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Magali P, Sophie M, Arnaud B, Pol L, Den Bulcke Julie V, Jonathan B. Retrospective study on the health and economic burden of hospitalized patients due to pneumonia and invasive pneumococcal infections in Belgium settings. Vaccine 2024; 42:3018-3023. [PMID: 38575434 DOI: 10.1016/j.vaccine.2024.03.057] [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: 08/15/2023] [Revised: 02/25/2024] [Accepted: 03/21/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION pneumococcal infections are associated with high morbidity, hospitalisation and mortality. The objective of this study was to investigate the health and economic burden of all-cause pneumonia and invasive pneumococcal disease in Belgian hospital settings, by patient's age and risk profile. METHODS This descriptive retrospective study was conducted in 17 Belgian hospitals. Univariate and multivariate logistic linear regression models were performed. The Health Insurance and patient's cost perspectives were considered because a few studies report these costs. RESULTS The analysis has included 4,712 hospital admissions over the year 2018. Median hospitalization costs were higher for invasive pneumococcal infection diagnosis than for all-cause pneumonia (p < 0,001), respectively 4,051€ and 3,362€. Other factors associated with higher hospitalization cost were patient's high-risk profile, admission to emergency unit, transfer from nursing home, admission to intensive care unit and length of stay. CONCLUSION Streptococcus pneumoniae infections remain a public health problem with significant cost for the Health Insurance and poor prognosis. Invasive pneumococcal infections are associated with longer hospital stays and required more intensive care than all other causes of pneumonia, in addition to be more costly, which justifies more attention for vaccination. This study also suggests an increase of economic and health burden with age and presence of underlying conditions.
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Affiliation(s)
- Pirson Magali
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Marbaix Sophie
- Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
| | - Bruyneel Arnaud
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Leclercq Pol
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Van Den Bulcke Julie
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | - Brauner Jonathan
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium; Laboratory Medecine, Epicura, Baudour, Belgium.
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2
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Zhao R, Jiang S, Ren S, Yang L, Han W, Guo Z, Gu J. A novel phage putative depolymerase, Depo16, has specific activity against K1 capsular-type Klebsiella pneumoniae. Appl Environ Microbiol 2024; 90:e0119723. [PMID: 38551353 PMCID: PMC11022553 DOI: 10.1128/aem.01197-23] [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: 07/11/2023] [Accepted: 03/10/2024] [Indexed: 04/18/2024] Open
Abstract
Klebsiella pneumoniae, especially hypervirulent K. pneumoniae (hvKP), is a common opportunistic pathogen that often causes hospital- and community-acquired infections. Capsular polysaccharide (CPS) is an important virulence factor of K. pneumoniae. Some phages encode depolymerases that can recognize and degrade bacterial polysaccharides. In this study, the lytic bacteriophage vB_KpnP_ZK1 (abbreviated as ZK1) was isolated using serotype K1 hvKP as the host. Although amino acid sequence BLAST analysis indicated that the tail fiber protein Depo16 of phage ZK1 showed no significant similarity to any reported phage depolymerases, it displayed enzymatic activities that are characteristic of phage depolymerases. After expression and purification, Depo16 could efficiently remove the capsular polysaccharide layer that surrounds the surface of serotype K1 K. pneumoniae. Although no bactericidal activity was detected, Depo16 makes serotype K1 K. pneumoniae sensitive to peritoneal macrophages (PMs). In addition, in a mouse bacteremia model of serotype K1 K. pneumoniae, 25 µg of Depo16 was effective in significantly prolonging survival. Depo16 treatment can reduce the bacterial load in blood and major tissues and alleviate tissue damage in mice. This indicates that the putative depolymerase Depo16 is a potential antibacterial agent against serotype K1 K. pneumoniae infections.IMPORTANCEKlebsiella pneumoniae often causes hospital-acquired infections and community-acquired infections. Capsular polysaccharide (CPS) is one of the crucial virulence factors of K. pneumoniae. K1 and K2 capsular-type K. pneumoniae strains are the most prevalent serotypes of hypervirulent K. pneumoniae (hvKP). In this study, a novel K. pneumoniae phage named vB_KpnP_ZK1 was isolated, and its putative depolymerase Depo16 showed low homology with other reported phage depolymerases. Depo16 can specifically degrade the K. pneumoniae K1 capsule making this serotype sensitive to peritoneal macrophages. More importantly, Depo16 showed a significant therapeutic effect in a mouse bacteremia model caused by serotype K1 K. pneumoniae. Thus, Depo16 is a potential antibacterial agent to combat serotype K1 K. pneumoniae infections.
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Affiliation(s)
- Rihong Zhao
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China
| | - Shanshan Jiang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China
| | - Siyu Ren
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China
| | - Li Yang
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China
| | - Wenyu Han
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China
| | - Zhimin Guo
- Clinical Laboratory Department, Infectious Diseases and Pathogen Biology Center, First Hospital of Jilin University, Changchun, China
| | - Jingmin Gu
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, Institute of Zoonosis, and College of Veterinary Medicine, Jilin University, Changchun, China
- Jiangsu Co-Innovation Center for the Prevention and Control of Important Animal Infectious Diseases and Zoonoses, Yangzhou University, Yangzhou, China
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3
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Chouchane O, Schuurman AR, Reijnders TDY, Peters-Sengers H, Butler JM, Uhel F, Schultz MJ, Bonten MJ, Cremer OL, Calfee CS, Matthay MA, Langley RJ, Alipanah-Lechner N, Kingsmore SF, Rogers A, van Weeghel M, Vaz FM, van der Poll T. The Plasma Lipidomic Landscape in Patients with Sepsis due to Community-acquired Pneumonia. Am J Respir Crit Care Med 2024; 209:973-986. [PMID: 38240721 DOI: 10.1164/rccm.202308-1321oc] [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: 08/01/2023] [Accepted: 01/18/2024] [Indexed: 04/16/2024] Open
Abstract
Rationale: The plasma lipidome has the potential to reflect many facets of the host status during severe infection. Previous work is limited to specific lipid groups or was focused on lipids as prognosticators.Objectives: To map the plasma lipidome during sepsis due to community-acquired pneumonia (CAP) and determine the disease specificity and associations with clinical features.Methods: We analyzed 1,833 lipid species across 33 classes in 169 patients admitted to the ICU with sepsis due to CAP, 51 noninfected ICU patients, and 48 outpatient controls. In a paired analysis, we reanalyzed patients still in the ICU 4 days after admission (n = 82).Measurements and Main Results: A total of 58% of plasma lipids were significantly lower in patients with CAP-attributable sepsis compared with outpatient controls (6% higher, 36% not different). We found strong lipid class-specific associations with disease severity, validated across two external cohorts, and inflammatory biomarkers, in which triacylglycerols, cholesterol esters, and lysophospholipids exhibited the strongest associations. A total of 36% of lipids increased over time, and stratification by survival revealed diverging lipid recovery, which was confirmed in an external cohort; specifically, a 10% increase in cholesterol ester levels was related to a lower odds ratio (0.84; P = 0.006) for 30-day mortality (absolute mortality, 18 of 82). Comparison with noninfected ICU patients delineated a substantial common illness response (57.5%) and a distinct lipidomic signal for patients with CAP-attributable sepsis (37%).Conclusions: Patients with sepsis due to CAP exhibit a time-dependent and partially disease-specific shift in their plasma lipidome that correlates with disease severity and systemic inflammation and is associated with higher mortality.
