 was 0.812, is superior to WBCs and CRP. Incorporation of IL-32 with the severity scores were shown to improve the prognostic accuracy considerably. Furthermore, the 30-day cumulative survival rate in high IL-32 concentration group was significantly lower than that in the low concentration group. In a multivariate Cox regression analysis, higher IL-32 concentration and higher PSI score were recognized as the independent risk factors for survival, and the relative risks were 2.568 and 3.362, respectively. CONCLUSIONS Admission IL-32 concentration closely related to the severity and mortality of SCAP, and it may be served as a potential biomarker to help clinical judgment and management.
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Bassetti M, Russo A, Cilloniz C, Giacobbe DR, Vena A, Amaro R, Graziano E, Soriano A, Torres A. Ceftaroline for severe community-acquired pneumonia: A real-world two-centre experience in Italy and Spain. Int J Antimicrob Agents 2020; 55:105921. [PMID: 32061999 DOI: 10.1016/j.ijantimicag.2020.105921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/27/2020] [Accepted: 02/08/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Ceftaroline is one of latest additions to the armamentarium for treating community-acquired pneumonia (CAP). This study aimed to describe the outcome of severe CAP (SCAP) in a cohort of hospitalised patients treated with ceftaroline. METHODS A retrospective, observational study of patients with SCAP treated with ceftaroline in two hospitals in Spain and Italy. The primary objective was to explore 30-day mortality after diagnosis of SCAP. RESULTS During the study period the following were observed: there were 89 cases of SCAP treated with ceftaroline and 53 cases used in combination with other antibiotics (60%). Overall, 30-day mortality and clinical failure were 20% (18 of 89) and 36% (32 of 89), respectively. Independent predictors of 30-day mortality were: increasing age (OR for 1 year increase 1.0, 95% CI 1.0-1.1, P 0.043), presence of solid neoplasm (OR 4.0, 95% CI 1.0-15.1, P 0.044) and concomitant therapy with oseltamivir (OR 8.5, 95% CI 1.2°57.3, P 0.029). The only independent predictor of clinical failure was the time elapsing from SCAP diagnosis to ceftaroline therapy (OR for each passing day 1.5, 95% CI 1.1-1.9, P 0.003). The clinical success rate was 64% (57 of 89). In the subgroups of patients with proven Streptococcus pneumoniae, methicillin-susceptible Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) infection, clinical success was 83% (10 of 12), 75% (three of four) and 56% (five of nine), respectively. CONCLUSIONS Considering its spectrum of activity, ceftaroline could represent an important therapeutic option for SCAP. Further studies are needed to identify the precise clinical success rate against MRSA in a larger cohort of patients with SCAP.
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Affiliation(s)
- Matteo Bassetti
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Alessandro Russo
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Catia Cilloniz
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Antonio Vena
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Rosanel Amaro
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
| | - Elena Graziano
- Infectious Diseases Clinic, Department of Medicine, University of Udine and Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona, Spain
| | - Antoni Torres
- Department of Pneumology, Hospital Clinic of Barcelona; August Pi i Sunyer Biomedical Research Institute - IDIBAPS, University of Barcelona; Biomedical Research Networking Centers in Respiratory Diseases (Ciberes), Barcelona, Spain
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Abstract
Introduction: Community-acquired pneumonia (CAP) has the highest rate of mortality of all infectious diseases, especially among the elderly. Severe CAP (sCAP) is defined as a CAP in which intensive care management is required and is associated with an unfavorable clinical course. Areas covered: This review aims to identify prevention strategies for reducing the incidence of CAP and optimized management of sCAP. We highlight the main prevention approaches for CAP, focusing on the latest vaccination plans and on the influence of health-risk behaviors. Lastly, we report the latest recommendations about the optimal approach for sCAP when CAP has already been diagnosed, including prompt admission to ICU, early empirical antibiotic therapy, and optimization of antibiotic use. Expert opinion: Despite improvements in the diagnosis and treatment of sCAP, more efforts are needed to combat preventable causes, including the implementation and improvement of vaccine coverage, anti-tobacco campaigns and correct oral hygiene. Moreover, future research should aim to assess the benefits of early antimicrobial therapy in primary care. Pharmacokinetic studies in the target population may help clinicians to adjust dosage regimens in critically ill patients with CAP and thus reduce rates of treatment failure.
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Affiliation(s)
- Giacomo Tanzella
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Ana Motos
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
| | - Denise Battaglini
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Department of Surgical Sciences and Integrated Diagnostics (DISC), San Martino Policlinico Hospital , Genoa , Italy
| | - Andrea Meli
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,University of Milan , Milan , Italy
| | - Antoni Torres
- Division of Animal Experimentation, Department of Pulmonary and Critical Care Medicine, Hospital Clinic , Barcelona , Spain.,Centro de Investigación Biomédica en Red Enfermedades Respiratorias , Madrid , Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer , Barcelona , Spain.,Faculty of Medicine, University of Barcelona , Barcelona , Spain
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27
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Vidaur L, Totorika I, Montes M, Vicente D, Rello J, Cilla G. Human metapneumovirus as cause of severe community-acquired pneumonia in adults: insights from a ten-year molecular and epidemiological analysis. Ann Intensive Care 2019; 9:86. [PMID: 31342206 PMCID: PMC6656825 DOI: 10.1186/s13613-019-0559-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/16/2019] [Indexed: 12/17/2022] Open
Abstract
Background Information on the clinical, epidemiological and molecular characterization of human metapneumovirus in critically ill adult patients with severe community-acquired pneumonia (CAP) and the role of biomarkers identifying bacterial coinfection is scarce. Methods This is a retrospective epidemiological study of adult patients with hMPV severe CAP admitted to ICU during a ten-year period with admission PSI score ≥ 3. Results The 92.8% of the 28 patients with severe CAP due to human metapneumovirus were detected during the first half of the year. Median age was 62 years and 60.7% were male. The genotyping of isolated human metapneumovirus showed group B predominance (60.7%). All patients had acute respiratory failure. Median APACHE II and SOFA score were 13 and 6.55, respectively. The 25% were coinfected with Streptococcus pneumoniae. 60.7% of the patients had shock at admission and 50% underwent mechanical ventilation. Seven patients developed ARDS, three of them younger than 60 years and without comorbidities. Mortality in ICU was 14.3%. Among survivors, ICU and hospital stay were 6.5 and 14 days, respectively. Plasma levels of procalcitonin were higher in patients with bacterial coinfection (18.2 vs 0.54; p < 0.05). The levels of C-reactive protein, however, were similar. Conclusion Human metapneumovirus was associated with severe CAP requiring ICU admission among elderly patients or patients with comorbidities, but also in healthy young subjects. These patients often underwent mechanical ventilation with elevated health resource consumption. While one out of four patients showed pneumococcal coinfection, plasma procalcitonin helped to implement antimicrobial stewardship. Electronic supplementary material The online version of this article (10.1186/s13613-019-0559-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Loreto Vidaur
- Critical Care Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain. .,CIBERES, Institute of Health Carlos III, Madrid, Spain.
| | - Izarne Totorika
- Critical Care Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain
| | - Milagrosa Montes
- Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain
| | - Diego Vicente
- Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain.,Faculty of Medicine, University of Basque Country (UPV/EHU), San Sebastian, Guipuzcoa, Spain
| | - Jordi Rello
- CIBERES, Institute of Health Carlos III, Madrid, Spain.,Research Institute Vall d`Hebron University Hospital (VHIR), Barcelona, Spain
| | - Gustavo Cilla
- Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, San Sebastian, Guipuzcoa, Spain
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28
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Pereira JM, Laszczyńska O, Azevedo A, Basílio C, Sousa-Dias C, Mergulhão P, Paiva JA. Early prediction of treatment failure in severe community-acquired pneumonia: The PRoFeSs score. J Crit Care 2019; 53:38-45. [PMID: 31177029 DOI: 10.1016/j.jcrc.2019.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 05/17/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify a single/panel of biomarkers and to provide a point score that, after 48 h of treatment, could early predict treatment failure at fifth day of Intensive Care Unit (ICU) stay in severe community-acquired pneumonia (SCAP) patients. MATERIALS AND METHODS Single-center, prospective cohort study of 107 ICU patients with SCAP. Primary outcome included death or absence of improvement in Sequential Organ Failure Assessment score by ≥2 points within 5 days of treatment. Biomarkers were evaluated within 12 h of first antibiotic dose (D1) and 48 h after the first assessment (D3). RESULTS A model based on Charlson's score and a panel of biomarkers (procalcitonin on D1 and D3, B-natriuretic peptide on D1, D-dimer and lactate on D3) had good discrimination for primary outcome in both derivation (AUC 0.82) and validation (AUC 0.76) samples and was well calibrated (X2 = 0.98; df = 1; p = .32). A point score system (PRoFeSs score) built on the estimates of regression coefficients presented good discrimination (AUC 0.81; 95% Confidence Interval 0.72-0.89) for primary outcome. CONCLUSIONS In SCAP, a combination of biomarkers measured at admission and 48 h later may early predict treatment failure. PRoFeSs score may recognize patients with poor short-term prognosis.