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Affiliation(s)
| | | | | | | | | | - Fabrice Uhel
- Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche S1151, Centre National de la Recherche Scientifique Unité Mixte de Recherche S8253, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France
- Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, Hôpital Louis Mourier, DMU ESPRIT, Colombes, France
| | - Marcus J Schultz
- Department of Intensive Care Medicine
- Laboratory of Experimental Intensive Care and Anesthesiology
- Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Marc J Bonten
- Department of Medical Microbiology
- Julius Center for Health Sciences and Primary Care, and
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carolyn S Calfee
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
| | - Michael A Matthay
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California, San Francisco, California
| | - Raymond J Langley
- Department of Pharmacology, University of South Alabama College of Medicine, Mobile, Alabama
| | | | - Stephen F Kingsmore
- Rady Children's Institute for Genomic Medicine, Rady Children's Hospital, San Diego, California
| | - Angela Rogers
- Division of Pulmonary and Critical Care, Department of Medicine, Stanford, California; and
| | - Michel van Weeghel
- Department of Clinical Chemistry and Pediatrics, Laboratory Genetic Metabolic Diseases, Emma Children's Hospital
- Core Facility Metabolomics, and
- Inborn Errors of Metabolism Program, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers-Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frédéric M Vaz
- Department of Clinical Chemistry and Pediatrics, Laboratory Genetic Metabolic Diseases, Emma Children's Hospital
- Core Facility Metabolomics, and
- Inborn Errors of Metabolism Program, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Centers-Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine
- Division of Infectious Diseases
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4
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Kim S, Kim MJ, Myong JP, Lee YH, Kim BY, Hwang A, Kim GO, Jeong SH, Yoon HK, An TJ, Lim JU. Prior pneumococcal vaccination improves in-hospital mortality among elderly population hospitalized due to community-acquired pneumonia. BMC Pulm Med 2024; 24:168. [PMID: 38589839 PMCID: PMC11000283 DOI: 10.1186/s12890-024-02928-8] [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: 12/03/2023] [Accepted: 02/22/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Pneumococcal vaccination is a preventive method to reduce pneumonia related mortality. However, real-world data on efficacy of the pneumococcal vaccine in reducing mortality is lacking, especially in elderly patients. This study was conducted to assess the effects of prior pneumococcal vaccination in elderly pneumonia patients. METHODS The data was procured from the Health Insurance Review and Assessment and Quality Assessment database. Hospitalized patients who met the criteria of community-acquired pneumonia (CAP) were included and they were grouped according to vaccination state. Patients were aged ≥ 65 years and treated with beta-lactam, quinolone, or macrolide. Patients were excluded when treatment outcomes were unknown. RESULTS A total of 4515 patients were evaluated, and 1609 (35.6%) of them were vaccinated prior to hospitalization. Mean age was 77.0 [71.0;82.0], 54.2% of them were male, and mean Charlson comorbidity index (CCI) was 3.0. The patients in the vaccinated group were younger than those in the unvaccinated group (76.0 vs. 78.0 years; P < 0.001), and showed higher in-hospital improvement (97.6 vs. 95.0%; P < 0.001) and lower 30-day mortality (2.6 vs. 5.3%; P < 0.001). After adjusting confounding factors such as age, gender, CURB score and CCI score, the vaccinated group demonstrated a significant reduction in 30-day mortality (hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.41-0.81; P < 0.01) and in-hospital mortality (HR 0.53, 95% CI0.37-0.78; P < 0.001) compared to the unvaccinated group in multivariate analysis. Vaccinated group showed better 30-day survival than those in non-vaccinated group (log-rank test < 0.05). CONCLUSIONS Among elderly hospitalized CAP patients, prior pneumococcal vaccination was associated with improved in-hospital mortality and 30-day mortality.
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Affiliation(s)
- Seohyun Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Moon Jin Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Pyo Myong
- Department of Occupational and Environmental Medicine, Seoul St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun-Hee Lee
- Department of Urology, Seoul St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bo Yeon Kim
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service , Wonju, Korea
| | - Ahyoung Hwang
- Quality Assessment Department, Health Insurance Review and Assessment Service , Wonju, Korea
| | - Gui Ok Kim
- Quality Assessment Administration Department, Health Insurance Review and Assessment Service , Wonju, Korea
| | - Sung Hwan Jeong
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service , Wonju, Korea
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tai Joon An
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| | - Jeong Uk Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal medicine, Yeouido St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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5
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Decker F. Utilisation des macrolides dans la pneumonie acquise en communauté. Rev Med Suisse 2024; 20:727. [PMID: 38568069 DOI: 10.53738/revmed.2024.20.868.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Affiliation(s)
- Félix Decker
- Avec la collaboration du groupe MIAjour, Service de médecine interne, Centre hospitalier universitaire vaudois, Lausanne
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6
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Doeleman SE, Reijnders TDY, Joosten SCM, Schuurman AR, van Engelen TSR, Verhoeff J, Léopold V, Brands X, Haak BW, Prins JM, Kanglie MMNP, van den Berk IAH, Faber DR, Douma RA, Stoker J, Saris A, Garcia Vallejo JJ, Wiersinga WJ, van der Poll T. Lymphopenia is associated with broad host response aberrations in community-acquired pneumonia. J Infect 2024; 88:106131. [PMID: 38431153 DOI: 10.1016/j.jinf.2024.106131] [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: 12/16/2023] [Revised: 02/16/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Lymphopenia at hospital admission occurs in over one-third of patients with community-acquired pneumonia (CAP), yet its clinical relevance and pathophysiological implications remain underexplored. We evaluated outcomes and immune features of patients with lymphopenic CAP (L-CAP), a previously described immunophenotype characterized by admission lymphocyte count <0.724 × 109 cells/L. METHODS Observational study in 149 patients admitted to a general ward for CAP. We measured 34 plasma biomarkers reflective of inflammation, endothelial cell responses, coagulation, and immune checkpoints. We characterized lymphocyte phenotypes in 29 patients using spectral flow cytometry. RESULTS L-CAP occurred in 45 patients (30.2%) and was associated with prolonged time-to-clinical-stability (median 5 versus 3 days), also when we accounted for competing events for reaching clinical stability and adjusted for baseline covariates (subdistribution hazard ratio 0.63; 95% confidence interval 0.45-0.88). L-CAP patients demonstrated a proportional depletion of CD4 T follicular helper cells, CD4 T effector memory cells, naïve CD8 T cells and IgG+ B cells. Plasma biomarker analyses indicated increased activation of the cytokine network and the vascular endothelium in L-CAP. CONCLUSIONS L-CAP patients have a protracted clinical recovery course and a more broadly dysregulated host response. These findings highlight the prognostic and pathophysiological relevance of admission lymphopenia in patients with CAP.