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Affiliation(s)
- José Manuel Pereira
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
| | - Olga Laszczyńska
- EPIUnit - Institute of Public Health, University of Porto, Portugal
| | - Ana Azevedo
- EPIUnit - Institute of Public Health, University of Porto, Portugal; Hospital Epidemiology Centre, Centro Hospitalar São João EPE, Porto, Portugal; Department of Public Health and Forensic Sciences and Medical Education, University of Porto Medical School, Portugal.
| | - Carla Basílio
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - Conceição Sousa-Dias
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal
| | - Paulo Mergulhão
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - José Artur Paiva
- Emergency and Intensive Care Department, Centro Hospitalar São João EPE, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Torres A, Chalmers JD, Dela Cruz CS, Dominedò C, Kollef M, Martin-Loeches I, Niederman M, Wunderink RG. Challenges in severe community-acquired pneumonia: a point-of-view review. Intensive Care Med 2019; 45:159-171. [PMID: 30706119 PMCID: PMC7094947 DOI: 10.1007/s00134-019-05519-y] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/04/2019] [Indexed: 12/28/2022]
Abstract
Purpose Severe community-acquired pneumonia (SCAP) is still associated with substantial morbidity and mortality. In this point-of-view review paper, a group of experts discuss the main controversies in SCAP: the role of severity scores to guide patient settings of care and empiric antibiotic therapy; the emergence of pathogens outside the core microorganisms of CAP; viral SCAP; the best empirical treatment; septic shock as the most lethal complication; and the need for new antibiotics. Methods For all topics, the authors describe current controversies and evidence and provide recommendations and suggestions for future research. Evidence was based on meta-analyses, most recent RCTs and recent interventional or observational studies. Recommendations were reached by consensus of all the authors. Results and conclusions The IDSA/ATS criteria remain the most pragmatic tool to predict ICU admission. The authors recommend a combination of a beta-lactam/beta-lactamase inhibitor or a third G cephalosporin plus a macrolide in most SCAP patients, and to empirically cover PES (P. aeruginosa, extended spectrum beta-lactamase producing Enterobacteriaceae, methicillin-resistant S. aureus) pathogens when at least two specific risk factors are present. In patients with influenza CAP, the authors recommend the use of oseltamivir and avoidance of the use of steroids. Corticosteroids can be used in case of refractory shock and high systemic inflammatory response.
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Affiliation(s)
- Antoni Torres
- Department of Pulmonary Medicine, Hospital Clinic of Barcelona, C/Villarroel 170, 08036, Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute, IDIBAPS, University of Barcelona, Barcelona, Spain.
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), Barcelona, Spain.
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Charles S Dela Cruz
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine and Microbial Pathogenesis, Center of Pulmonary Infection Research and Treatment, Yale University School of Medicine, New Haven, CT, USA
| | - Cristina Dominedò
- Department of Anesthesiology and Intensive Care Medicine, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marin Kollef
- Division of Pulmonary and Critical Care Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Ignacio Martin-Loeches
- Biomedical Research Networking Centres in Respiratory Diseases (Ciberes), Barcelona, Spain
- St. James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Dublin, Ireland
| | - Michael Niederman
- Weill Cornell Medical College and New York Presbyterian/Weill Cornell Medical Center, New York City, USA
| | - Richard G Wunderink
- Pulmonary and Critical Care Division, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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30
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Karhu J, Ala-Kokko TI, Vuorinen T, Ohtonen P, Julkunen I, Syrjälä HT. Interleukin-5, interleukin-6, interferon induced protein-10, procalcitonin and C-reactive protein among mechanically ventilated severe community-acquired viral and bacterial pneumonia patients. Cytokine 2019; 113:272-276. [PMID: 30055898 PMCID: PMC7129555 DOI: 10.1016/j.cyto.2018.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/18/2018] [Accepted: 07/16/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND The serum cytokine levels among 45 mechanically ventilated, intensive care unit (ICU)-treated severe community-acquired pneumonia (SCAP) patients with known microbial etiology in three different etiology groups were assessed. METHODS Blood samples for C-reactive protein (CRP), procalcitonin (PCT), interleukin (IL)-5, IL-6, IL-10, human interferon gamma induced protein (IP)-10, and TNF-α (tumor necrosis factor alpha) were collected at time points 0, 12, 24, 48, 72 and 96 h after study inclusion. RESULTS There were 21 (43%) pure bacterial infections (bacterial group, BG), 5 (10%) pure viral infections (viral group, VG), and 19 (39%) mixed bacterial-viral infections (mixed group, MG) among 45 mechanically ventilated SCAP patients. CRP and PCT levels were significantly higher in the MG and values decreased with time in all groups. PCT differed also in time and group analysis (P = 0.001), the highest being in the MG. IL-5 levels were significantly higher in the VG compared to others (Ptime = 0.001, Pgroup = 0.051 and Ptimexgroup = 0.016). IL-6 and IP-10 levels decreased over time (Ptime = 0.003 and Ptime = 0.021), but there were no differences between groups. CONCLUSION SCAP patients with viral etiology have higher IL-5 levels. Patients with mixed viral and bacterial group have higher PCT compared to other etiologies.