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Affiliation(s)
- Susanne E Doeleman
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Tom D Y Reijnders
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Sebastiaan C M Joosten
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Alex R Schuurman
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Tjitske S R van Engelen
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan Verhoeff
- Department of Molecular Cell Biology & Immunology, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan, 1117 Amsterdam, the Netherlands
| | - Valentine Léopold
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Xanthe Brands
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Bastiaan W Haak
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jan M Prins
- Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maadrika M N P Kanglie
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Department of Radiology, Spaarne Gasthuis, Haarlem and Hoofddorp, the Netherlands
| | - Inge A H van den Berk
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Daniël R Faber
- Department of Internal Medicine, BovenIJ Hospital, Amsterdam, the Netherlands
| | - Renée A Douma
- Department of Internal Medicine, Flevo Hospital, Almere, the Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anno Saris
- Infectious Disease, Leiden Universitair Medisch Centrum, Leiden, the Netherlands
| | - Juan J Garcia Vallejo
- Department of Molecular Cell Biology & Immunology, Amsterdam UMC location Vrije Universiteit Amsterdam, Boelelaan, 1117 Amsterdam, the Netherlands
| | - W Joost Wiersinga
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
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Gu M, Lv S, Song Y, Wang H, Zhang X, Liu J, Liu D, Han X, Liu X. Predictive Value of Lysophosphatidylcholine for Determining the Disease Severity and Prognosis of Elderly Patients with Community-Acquired Pneumonia. Clin Interv Aging 2024; 19:517-527. [PMID: 38528884 PMCID: PMC10961246 DOI: 10.2147/cia.s454239] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
Purpose To investigate the clinical value of serum lysophosphatidylcholine (LPC) as a predictive biomarker for determining disease severity and mortality risk in hospitalized elderly patients with community-acquired pneumonia (CAP). Methods This prospective, single-center study enrolled 208 elderly patients, including 67 patients with severe CAP (SCAP) and 141 with non-SCAP between November 1st, 2020, and November 30th, 2021 at the Qingdao Municipal Hospital, Shandong Province, China. The demographic and clinical parameters were recorded for all the included patients. Serum LPC levels were measured on day 1 and 6 after admission using ELISA. Propensity score matching (PSM) was used to balance the baseline variables between SCAP and non-SCAP patient groups. Receiver operative characteristic (ROC) curve analysis was used to compare the predictive performances of LPC and other clinical parameters in discriminating between SCAP and non-SCAP patients and determining the 30-day mortality risk of the hospitalized CAP patients. Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with SCAP. Cox proportional hazard regression analysis was used to determine if serum LPC was an independent risk factor for the 30-day mortality of CAP patients. Results The serum LPC levels at admission were significantly higher in the non-SCAP patients than in the SCAP patients (P = 0.011). Serum LPC level <24.36 ng/mL, and PSI score were independent risk factors for the 30-day mortality in the elderly patients with CAP. The risk of 30-day mortality in the elderly CAP patients with low serum LPC levels (< 24.36ng/mL) was >5-fold higher than in the patients with high serum LPC levels (≥ 24.36ng/mL). Conclusion Low serum LPC levels were associated with significantly higher disease severity and 30-day mortality in the elderly patients with CAP. Therefore, serum LPC is a promising predictive biomarker for the early identification of elderly CAP patients with poor prognosis.
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Affiliation(s)
- Minghao Gu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
- School of Medicine, Qingdao University, Qingdao, 266071, People’s Republic of China
| | - SenSen Lv
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
| | - Yihui Song
- Department of Neurology, Weihai Municipal Hospital, Weihai, 264200, People’s Republic of China
| | - Hong Wang
- Hospital-Acquired Infection Control Department, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
| | - Xingyu Zhang
- Human Resources Department, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
| | - Jing Liu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
| | - Deshun Liu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
| | - Xiudi Han
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
| | - Xuedong Liu
- Department of Respiratory and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, 266011, People’s Republic of China
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Odeyemi YE, Lal A, Barreto EF, LeMahieu AM, Yadav H, Gajic O, Schulte P. Early machine learning prediction of hospitalized patients at low risk of respiratory deterioration or mortality in community-acquired pneumonia: Derivation and validation of a multivariable model. Biomol Biomed 2024; 24:337-345. [PMID: 37795970 PMCID: PMC10950343 DOI: 10.17305/bb.2023.9754] [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] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/26/2023] [Accepted: 10/04/2023] [Indexed: 10/06/2023]
Abstract
Current prognostic tools for pneumonia predominantly focus on mortality, often neglecting other crucial outcomes such as the need for advanced respiratory support. The objective of this study was to develop and validate a tool that predicts the early risk of non-occurrence of respiratory deterioration or mortality. We conducted a single-center, retrospective cohort study involving hospitalized adult patients with community-acquired pneumonia (CAP) and acute hypoxic respiratory failure from January 2009 to December 2019 (n = 4379). We employed the gradient boosting machine (GBM) learning to create a model that estimates the likelihood of patients requiring advanced respiratory support (high flow nasal cannula [HFNC], non-invasive mechanical ventilation [NIMV], and invasive mechanical ventilation [IMV]) or facing mortality during hospitalization. This model utilized readily available data including demographic, physiologic, and laboratory data, sourced from electronic health records and obtained within the first six hours of admission. Out of the cohort, 890 patients (25.2%) either required advanced respiratory support or died during their hospital stay. Our predictive model displayed superior discrimination and higher sensitivity (cross-validation C-statistic = 0.71; specificity = 0.56; sensitivity = 0.72) compared to the pneumonia severity index (PSI) (C-statistic = 0.65; specificity = 0.91; sensitivity = 0.24; P value < 0.001), while maintaining a negative predictive value (NPV) of approximately 0.85. These data demonstrate that our machine learning model predicted the non-occurrence of respiratory deterioration or mortality among hospitalized CAP patients more accurately than the PSI. The enhanced sensitivity of this model holds potential for reliably excluding low-risk patients from pneumonia clinical trials.
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Affiliation(s)
- Yewande E Odeyemi
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Amos Lal
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Erin F Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN, United States
| | - Allison M LeMahieu
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
| | - Hemang Yadav
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Phillip Schulte
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN, United States
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9
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Tang F, Hou XF, Cheng Y, Liu Y, Sun J, Liu HY, Lv LP, Fu L. Longitudinal associations between serum IL-34 with severity and prognosis in community-acquired pneumonia patients. Respir Investig 2024; 62:223-230. [PMID: 38218098 DOI: 10.1016/j.resinv.2023.12.008] [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: 07/03/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Interleukin-34 (IL-34) is a hematopoietic cytokine and a ligand of colony-stimulating factor 1 receptor (CSF-1R). Numerous studies have demonstrated that IL-34 is involved in several inflammatory diseases. Nevertheless, the role of IL-34 is obscure in community-acquired pneumonia (CAP) patients. This research aimed to assess the associations of serum IL-34 with severity and prognosis in CAP patients through a longitudinal study. METHODS CAP patients and healthy volunteers were recruited. Peripheral blood samples were collected. Serum IL-34 and inflammatory cytokines were tested by enzyme linked immunosorbent assay (ELISA). Demographic characteristics and clinical information were acquired through electronic medical records. RESULTS Serum IL-34 was elevated in CAP patients compared with healthy volunteers. The content of serum IL-34 was gradually upregulated with increased CAP severity scores. Mixed logistic and linear regression models suggested that serum IL-34 elevation was associated with increased PSI and SMART-COP scores. Correlative analysis found that serum IL-34 was positively correlated with inflammatory cytokines among CAP patients. A longitudinal study indicated that higher serum IL-34 at admission elevated the risks of mechanical ventilation and death during hospitalization. Serum IL-34 had a higher predictive capacity for death than CAP severity scores. CONCLUSION There are prominently positive dose-response associations between serum IL-34 at admission with the severity and poor prognosis, suggesting that IL-34 is implicated in the occurrence and development of CAP. Serum IL-34 may serve as a biomarker to forecast disease progression and poor prognosis in CAP patients.
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Affiliation(s)
- Fei Tang
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui, 230022, China
| | - Xue-Feng Hou
- School of Pharmacy, Drug Research & Development Center, Wannan Medical College, Wuhu, Anhui, 241002, China
| | - Yu Cheng
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui, 230022, China
| | - Ying Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
| | - Jing Sun
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China
| | - Hong-Yan Liu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China; Institute of Respiratory Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China.
| | - Li-Ping Lv
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, Anhui, 230022, China.
| | - Lin Fu
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China; Institute of Respiratory Diseases, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, China.