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Affiliation(s)
- Jaana Karhu
- Department of Anaesthesiology, Division of Intensive Care, Oulu University Hospital, P.O. Box 21, FI-90029 OUH, Finland; Medical Research Center Oulu Research Group of Surgery, Anaesthesiology and Intensive Care, University of Oulu, Finland.
| | - Tero Ilmari Ala-Kokko
- Department of Anaesthesiology, Division of Intensive Care, Oulu University Hospital, P.O. Box 21, FI-90029 OUH, Finland; Medical Research Center Oulu Research Group of Surgery, Anaesthesiology and Intensive Care, University of Oulu, Finland
| | - Tytti Vuorinen
- Institute of Biomedicine/Virology, University of Turku, Kiinamyllynkatu 10 C 7, FI-20520 Turku, Finland
| | - Pasi Ohtonen
- Departments of Anaesthesiology and Surgery, Oulu University Hospital, P.O. Box 21, FI-90029 OUH, Finland; Medical Research Center Oulu Research Group of Surgery, Anaesthesiology and Intensive Care, University of Oulu, Finland
| | - Ilkka Julkunen
- Institute of Biomedicine/Virology, University of Turku, Kiinamyllynkatu 10 C 7, FI-20520 Turku, Finland
| | - Hannu Tapani Syrjälä
- Department of Infection Control, Oulu University Hospital, P.O. Box 21, FI-90029 OUH, Finland; Medical Research Center Oulu Research Group of Surgery, Anaesthesiology and Intensive Care, University of Oulu, Finland
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31
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Bedos JP, Varon E, Porcher R, Asfar P, Le Tulzo Y, Megarbane B, Mathonnet A, Dugard A, Veinstein A, Ouchenir K, Siami S, Reignier J, Galbois A, Cousson J, Preau S, Baldesi O, Rigaud JP, Souweine B, Misset B, Jacobs F, Dewavrin F, Mira JP. Host-pathogen interactions and prognosis of critically ill immunocompetent patients with pneumococcal pneumonia: the nationwide prospective observational STREPTOGENE study. Intensive Care Med 2018; 44:2162-2173. [PMID: 30456466 DOI: 10.1007/s00134-018-5444-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the relative importance of host and bacterial factors associated with hospital mortality in patients admitted to the intensive care unit (ICU) for pneumococcal community-acquired pneumonia (PCAP). METHODS Immunocompetent Caucasian ICU patients with PCAP documented by cultures and/or pneumococcal urinary antigen (UAg Sp) test were included in this multicenter prospective study between 2008 and 2012. All pneumococcal strains were serotyped. Logistic regression analyses were performed to identify risk factors for hospital mortality. RESULTS Of the 614 patients, 278 (45%) had septic shock, 270 (44%) had bacteremia, 307 (50%) required mechanical ventilation at admission, and 161 (26%) had a diagnosis based only on the UAg Sp test. No strains were penicillin-resistant, but 23% had decreased susceptibility. Of the 36 serotypes identified, 7 accounted for 72% of the isolates, with different distributions according to age. Although antibiotics were consistently appropriate and were started within 6 h after admission in 454 (74%) patients, 116 (18.9%) patients died. Independent predictors of hospital mortality in the adjusted analysis were platelets ≤ 100 × 109/L (OR, 7.7; 95% CI, 2.8-21.1), McCabe score ≥ 2 (4.58; 1.61-13), age > 65 years (2.92; 1.49-5.74), lactates > 4 mmol/L (2.41; 1.27-4.56), male gender and septic shock (2.23; 1.30-3.83 for each), invasive mechanical ventilation (1.78; 1-3.19), and bilateral pneumonia (1.59; 1.02-2.47). Women with platelets ≤ 100 × 109/L had the highest mortality risk (adjusted OR, 7.7; 2.8-21). CONCLUSIONS In critically ill patients with PCAP, age, gender, and organ failures at ICU admission were more strongly associated with hospital mortality than were comorbidities. Neither pneumococcal serotype nor antibiotic regimen was associated with hospital mortality.
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Affiliation(s)
- Jean-Pierre Bedos
- Réanimation Médico-Chirurgicale, Hôpital A. Mignot, CH Versailles, 177 Rue de Versailles, 78157, Le Chesnay, France.
| | - Emmanuelle Varon
- Laboratoire de Microbiologie, Centre National de Référence des Pneumocoques, AP-HP Hôpital Européen Georges-Pompidou, 75908, Paris Cedex 15, France.,Centre National de Référence des Pneumocoques, Centre Hospitalier Interrcommunal de Créteil, 94000, Créteil, France
| | - Raphael Porcher
- Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS-UMR1153), Inserm/Université Paris Descartes, Centre d'épidémiologie clinique, Centre Equator France, Hôpital Hôtel-Dieu, 75004, Paris, France
| | - Pierre Asfar
- CHU Angers, Réanimation Médicale, 49933, Angers Cedex 9, France
| | | | - Bruno Megarbane
- Hôpital Lariboisière, Réanimation Médicale et Toxicologique, 75010, Paris, France
| | - Armelle Mathonnet
- Hôpital de La Source, Réanimation Polyvalente, 45067, Orléans Cedex 2, France
| | - Anthony Dugard
- CHU Dupuytren, Réanimation Polyvalente, 87042, Limoges, France
| | - Anne Veinstein
- CHU Jean Bernard, Réanimation, 86021, Poitiers Cedex, France
| | - Kader Ouchenir
- Hôpital Louis Pasteur, Réanimation, 28018, Chartres Cedex, France
| | - Shidasp Siami
- CH Sud Essonne, Réanimation Polyvalente, 91152, Etampes Cedex 02, France
| | - Jean Reignier
- CHU Nantes, Réanimation Médicale, 44093, Nantes Cedex 1, France
| | - Arnaud Galbois
- Hôpital St Antoine, Réanimation Médicale, 75012, Paris, France
| | - Joël Cousson
- Hôpital Robert Debré, Réanimation Polyvalente, 51092, Reims Cedex, France
| | - Sébastien Preau
- Hôpital A. Calmette, Réanimation, 59037, Lille Cedex, France
| | - Olivier Baldesi
- CH du Pays d'Aix, Réanimation, 13616, Aix En Provence, France
| | | | - Bertrand Souweine
- CHU Gabriel Montpied, Réanimation Médicale, 63000, Clermont Ferrand, France
| | - Benoit Misset
- Hôpital Saint Joseph, Réanimation, 75014, Paris, France
| | - Frederic Jacobs
- Hôpital Antoine Béclère, Réanimation Médicale, 92140, Clamart, France
| | | | - Jean-Paul Mira
- Hôpital Cochin, Réanimation Médicale, 75679, Paris Cedex 14, France
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32
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Welte T, Dellinger RP, Ebelt H, Ferrer M, Opal SM, Singer M, Vincent JL, Werdan K, Martin-Loeches I, Almirall J, Artigas A, Ignacio Ayestarán J, Nuding S, Ferrer R, Sirgo Rodríguez G, Shankar-Hari M, Álvarez-Lerma F, Riessen R, Sirvent JM, Kluge S, Zacharowski K, Bonastre Mora J, Lapp H, Wöbker G, Achtzehn U, Brealey D, Kempa A, Sánchez García M, Brederlau J, Kochanek M, Reschreiter HP, Wise MP, Belohradsky BH, Bobenhausen I, Dälken B, Dubovy P, Langohr P, Mayer M, Schüttrumpf J, Wartenberg-Demand A, Wippermann U, Wolf D, Torres A. Efficacy and safety of trimodulin, a novel polyclonal antibody preparation, in patients with severe community-acquired pneumonia: a randomized, placebo-controlled, double-blind, multicenter, phase II trial (CIGMA study). Intensive Care Med 2018; 44:438-448. [PMID: 29632995 PMCID: PMC5924663 DOI: 10.1007/s00134-018-5143-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/17/2018] [Indexed: 01/05/2023]
Abstract
Purpose The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP). Methods In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L). Results Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58–78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline. Conclusions No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation. Trial registration: NCT01420744. Electronic supplementary material The online version of this article (10.1007/s00134-018-5143-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tobias Welte
- Department of Pneumology and German Center for Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - R Phillip Dellinger
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Health Care, Camden, NJ, USA
| | - Henning Ebelt
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Miguel Ferrer
- Department of Pneumology, Respiratory Institute, Hospital Clinic of Barcelona, IDIBAPS, CibeRes (CB06/06/0028), University of Barcelona, Barcelona, Spain
| | - Steven M Opal
- Infectious Disease Division, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Mervyn Singer
- Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
| | - Jean-Louis Vincent
- Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Karl Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO) Wellcome Trust - HRB Clinical Research Facility (CRF) at St. James's Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Critical Care Center, CIBER Enfermedades Respiratorias, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Jordi Almirall
- Unitat de Cures Intensives, Hospital de Mataró, Universitat Autónoma de Barcelona, Mataró, Barcelona, Spain
| | - Antonio Artigas
- Critical Care Center, CIBER Enfermedades Respiratorias, Corporació Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain
| | - Jose Ignacio Ayestarán
- Unidad de Cuidados Intensivos, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Sebastian Nuding
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | - Ricard Ferrer
- Hospital Universitario Mútua de Terrassa, SODIR-VHIR Research Group, Barcelona, Spain
| | - Gonzalo Sirgo Rodríguez
- Intensive Care Unit, Hospital Universitario Joan XXIII, Instituto de Investigación Sanitaria Pere Virgili, Rovira i Virgili University, Tarragona, Spain
| | - Manu Shankar-Hari
- Intensive Care Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Reimer Riessen
- Universitätsklinikum Tübingen, Internistische Intensivstation, Tübingen, Germany
| | - Josep-Maria Sirvent
- Servicio de Medicina Intensiva, Hospital U. Girona Dr. Josep Trueta, Avinguda França, Girona, Spain
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Kai Zacharowski