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10
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Kwas H, Fehri Majdoub S. [Predictive factors of severity and mortality in acute community-acquired pneumonia : results of a monocentric study in Tunisia]. Rev Med Liege 2024; 79:161-167. [PMID: 38487910] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Community-acquired pneumonia (CAP), a frequent reason for hospitalization in pulmonology, is a major cause of morbidity and mortality in adults. METHODS It is a retrospective, descriptive and analytical study including patients hospitalized for CAP. We studied the predictors of NIV, ICU transfer and hospital mortality. RESULTS we included 50 patients (mean age: 56.3 ± 12.8 years). Predictive factors of NIV were PaCO2 ≥ 45 mmHg [Odds Ratio (OR): 15.45, 95 % Confidence Interval (IC): 1.29-184.7], pH ≤ 7.35 (OR: 6.42;1.72-23.9), Fine ≥ 57.5 (OR: 17.36;4.32-693.9) and CURB-65 ≥ 2 (OR: 13.54;1.73-105.7). Taking antibiotics before hospitalization (OR: 1.92;1.08-3.49), PaO2 ≤ 60 mmHg (OR: 4.15;1.27-13.60), Fine score ≥ 100 (OR: 13.54;1.73-105.7) and CURB-65 ≥ 2 (OR: 7.50;1.44-36.9) were associated with the admission in the ICU. PH ≤ 7.35 (OR: 6.39;1.77-23.2) and Fine score ≥ 100 (OR: 8.86;3.33-25.2) were correlated with mortality. CONCLUSION Arterial pH ≤ 7.35, hypoxemia, hypercapnia, CURB-65 ≥ 2, Fine ≥ 100 and taking antibiotics before hospitalization are predictive factors of a poor prognosis of CAP.
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Affiliation(s)
- Hamida Kwas
- Service de Pneumologie. Université de Sfax, Faculté de Médecine de Sfax. Hôpital universitaire de Gabès, Tunisie
| | - Sabrine Fehri Majdoub
- Service de Pneumologie. Université de Sfax, Faculté de Médecine de Sfax. Hôpital universitaire de Gabès, Tunisie
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11
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Febbo J, Revels J, Ketai L. Viral Pneumonias. Infect Dis Clin North Am 2024; 38:163-182. [PMID: 38280762 DOI: 10.1016/j.idc.2023.12.009] [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] [Indexed: 01/29/2024]
Abstract
Viral pneumonia is usually community acquired and caused by influenza, parainfluenza, respiratory syncytial virus, human metapneumovirus, and adenovirus. Many of these infections are airway centric and chest imaging demonstrates bronchiolitis and bronchopneumonia, With the exception of adenovirus infections, the presence of lobar consolidation usually suggests bacterial coinfection. Community-acquired viral pathogens can cause more severe pneumonia in immunocompromised hosts, who are also susceptible to CMV and varicella infection. These latter 2 pathogens are less likely to manifest the striking airway-centric pattern. Airway-centric pattern is distinctly uncommon in Hantavirus pulmonary syndrome, a rare environmentally acquired infection with high mortality.
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Affiliation(s)
- Jennifer Febbo
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA.
| | - Jonathan Revels
- University of New Mexico, 2211 Lomas Boulevard NE, Albuquerque, NM 87106, USA
| | - Loren Ketai
- Department of Radiology, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA
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12
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See XY, Wang TH, Chang YC, Lo J, Liu W, Choo CYW, Lee YC, Ma KSK, Chiang CH, Hsia YP, Chiang CH, Chiang CH. Impact of different corticosteroids on severe community-acquired pneumonia: a systematic review and meta-analysis. BMJ Open Respir Res 2024; 11:e002141. [PMID: 38262670 PMCID: PMC10806634 DOI: 10.1136/bmjresp-2023-002141] [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: 10/17/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES Randomised controlled trials (RCTs) have demonstrated conflicting results regarding the effects of corticosteroids on the treatment of severe community-acquired pneumonia (CAP). We aimed to investigate the efficacy and safety of different corticosteroids on patients who were hospitalised for severe CAP. METHODS We performed a systematic search through PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus from inception to May 2023. The primary outcome was all-cause mortality. Data analysis was performed using a random-effects model. RESULTS A total of 10 RCTs comprising 1962 patients were included. Corticosteroids were associated with a lower rate of all-cause mortality (risk ratio (RR), 0.70 (95% CI 0.54 to 0.90); I2=0.00%). When stratified into different corticosteroid types, hydrocortisone was associated with an approximately 50% lower mortality risk (RR, 0.48 (95% CI 0.32 to 0.72); I2=0.00%). However, dexamethasone, methylprednisolone or prednisolone were not associated with an improvement in mortality. Furthermore, hydrocortisone was associated with a reduction in the rate of mechanical ventilation, acute respiratory distress syndrome, shock and duration of intensive care unit stay. These trends were not observed for dexamethasone, methylprednisolone or prednisolone. Corticosteroids were not associated with an increased risk of adverse events including gastrointestinal bleeding, secondary infection or hyperglycaemia. CONCLUSIONS The use of hydrocortisone, but not other types of corticosteroids, was associated with a reduction in mortality and improvement in pneumonia outcomes among patients hospitalised with severe CAP.PROSPERO registration numberCRD42023431360.
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Affiliation(s)
- Xin Ya See
- Department of Medicine, Unity Hospital, Rochester Regional Health, Rochester, New York, USA
| | - Tsu Hsien Wang
- Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan
| | - Yu-Cheng Chang
- Department of Medicine, Danbury Hospital, Danbury, Connecticut, USA
| | - Juien Lo
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Weitao Liu
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | | | - Yu-Che Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Kevin Sheng Kai Ma
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Cho-Hsien Chiang
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuan Ping Hsia
- Department of Family Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Foundation, New Taipei City, Taiwan
| | - Cho-Hung Chiang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Cho-Han Chiang
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
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13
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Wei C, Wang X, He D, Huang D, Zhao Y, Wang X, Liang Z, Gong L. Clinical profile analysis and nomogram for predicting in-hospital mortality among elderly severe community-acquired pneumonia patients: a retrospective cohort study. BMC Pulm Med 2024; 24:38. [PMID: 38233787 PMCID: PMC10795228 DOI: 10.1186/s12890-024-02852-x] [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: 10/07/2023] [Accepted: 01/07/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Severe community-acquired pneumonia is one of the most lethal forms of CAP with high mortality. For rapid and accurate decisions, we developed a mortality prediction model specifically tailored for elderly SCAP patients. METHODS The retrospective study included 2365 elderly patients. To construct and validate the nomogram, we randomly divided the patients into training and testing cohorts in a 70% versus 30% ratio. The primary outcome was in-hospital mortality. Univariate and multivariate logistic regression analyses were used in the training cohort to identify independent risk factors. The robustness of this model was assessed using the C index, ROC and AUC. DCA was employed to evaluate the predictive accuracy of the model. RESULTS Six factors were used as independent risk factors for in-hospital mortality to construct the prediction model, including age, the use of vasopressor, chronic renal disease, neutrophil, platelet, and BUN. The C index was 0.743 (95% CI 0.719-0.768) in the training cohort and 0.731 (95% CI 0.694-0.768) in the testing cohort. The ROC curves and AUC for the training cohort and testing cohort (AUC = 0.742 vs. 0.728) indicated a robust discrimination. And the calibration plots showed a consistency between the prediction model probabilities and observed probabilities. Then, the DCA demonstrated great clinical practicality. CONCLUSIONS The nomogram incorporated six risk factors, including age, the use of vasopressor, chronic renal disease, neutrophil, platelet and BUN, which had great predictive accuracy and robustness, while also demonstrating clinical practicality at ICU admission.
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Affiliation(s)
- Chang Wei
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, Sichuan, Sichuan, China
| | - Xinyu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, Sichuan, Sichuan, China
| | - Dingxiu He
- Department of Emergency Medicine, The People's Hospital of Deyang, Deyang, Sichuan, China
| | - Dong Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, Sichuan, Sichuan, China
| | - Yue'an Zhao
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, Sichuan, Sichuan, China
| | - Xinyuan Wang
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zong'an Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, Sichuan, Sichuan, China.
| | - Linjing Gong
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, No. 37 Guoxue Alley, 610041, Chengdu, Sichuan, Sichuan, China.