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - Juan Bonastre Mora
- Servicio de Cuidados Intensivos Adultos, Hospital Universitari y Politècnico La Fe, Valencia, Spain
| | - Harald Lapp
- 3 Medizinische Klinik, Kardiologie und Intensivmedizin, Helios Klinikum Erfurt, Erfurt, Germany
| | - Gabriele Wöbker
- Klinik für Intensivmedizin, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Ute Achtzehn
- Innere Medizin IV - Pneumologie, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - David Brealey
- Critical Care Unit, NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Axel Kempa
- Klinik für Allgemeine Innere Medizin, Katharinenhospital, Stuttgart, Germany
| | | | - Jörg Brederlau
- Helios Klinikum Berlin-Buch, Klinik für Intensivmedizin, Berlin, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Intensive Care Unit and Hemostasis, University Hospital of Cologne, Cologne, Germany
| | | | - Matthew P Wise
- Critical Care Unit, University Hospital of Wales, Heath Park, Cardiff, UK
| | - Bernd H Belohradsky
- University Children's Hospital Munich, Ludwig-Maximilians University Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | - Antoni Torres
- Servei de Pneumologia, Hospital Clínic, Universitat de Barcelona IDIBAPS, CIBERES, Barcelona, Spain
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Pereira JM, Gonçalves-Pereira J, Ribeiro O, Baptista JP, Froes F, Paiva JA. Impact of antibiotic therapy in severe community-acquired pneumonia: Data from the Infauci study. J Crit Care 2017; 43:183-189. [PMID: 28915392 DOI: 10.1016/j.jcrc.2017.08.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/23/2017] [Accepted: 08/31/2017] [Indexed: 11/17/2022]
Abstract
Antibiotic therapy (AT) is the cornerstone of the management of severe community-acquired pneumonia (CAP). However, the best treatment strategy is far from being established. To evaluate the impact of different aspects of AT on the outcome of critically ill patients with CAP, we performed a post hoc analysis of all CAP patients enrolled in a prospective, observational, multicentre study. Of the 502 patients included, 76% received combination therapy, mainly a β-lactam with a macrolide (80%). AT was inappropriate in 16% of all microbiologically documented CAP (n=177). Hospital and 6months mortality were 34% and 35%. In adjusted multivariate logistic regression analysis, combination AT with a macrolide was independently associated with a reduction in hospital (OR 0.17, 95%CI 0.06-0.51) and 6months (OR 0.21, 95%CI 0.07-0.57) mortality. Prolonged AT (>7days) was associated with a longer ICU (14 vs. 7days; p<0.001) and hospital length of stay (LOS) (25 vs. 17days; p<0.001). Combination AT with a macrolide may be the most suitable AT strategy to improve both short and long term outcome of severe CAP patients. AT >7days had no survival benefit and was associated with a longer LOS.
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Affiliation(s)
- J M Pereira
- Emergency and Intensive Care Department, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal; Grupo de Infecção e Sepsis, Portugal.
| | - J Gonçalves-Pereira
- Intensive Care Unit, Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal; Nova Medical School, Lisboa, Portugal
| | - O Ribeiro
- Department of Health Information and Decision Sciences, Center for Research in Health Technologies and Information Systems, CINTESIS, University of Porto Medical School, Porto, Portugal
| | - J P Baptista
- Intensive Care Service, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - F Froes
- Intensive Care Unit, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - J A Paiva
- Emergency and Intensive Care Department, Centro Hospitalar S. João, Porto, Portugal; Department of Medicine, University of Porto Medical School, Porto, Portugal; Grupo de Infecção e Sepsis, Portugal
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Wang X, Jiao J, Wei R, Feng Y, Ma X, Li Y, Du Y. A new method to predict hospital mortality in severe community acquired pneumonia. Eur J Intern Med 2017; 40:56-63. [PMID: 28320569 DOI: 10.1016/j.ejim.2017.02.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 02/16/2017] [Accepted: 02/18/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND & AIMS The aim of this study is to develop a new method that is able to accurately predict the 28day hospital mortality in patients with severe community acquired pneumonia (SCAP) at an early stage. METHODS We selected 37,348 SCAP patients in ICU from 173 hospitals during 2011.1-2013.12. The predictive factors for 28day hospital mortality were evaluated retrospectively. All cases underwent intensive care, blood routine, blood biochemical tests and arterial blood gas analysis. Under the Classification and Regression Tree (CART) analysis, a new clinical scoring system was developed for early prediction in SCAP patients. The receiver-operating characteristic (ROC) curve was plotted to calculate the area under the receiver operating characteristic curve (AUC). RESULTS A novel clinical model named CLCGH scoring system, including Serum creatinine (Cr) >259.5μmol/L, leukocyte (WBC)>17.35×109/L, C-reactive protein (CRP)>189.4μg/mL, GCS≤9 and serum HCO3-≤17.65mmol/L, was carried out and each index was an independent factor for hospital mortality in SCAP. In validation cohort, the AUC of the new scoring system was 0.889 for prediction of hospital mortality, which was similar to SOFA score 0.877, APACHEII score 0.864, and was better than the PSI score 0.761 and CURB-65 score 0.767. CONCLUSIONS The new scoring system CLCGH is an efficient, accurate and objective method to predicate the early hospital mortality among SCAP patients.
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Affiliation(s)
- Xin Wang
- Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, China; Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China; Department of General Surgery, The Fourth Center Hospital, Tianjin, China; Center for Pulmonary Disease, Division of ICU, The Fourth Center Hospital, Tianjin, China
| | - Jianlong Jiao
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Rongwei Wei
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Yongli Feng
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Xiuqin Ma
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Yuan Li
- Department of General Surgery, The Fourth Center Hospital, Tianjin, China
| | - Yue Du
- Department of Public Health, Tianjin Medical University, Tianjin, China; Center of Evidence-based Medicine, Department of statistics and epidemiology, College of Public Health, Tianjin Medical University, China.
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Abstract
Severe legionella pneumonia poses a diagnostic challenge and requires early intervention. Legionnaire's disease can have several presenting signs, symptoms, and laboratory abnormalities that suggest that Legionella pneumophila is the pathogen, but none of these are sufficient to distinguish L pneumophila pneumonia from other respiratory pathogens. L pneumophila is primarily an intracellular pathogen and needs treatment with antibiotics that efficiently enter the intracellular space.
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Affiliation(s)
- Abdullah Chahin
- Critical Care Division, Miriam Hospital, Brown University Alpert School of Medicine, Providence, RI, USA; Infectious Disease Division, Rhode Island Hospital, Brown University Alpert School of Medicine, Providence, RI, USA.
| | - Steven M Opal
- Critical Care Division, Miriam Hospital, Brown University Alpert School of Medicine, Providence, RI, USA; Infectious Disease Division, Rhode Island Hospital, Brown University Alpert School of Medicine, Providence, RI, USA
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Li HY, Guo Q, Song WD, Zhou YP, Li M, Chen XK, Liu H, Peng HL, Yu HQ, Chen X, Liu N, Lü ZD, Liang LH, Zhao QZ, Jiang M. Mortality among severe community-acquired pneumonia patients depends on combinations of 2007 IDSA/ATS minor criteria. Int J Infect Dis 2015; 38:141-5. [PMID: 26255891 DOI: 10.1016/j.ijid.2015.07.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/23/2015] [Accepted: 07/30/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The individual 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is not clear whether the combinations of predictive findings might imply diverse severities or different mortalities. METHODS A prospective two centre cohort study was performed of 385 severe CAP patients fulfilling three or more IDSA/ATS minor criteria amongst 1430 patients. RESULTS Hospital mortality rose sharply from 5.7%, 9.9%, and 16.5%, respectively, for patients with none of three predictive findings most strongly associated to mortality (PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia), one of those, and two of those to 38.6% for patients with all those (p<0.001). The number of three predictive findings present had a significantly increased odds ratio for mortality of 2.796 (p<0.001), and had the degree of positive association with sequential organ failure assessment scores at 72hours, incurring significantly longer hospital stay and higher costs. CONCLUSIONS Different combinations of 2007 IDSA/ATS minor criteria for severe CAP were associated to diverse severities and different mortalities. The combination of PaO2/FiO2 ≤ 250mm Hg, confusion and uraemia predicted more severity and higher mortality compared with others.
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Affiliation(s)
- Hai-yan Li
- Department of Primary Care, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Qi Guo
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033.