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14
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Dou JY, Zhou YP, Cui Y, Sun T, Shi JY, Xiong X, Zhang YC. [Pathogenic characteristics and influence factors of bloodstream infection-induced severe sepsis in pediatric intensive care unit]. Zhonghua Yi Xue Za Zhi 2024; 104:198-204. [PMID: 38220445 DOI: 10.3760/cma.j.cn112137-20230729-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Objective: To summarize the pathogenic characteristics of bloodstream infection (BSI)-induced severe sepsis and analyze the influence factors in pediatric intensive care unit (PICU). Methods: Pediatric patients who were diagnosed with severe sepsis caused by BSI in the PICU of Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2016 to December 2021 were retrospectively selected and divided into survival group and death group according to their discharge outcomes. Clinical characteristics, laboratory parameters, pathogenic characteristics and drug resistance of the patients were collected. The characteristics of pathogens, clinical and laboratory indicators were summarized, and the influencing factors of death in children with severe sepsis caused by BSI were analyzed based on binary multivariate logistic regression. Results: A total of 132 patients, aged [M (Q1, Q3)] 36 (10, 119) months, with BSI-induced severe sepsis were enrolled in this study, including 81 males and 51 females. There were 38 cases aged 36 (15, 120) months in the death group, including 23 males and 15 females. There were 94 cases, aged 36 (8, 108) months, in the survival group, including 58 males and 36 females. A total of 132 strains of pathogens were isolated, including 87 strains (65.9%) of Gram-negative bacteria. The top 5 pathogens were Klebsiella pneumoniae (24 cases, 18.2%), Escherichia coli (17 cases, 12.9%), Acinetobacter baumannii (13 cases, 9.8%), Pseudomonas aeruginosa (10 cases, 7.6%) and Staphylococcus aureus (10 cases, 7.6%). The proportion of multi-drug resistant bacteria in hospital-acquired BSI was higher than that in community-acquired BSI [52.9% (36/68) vs 15.6% (10/64), P=0.001]. The proportions of community-acquired infection were 58.5% (55/94) and 23.7% (9/38) in the survival and death groups, respectively, the difference was statistically significant (P<0.001). The proportion of central venous catheter insertion before bloodstream infection in the death group was higher than that in the survival group [63.2% (24/38) vs 42.6% (40/94), P=0.034]. According to the binary multivariate logistic regression analysis, hospital-acquired infection (OR=4.80, 95%CI: 1.825-12.621, P=0.001), absolute neutrophil count (ANC) (OR=0.93, 95%CI: 0.863-0.993, P=0.030) and decreased albumin (OR=0.89, 95%CI: 0.817-0.977, P=0.014) were risk factors for death. Conclusions: The common pathogen of BSI-induced severe sepsis in PICU is Gram-negative bacteria. The proportion of multi-drug resistant organisms of BSI obtained in hospitals is high. Children with severe sepsis due to BSI with nosocomial acquired infection, ANC and decreased albumin have a high risk of death.
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Affiliation(s)
- J Y Dou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
| | - Y P Zhou
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
| | - Y Cui
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
| | - T Sun
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
| | - J Y Shi
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
| | - X Xiong
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
| | - Y C Zhang
- Department of Critical Care Medicine, Shanghai Children's Hospital, Children's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200062, China
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15
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Chittams-Miles AE, Malik A, Purcell EB, Muratori C. Nanosecond pulsed electric fields increase antibiotic susceptibility in methicillin-resistant Staphylococcus aureus. Microbiol Spectr 2024; 12:e0299223. [PMID: 38092563 PMCID: PMC10783032 DOI: 10.1128/spectrum.02992-23] [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: 08/14/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
IMPORTANCE We have found that treatment with short electric pulses potentiates the effects of multiple antibiotics against methicillin-resistant Staphylococcus aureus. By reducing the dose of antibiotic necessary to be effective, co-treatment with electric pulses could amplify the effects of standard antibiotic dosing to treat S. aureus infections such as skin and soft-tissue infections (SSTIs). SSTIs are accessible to physical intervention and are good candidates for electric pulse co-treatment, which could be adopted as a step-in wound and abscess debridement.
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Affiliation(s)
- Alexandra E. Chittams-Miles
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
- Biomedical Sciences Program, Old Dominion University, Norfolk, Virginia, USA
| | - Areej Malik
- Biomedical Sciences Program, Old Dominion University, Norfolk, Virginia, USA
- Department of Chemistry and Biochemistry, Old Dominion University, Norfolk, Virginia, USA
| | - Erin B. Purcell
- Department of Chemistry and Biochemistry, Old Dominion University, Norfolk, Virginia, USA
| | - Claudia Muratori
- Frank Reidy Research Center for Bioelectrics, Old Dominion University, Norfolk, Virginia, USA
- Department of Electrical and Computer Engineering, Old Dominion University, Norfolk, Virginia, USA
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16
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Sui DX, Ma HC, Wang CC, Shao HY, Xu SH, Fang NN. Diagnostic significance of HRCT imaging features in adult mycoplasma pneumonia: a retrospective study. Sci Rep 2024; 14:153. [PMID: 38168479 PMCID: PMC10761950 DOI: 10.1038/s41598-023-50702-3] [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: 09/14/2023] [Accepted: 12/23/2023] [Indexed: 01/05/2024] Open
Abstract
Mycoplasma pneumoniae pneumonia (MPP) often overlaps with the clinical manifestations and chest imaging manifestations of other types of community-acquired pneumonia (CAP). We retrospectively analyzed the clinical and imaging data of a group of patients with CAP, summarized their clinical and imaging characteristics, and discussed the diagnostic significance of their certain HRCT findings. The HRCT findings of CAP researched in our study included tree-in-bud sign (TIB), ground-glass opacity (GGO), tree fog sign (TIB + GGO), bronchial wall thickening, air-bronchogram, pleural effusion and cavity. The HRCT findings of all cases were analyzed. Among the 200 cases of MPP, 174 cases showed the TIB, 193 showed the GGO, 175 showed the tree fog sign, 181 lacked air-bronchogram. In case taking the tree fog sign and lack of air-bronchogram simultaneously as an index to distinguish MPP from OCAP, the sensitivity was 87.5%, the specificity was 97.5%, the accuracy was 92.5%. This study showed that that specific HRCT findings could be used to distinguish MPP from OCAP. The combined HRCT findings including the tree fog sign and lacked air-bronchogram simultaneously would contribute to a more accurate diagnosis of MPP.
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Affiliation(s)
- Dong-Xin Sui
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Han-Chen Ma
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Chao-Chao Wang
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Hong-Yan Shao
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Shao-Hua Xu
- Department of Respiration, The Second Hospital of Shandong University, Jinan, China
| | - Ning-Ning Fang
- Department of Anesthesiology, Qilu Hospital of Shandong University, No. 107, Wenhua Xi Road, Jinan, 250012, Shandong, China.
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17
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Ishiguro T, Kobayashi Y, Shimizu Y, Uemura Y, Toriba R, Takata N, Ueda M, Shimizu Y. Prognostic factors of virus-associated pneumonia other than COVID-19 in adults. Respir Med 2024; 221:107497. [PMID: 38097142 DOI: 10.1016/j.rmed.2023.107497] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/07/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023]
Abstract
OBJECTIVE To determine prognostic factors of virus-associated pneumonia other than coronavirus disease 2019. METHODS We retrospectively studied patients suffering from virus-associated community-acquired pneumonia, and who were admitted to Saitama Cardiovascular and Respiratory Center from 2002 to 2020. Prognostic factors were analyzed by univariable and multivariable regression analysis of patient demographics, laboratory data, chest imaging, severity on admission, and initial treatment. PATIENTS HIV-positive patients, those with non-resected lung cancer or receiving chemotherapy, and those with COVID-19 were excluded. Included were 363 patients diagnosed by nucleic acid amplification method, paired sera, and rapid diagnostic tests. RESULTS A CURB-65 score of ≥3 was significant by univariable analysis for 60-day mortality but was nonsignificant by multivariable analysis. The poor prognostic factors that were significant by multivariable analysis (p < 0.05) included immunosuppressive state due to systemic corticosteroid or immunosuppressant administration, acute kidney injury on admission, and corticosteroid administration initiated within 5 days or 5 days to 2 weeks from onset. CONCLUSION A CURB-65 score of ≥3, which is considered to indicate severe pneumonia, was of limited value for predicting mortality of virus-associated pneumonia. We showed patients' underlying diseases and complications to be independent factors of poor prognosis for 60-day mortality. Timing of the initiation of corticosteroid administration remains to be elucidated.