| | - Wei-dong Song
- Department of Respiratory Medicine, Affiliated Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China, 518036
| | - Yi-ping Zhou
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Ming Li
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Xiao-ke Chen
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Hui Liu
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Hong-lin Peng
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Hai-qiong Yu
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Xia Chen
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Nian Liu
- Department of Respiratory Medicine, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Zhong-dong Lü
- Department of Respiratory Medicine, Affiliated Shenzhen Hospital, Peking University, Shenzhen, Guangdong, China, 518036
| | - Li-hua Liang
- Department of Radiology, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Qing-zhou Zhao
- Department of Radiology, Affiliated Futian Hospital, Guangdong Medical College, Shenzhen, Guangdong, China, 518033
| | - Mei Jiang
- Guangzhou Institute of Respiratory Diseases (State Key Laboratory of Respiratory Diseases), First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China, 510120
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Fekih Hassen M, Ben Haj Khalifa A, Tilouche N, Ben Sik Ali H, Ayed S, Kheder M, Elatrous S. [ Severe community-acquired pneumonia admitted at the intensive care unit: main clinical and bacteriological features and prognostic factors: a Tunisian experience]. Rev Pneumol Clin 2014; 70:253-259. [PMID: 24874404 DOI: 10.1016/j.pneumo.2014.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 03/11/2014] [Accepted: 03/15/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Severe community-acquired pneumonia (SCAP) remains a major cause of death. The aim of this study was to describe the main clinical and bacteriological features and to determine predictive factors for death in patients with SCAP who were admitted in intensive care unit (ICU) in a Tunisian setting. METHOD It is a retrospective study conducted between March 2005 and December 2010 at the intensive care unit of the University Hospital of Mahdia (Tunisia). All patients hospitalized at the ICU with a SCAP diagnosis according to the American Thoracic Society criteria were included. RESULTS Two hundred and nine patients (mean age: 64±16 years, and mean SAPS II: 42±17) were included. Overall, 24% had a bacteriological diagnosis. Streptococcus pneumoniae was the most frequently detected. Use of mechanical ventilation was required in 57% of patients and 45% experimented septic shock upon admission. The mortality rate at ICU was 29% (n=60). In multivariate analysis, a septic shock at admission and the use of mechanical ventilation were both associated with death. CONCLUSION SCAP were associated with high mortality in the ICU.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/therapeutic use
- Community-Acquired Infections/diagnosis
- Community-Acquired Infections/microbiology
- Community-Acquired Infections/mortality
- Community-Acquired Infections/therapy
- Drug Resistance, Bacterial
- Female
- Hospital Mortality
- Hospitals, University
- Humans
- Intensive Care Units
- Male
- Middle Aged
- Pneumonia, Bacterial/diagnosis
- Pneumonia, Bacterial/microbiology
- Pneumonia, Bacterial/mortality
- Pneumonia, Bacterial/therapy
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/mortality
- Pneumonia, Pneumococcal/therapy
- Prognosis
- Respiration, Artificial
- Retrospective Studies
- Shock, Septic/diagnosis
- Shock, Septic/microbiology
- Shock, Septic/therapy
- Tunisia
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Affiliation(s)
- M Fekih Hassen
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - A Ben Haj Khalifa
- Laboratoire de microbiologie, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie.
| | - N Tilouche
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - H Ben Sik Ali
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - S Ayed
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
| | - M Kheder
- Laboratoire de microbiologie, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie
| | - S Elatrous
- Service de réanimation médicale, CHU Tahar-Sfar de Mahdia, Mahdia 5100, Tunisie; Laboratoire de recherche LR12SP15, Mahdia, Tunisie
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Ishida T, Tachibana H, Ito A, Tanaka M, Tokioka F, Furuta K, Nishiyama A, Ikeda S, Niwa T, Yoshioka H, Arita M, Hashimoto T. Clinical characteristics of severe community-acquired pneumonia among younger patients: an analysis of 18 years at a community hospital. J Infect Chemother 2014; 20:471-6. [PMID: 24951291 DOI: 10.1016/j.jiac.2014.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/21/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
Unlike elderly patients with community-acquired pneumonia whose outcomes are markedly affected by their background characteristics, it appears that the severity of the infection itself contributes to outcomes in younger patients with community-acquired pneumonia. In order to identify clinical characteristics of severe community-acquired pneumonia in younger patients under 60 years old, among such cases prospectively collected at our hospital over a period of 18 years, those meeting the criteria for severe community-acquired pneumonia, as defined in the Infectious Diseases Society of America/American Thoracic Society Guidelines for community-acquired pneumonia, were retrospectively examined and compared to elderly patients with severe community-acquired pneumonia. Younger patients with severe pneumonia accounted for 12.9% of younger hospitalized patients. Although the incidence of severe pneumonia in younger patients was lower than that in elderly patients, its severity may be underestimated by severity assessment based on the conventional guidelines. Thus, attention is required. While Streptococcus pneumoniae and Legionella species were important causative pathogens, atypical pathogens and viruses were also frequently detected. There were only 11 deaths over a period of 18 years. Based on multivariate analysis, the risk factors for aggravation of community-acquired pneumonia among younger patients were age 50 years or older, diabetes mellitus, chronic liver disease, and Legionella pneumonia. Although the mortality rate from community-acquired pneumonia is extremely low in previously healthy younger patients, outcomes might be poor for patients with underlying diseases and those with rapid progression. Multimodal treatments including respiratory management may be appropriate.
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Affiliation(s)
- Tadashi Ishida
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Hiromasa Tachibana
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akihiro Ito
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Maki Tanaka
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Fumiaki Tokioka
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kenjiro Furuta
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Akihiro Nishiyama
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Satoshi Ikeda
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takashi Niwa
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroshige Yoshioka
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Machiko Arita
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Toru Hashimoto
- Dept. of Respiratory Medicine, Kurashiki Central Hospital, Kurashiki, Japan
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