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Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan.
| | - Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Japan
| | - Yosuke Shimizu
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukari Uemura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Riho Toriba
- Pathology, Saitama Cardiovascular and Respiratory Center, Japan
| | - Naomi Takata
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Miyuki Ueda
- Department of Radiology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
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18
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Jiang JH, Cameron DR, Nethercott C, Aires-de-Sousa M, Peleg AY. Virulence attributes of successful methicillin-resistant Staphylococcus aureus lineages. Clin Microbiol Rev 2023; 36:e0014822. [PMID: 37982596 PMCID: PMC10732075 DOI: 10.1128/cmr.00148-22] [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] [Indexed: 11/21/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of severe and often fatal infections. MRSA epidemics have occurred in waves, whereby a previously successful lineage has been replaced by a more fit and better adapted lineage. Selection pressures in both hospital and community settings are not uniform across the globe, which has resulted in geographically distinct epidemiology. This review focuses on the mechanisms that trigger the establishment and maintenance of current, dominant MRSA lineages across the globe. While the important role of antibiotic resistance will be mentioned throughout, factors which influence the capacity of S. aureus to colonize and cause disease within a host will be the primary focus of this review. We show that while MRSA possesses a diverse arsenal of toxins including alpha-toxin, the success of a lineage involves more than just producing toxins that damage the host. Success is often attributed to the acquisition or loss of genetic elements involved in colonization and niche adaptation such as the arginine catabolic mobile element, as well as the activity of regulatory systems, and shift metabolism accordingly (e.g., the accessory genome regulator, agr). Understanding exactly how specific MRSA clones cause prolonged epidemics may reveal targets for therapies, whereby both core (e.g., the alpha toxin) and acquired virulence factors (e.g., the Panton-Valentine leukocidin) may be nullified using anti-virulence strategies.
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Affiliation(s)
- Jhih-Hang Jiang
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - David R. Cameron
- Department of Biomedical Research, University of Bern, Bern, Switzerland
| | - Cara Nethercott
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Marta Aires-de-Sousa
- Laboratory of Molecular Genetics, Institutode Tecnologia Químicae Biológica António Xavier (ITQB-NOVA), Universidade Nova de Lisboa, Oeiras, Portugal
- Escola Superior de Saúde da Cruz Vermelha Portuguesa-Lisboa (ESSCVP-Lisboa), Lisbon, Portugal
| | - Anton Y. Peleg
- Department of Microbiology, Infection Program, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Centre to Impact Antimicrobial Resistance, Monash University, Clayton, Melbourne, Victoria, Australia
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Reijnders TDY, Schuurman AR, Verhoeff J, van den Braber M, Douma RA, Faber DR, Paul AGA, Wiersinga WJ, Saris A, Garcia Vallejo JJ, van der Poll T. High-dimensional phenotyping of the peripheral immune response in community-acquired pneumonia. Front Immunol 2023; 14:1260283. [PMID: 38077404 PMCID: PMC10704504 DOI: 10.3389/fimmu.2023.1260283] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Background Community-acquired pneumonia (CAP) represents a major health burden worldwide. Dysregulation of the immune response plays an important role in adverse outcomes in patients with CAP. Methods We analyzed peripheral blood mononuclear cells by 36-color spectral flow cytometry in adult patients hospitalized for CAP (n=40), matched control subjects (n=31), and patients hospitalized for COVID-19 (n=35). Results We identified 86 immune cell metaclusters, 19 of which (22.1%) were differentially abundant in patients with CAP versus matched controls. The most notable differences involved classical monocyte metaclusters, which were more abundant in CAP and displayed phenotypic alterations reminiscent of immunosuppression, increased susceptibility to apoptosis, and enhanced expression of chemokine receptors. Expression profiles on classical monocytes, driven by CCR7 and CXCR5, divided patients with CAP into two clusters with a distinct inflammatory response and disease course. The peripheral immune response in patients with CAP was highly similar to that in patients with COVID-19, but increased CCR7 expression on classical monocytes was only present in CAP. Conclusion CAP is associated with profound cellular changes in blood that mainly relate to classical monocytes and largely overlap with the immune response detected in COVID-19.
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Affiliation(s)
- Tom D. Y. Reijnders
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Alex R. Schuurman
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Jan Verhoeff
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marlous van den Braber
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Renée A. Douma
- Department of Internal Medicine, Flevo Hospital, Almere, Netherlands
| | - Daniël R. Faber
- Department of Internal Medicine, BovenIJ Hospital, Amsterdam, Netherlands
| | - Alberta G. A. Paul
- Application Department, Cytek Biosciences, Inc., Fremont, CA, United States
| | - W. Joost Wiersinga
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Anno Saris
- Infectious Disease, Leiden Universitair Medisch Centrum, Leiden, Netherlands
| | - Juan J. Garcia Vallejo
- Department of Molecular Cell Biology and Immunology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine (CEMM), Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Division of Infectious Diseases, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
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20
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Wei J, Zang N, Zhang J, He Y, Huang H, Liu X, Xu X, Ren L, Deng Y, Wu J, Seto D, Zhong W, Zhang Q, Liu E. Genome and proteomic analysis of risk factors for fatal outcome in children with severe community-acquired pneumonia caused by human adenovirus 7. J Med Virol 2023; 95:e29182. [PMID: 37909805 DOI: 10.1002/jmv.29182] [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: 06/05/2023] [Revised: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Human adenovirus 7 (HAdV-7) is an important viral pathogen of severe pneumonia in children and a serious threat to health. METHODS A cohort of 45 pediatric patients diagnosed with HAdV-7-associated severe pneumonia and admitted to the Pediatric Intensive Care Unit at the Children's Hospital of Chongqing Medical University from May 2018 to January 2020 were included. Risk factors of death were analyzed by the Cox proportional risk mode with Clinical data, serum, and nasopharyngeal aspirate adenovirus load, Genome analysis, Olink proteomics, and cytokine profile between dead and surviving patients were also analyzed. RESULTS A total of 45 children with a median age of 12.0 months (interquartile range [IQR]: 6.5, 22.0) were included (female 14), including 14 (31.1%) who died. High serum viral load was an independent risk factor for mortality (hazard ratio [HR] = 2.16, 95% confidence interval [CI], 1.04-4.49, p = 0.039). BTB and CNC homology 1 (BACH1), interleukin-5 (IL-5), and IL-9 levels were significantly correlated with serum viral load (p = 0.0400, 0.0499, and 0.0290; r = 0.4663, 0.3339, and -0.3700, respectively), with significant differences between the dead and survival groups (p = 0.021, 0.001, and 0.021). CONCLUSIONS Severe cytokine storm-associated high serum viral load after HAdV-7 infection may be the main mechanism responsible for poor prognosis in children.
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Affiliation(s)
- Jianhua Wei
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Na Zang
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Zhang
- Key Laboratory of Viral Pathogenesis & Infection Prevention and Control, Ministry of Education, Institute of Medical Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Yu He
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Haixia Huang
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiangyu Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ximing Xu
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Luo Ren
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Deng
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jianguo Wu
- Key Laboratory of Viral Pathogenesis & Infection Prevention and Control, Ministry of Education, Institute of Medical Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Donald Seto
- Bioinformatics and Computational Biology Program, School of Systems Biology, George Mason University, Manassas, Virginia, USA
| | - Wen Zhong
- Science for Life Laboratory, Department of Biomedical and Clinical Sciences (BKV), Linköping University, Linköping, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Qiwei Zhang
- Key Laboratory of Viral Pathogenesis & Infection Prevention and Control, Ministry of Education, Institute of Medical Microbiology, College of Life Science and Technology, Jinan University, Guangzhou, China
- BSL-3 Laboratory (Guangdong), Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- China International Science and Technology Cooperation base of Child Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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Latif M, Guo N, Tereshchenko LG, Rothberg MB. Association of hospital spending with care patterns and mortality in patients hospitalized with community-acquired pneumonia. J Hosp Med 2023; 18:986-993. [PMID: 37811980 DOI: 10.1002/jhm.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Pneumonia is a leading cause of mortality and intensive therapy is costly. However, it is unclear whether more spending is associated with better patient outcomes or how hospitals could decrease costs. OBJECTIVES This study investigates the association between hospital spending and 14-day inpatient mortality among community-acquired pneumonia inpatients. METHODS This retrospective cohort study focused on adult pneumonia patients discharged between July 2010 and June 2015 from 260 US hospitals in the Premier database. Hospitals were divided into four pneumonia cost-of-care quartiles and average cost was calculated for each hospital. Odds of 14-day inpatient mortality and care practices were compared among high and low-cost hospitals. RESULTS The study population comprised 534,038 patients with a mean age 69.5 (SD 16.3); 51.9% were female, 75% White, and 71.9% covered by Medicare. Hospitals were largely medium-sized (40.4%), located in the South (49.2%), and in urban areas (82.3%). The fully adjusted population-averaged cost was 14,486 US dollars (95% confidence interval [CI] 13,982-14,867). Hospital practices associated with cost included intensity of diagnostic work-up +$14 (95% CI +12 to +18; p < .0001) and de-escalation of antibiotic therapy, +$6836 (95% CI +2291 to +11,160; p = .004). There was no significant difference in odds of 14-day inpatient mortality between hospitals in the highest and lowest cost quartiles. CONCLUSIONS Greater spending at the hospital level was not associated with lower mortality. Lower diagnostic costs were associated with lower cost of care, suggesting that judicious use of diagnostic testing might reduce costs without worsening patient outcomes.
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Affiliation(s)
- Marina Latif
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ning Guo
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Michael B Rothberg
- Center for Value-Based Care Research, Community Care, Cleveland Clinic, Cleveland, Ohio, USA
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22
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Verma N, Gupta P, Pandey AK, Awasthi S. Nasopharyngeal carriage of Streptococcus pneumoniae serotypes among sick and healthy children in northern India: A case-control study. Vaccine 2023; 41:6619-6624. [PMID: 37758571 PMCID: PMC10663590 DOI: 10.1016/j.vaccine.2023.09.029] [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: 06/08/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Streptococcus pneumoniae is leading bacterial cause of community acquired pneumonia and according to World Health Organization, responsible for 14 % death in children. There is effective vaccine available against Streptococcus pneumoniae. Hence the primary objective was to isolate Streptococcus pneumoniae from nasopharyngeal swabs in children aged 2-59 months with and without community acquired pneumonia and to assess their serotypes. METHODS This case-control study was conducted in tertiary teaching institutes in northern India. Hospitalized children, aged 2-59 months, with World Health Organization-defined community acquired pneumonia were included as cases. Age matched healthy controls were recruited from immunization clinic. All enrolments were done after written informed parental consent. Nasopharyngeal swabs were taken from both cases and controls, and were cultured on 5 % sheep blood agar with gentamycin plate for growth of Streptococcus pneumoniae and incubated in a jar at 370 for 18-24 hrs. Quellung reaction test was used for serotyping. RESULTS From March 2017 to December 2022, 2693 children (1910 cases and 783 controls), were recruited. The median age of cases was 7 months and controls 10 months. Almost all the cases had received antibiotics prior to hospitalization. Streptococcus pneumoniae positivity in nasopharyngeal swab was 8.1 % in cases, of which 56.8 % were vaccine serotypes and 23.6 % in controls, of which 37.8 % were vaccine serotypes. Adjusted odds ratio of isolating vaccine serotypes among cases as compared to controls was 1.77 (95 % CI, 1.09-2.88). CONCLUSION Streptococcus pneumoniae isolation from nasopharyngeal was found to be in lower proportion in cases as compared to control, though colonization with vaccine serotypes was higher in cases as compared to control. Therefore, pneumococcal vaccine coverage must be increased to prevent community acquired pneumonia.
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Affiliation(s)
- N Verma
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - P Gupta
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - A K Pandey
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - S Awasthi
- Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
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23
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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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Moustafa AN, Moness HM, Ali MWE. Red cell distribution width as a prognostic marker for complications of community-acquired pneumonia in children: a comparison with Proadrenomedullin and Copeptin. BMC Pulm Med 2023; 23:371. [PMID: 37794382 PMCID: PMC10548563 DOI: 10.1186/s12890-023-02686-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: 05/06/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is the most common leading cause of morbidity and mortality in children; so, early identification of patients with CAP, who are at risk of complications or high mortality, is very critical to identify patients who need early admission to the intensive care unit. PURPOSE OF THE STUDY To explore the prognostic value of Red Cell Distribution Width (RDW), Proadrenomedullin and Copeptin in the prediction of complicated CAP in children. METHODS 99 children were enrolled in the study, which was done at the Pediatric Department of Minia University Hospital. Measurement of serum Proadrenomedullin, Copeptin, and RDW was done to all participating children in the first 24 h of admission. Assessment of the severity of CAP was done using the Pediatric Respiratory Severity Score (PRESS). RESULTS The values of RDW, Proadrenomedullin, and Copeptin were significantly higher in the complicated CAP group than in the uncomplicated one (P value < 0.01). There were significant positive correlations between RDW and Proadrenomedullin with PRESS (r 0.56 for both). For the prediction of complications, RDW at cutoff point > 17.4, has 77.7% of sensitivity and 98.6% of specificity, followed by Pro ADM at cutoff point > 5.1 nmol/L, of 74% of sensitivity and 90.2% of specificity. For the prediction of mortality, RDW at cutoff point > 17.4 has 81.25% of sensitivity and 89.16% of specificity. CONCLUSION The RDW is a reliable predictor of poor outcomes in pediatric CAP.
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Affiliation(s)
- Asmaa N Moustafa
- Department of Pediatrics, Faculty of Medicine, Minya University Hospital, Minya, 61111, Egypt.
| | - Hend M Moness
- Department of Clinical Pathology, Faculty of Medicine, Minya University, Minya, Egypt
| | - Marwa Waly Eldin Ali
- Department of Pediatrics, Faculty of Medicine, Minya University Hospital, Minya, 61111, Egypt
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Poutanen R, Korppi M, Csonka P, Pauniaho SL, Renko M, Palmu S. Use of antibiotics contrary to guidelines for children's lower respiratory tract infections in different health care settings. Eur J Pediatr 2023; 182:4369-4377. [PMID: 37464182 PMCID: PMC10587298 DOI: 10.1007/s00431-023-05099-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023]
Abstract
This study aimed to evaluate antibiotic prescriptions for children with lower respiratory tract infection (LRTI) in public and private primary care clinics and in a hospital's pediatric emergency department (PED) in 2012-2013 (pre-guideline) and in 2014-2015 (post-guideline). Special attention was paid to guideline compliance, especially regarding macrolide prescriptions, which the guidelines discourage. Retrospective data of 1431 children with LRTI in November-December 2012-2015 were collected from electronic registers and checked manually. Three diagnostic groups were analyzed: community-acquired pneumonia (CAP), wheezing bronchitis, and non-wheezing bronchitis. A comparison of the pre- and post-guideline periods revealed antibiotic prescription rates of 48.7% and 48.9% (p = 0.955) for all LRTIs, respectively, and 77.6% and 71.0% (p = 0.053) for non-wheezing bronchitis. The prescription rates for all LRTIs were 24.9% in PED and 45.9% in public (p < 0.001 vs. PED) and 75.4% in private clinics (p < 0.001 vs. PED and p < 0.001 vs. public clinics). During post-guideline periods, antibiotics were prescribed for CAP less often in private (56.3%) than in public clinics (84.6%; p = 0.037) or in PED (94.3%; p < 0.001 vs. private and p = 0.091 vs. public primary clinics). Macrolide prescriptions were highest in private clinics (42.8%), followed by public primary care clinics (28.5%; p < 0.05) and PED (0.8%; p < 0.05 vs. both public and private primary care). Amoxicillin was the predominant antibiotic in public primary care and PED and macrolides in private primary care. CONCLUSION Antibiotic prescribing for children with LRTI differed significantly between healthcare providers. CAP was undertreated and bronchitis overtreated with antibiotics in primary care, especially in the private clinics. WHAT IS KNOWN • Clinical Treatment Guidelines tend to have modest effect on physicians' antibiotic prescribing habits. • Pediatric viral LRTIs are widely treated with unnecessary antibiotics. WHAT IS NEW • Remarkable differences in antibiotic prescriptions in pediatric LRTIs between Finnish private and public providers were observed. • Overuse of macrolides was common especially in private clinics.
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Affiliation(s)
- Roope Poutanen
- Center for Child, Adolescent and Maternal Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampre, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Matti Korppi
- Center for Child, Adolescent and Maternal Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampre, Finland
| | - Peter Csonka
- Center for Child, Adolescent and Maternal Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampre, Finland
- Terveystalo Healthcare, Tampere, Finland
| | - Satu-Liisa Pauniaho
- Center for Child, Adolescent and Maternal Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampre, Finland
| | - Marjo Renko
- Department of Paediatrics, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Sauli Palmu
- Center for Child, Adolescent and Maternal Health Research, Tampere University and Department of Pediatrics, Tampere University Hospital, Tampre, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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26
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Mangalesh S, Dudani S. Inflammatory ratios for mortality prediction in community acquired pneumonia. Infection 2023; 51:1591-1592. [PMID: 36930374 DOI: 10.1007/s15010-023-02019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Sridhar Mangalesh
- Department of Medicine, Army College of Medical Sciences, New Delhi, Delhi, India
| | - Sharmila Dudani
- Department of Pathology, Army College of Medical Sciences, New Delhi, Delhi, India.
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27
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Grudzinska FS, Faniyi AA, Scott A, Sapey E, Thickett DR. Observational cohort study protocol: neutrophil function and energetics in adults with pneumonia and sepsis - Pneumonia Metabolism in Ageing (PUMA). BMJ Open Respir Res 2023; 10:e001806. [PMID: 37827807 PMCID: PMC10582892 DOI: 10.1136/bmjresp-2023-001806] [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: 05/05/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION Community-acquired pneumonia has high mortality and is associated with significant healthcare costs. In older adults with community-acquired pneumonia neutrophil dysfunction has been identified and is associated with poor outcomes for patients. Immunometabolism is a rapidly developing field which links immune cell function to metabolism. This study aims to explore neutrophil metabolism in community-acquired pneumonia. METHODS AND ANALYSIS Pneumonia Metabolism in Ageing study is a prospective observational study recruiting older adults hospitalised with community-acquired pneumonia to examine neutrophil function and metabolic status. Controls will be older adults with no acute illness. The primary endpoint is neutrophil chemotaxis. ETHICS AND DISSEMINATION The study has ethical approval from the Research Ethics Committee Wales, reference 19/WA/0299. This study involves participants who may lack the capacity to consent to research involvement, in this situation, personal or professional assent will be sought. The results from this study will be submitted for publication in peer-reviewed journals and disseminated at local and international conferences.
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Affiliation(s)
- Frances S Grudzinska
- Birmingham Acute Care Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Aduragbemi A Faniyi
- Birmingham Acute Care Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Aaron Scott
- Birmingham Acute Care Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Elizabeth Sapey
- Birmingham Acute Care Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- PIONEER Data Hub, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - David R Thickett
- Birmingham Acute Care Research, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
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Oladele RO, Ettu AO, Medugu N, Habib A, Egbagbe E, Osinaike T, Makanjuola OB, Ogunbosi B, Irowa OO, Ejembi J, Uwaezuoke NS, Adeleke G, Mutiu B, Ogunsola F, Rotimi V. Antibiotic Guidelines for Critically Ill Patients in Nigeria. West Afr J Med 2023; 40:962-972. [PMID: 37768104] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients. METHODS A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members. RESULTS Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole. CONCLUSION Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs.
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Affiliation(s)
- R O Oladele
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - A O Ettu
- Lagos State Health Service Commission, Lagos 102273, Nigeria
| | - N Medugu
- Nile University of Nigeria, Abuja, Nigeria. +234-8059083612
| | - A Habib
- Bayero University Kano, Kano State, Nigeria
- Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - E Egbagbe
- University of Benin, Benin City, Edo State, Nigeria
- University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - T Osinaike
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - O B Makanjuola
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - B Ogunbosi
- University of Ibadan, Ibadan, Oyo Sate, Nigeria
- University College Hospital, Ibadan, Oyo Sate, Nigeria
| | - O O Irowa
- University of Benin, Benin City, Edo State, Nigeria
- University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
| | - J Ejembi
- Ahmadu Bello University, Zaria, Kaduna State, Nigeria
- Ahmadu Bello University Teaching Hospital, Kaduna State, Nigeria
| | | | - G Adeleke
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - B Mutiu
- Lagos State University College of Medicine, Ikeja, Lagos State, Nigeria
| | - F Ogunsola
- College of Medicine, University of Lagos, Lagos State, Nigeria
- Lagos University Teaching Hospital, Idi-Araba, Lagos State
| | - V Rotimi
- Center for Infection Control and Patient Safety
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Gong H, Zhao J, Xu W, Wan Y, Mu X, Zhang M. The distribution of myeloid-derived suppressor cells subsets and up-regulation of programmed death-1/PD-L1 axis in peripheral blood of adult CAP patients. PLoS One 2023; 18:e0291455. [PMID: 37756307 PMCID: PMC10529571 DOI: 10.1371/journal.pone.0291455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Myeloid-derived suppressor cells (MDSCs) have been reported to expand and have a potent ability in the expansion of regulatory T cells in malignant and infectious disease. The current study was performed to investigate the role of MDSCs and possible immune mechanisms in dampening immune responses of community acquired pneumonia (CAP). METHODS This was a single-center cross-sectional study. The distribution of MDSCs subsets, the PD-1/PD-L1(L2) level of MDSCs subsets and Tregs in the peripheral blood of adult CAP patients and healthy control were measured by flow cytometry analysis. RESULTS Peripheral blood mononuclear cells (PBMCs) from 63 adult CAP patients contained an elevated frequency of both G-MDSC (4.92±0.30 vs 2.25±0.21,p<0.0001) and M-MDSC (19.40±1.30 vs 9.64±0.57,p<0.001) compared to healthy controls. Treg in the peripheral blood of CAP patients exhibited increased expression of PD-1 and CTLA-4, accompanied by no difference of their frequency. Moreover, up-regulated expression of PD-L1 on MDSC subsets in the peripheral blood of CAP patients was also revealed. Of note, the frequency of circulating MDSCs subset displayed a positive correlation with neutrophil count percentage in blood in CAP patients. CONCLUSIONS In summary, the significant expansion of circulating MDSCs subsets and the up-regulated expression of PD-1/PD-L1 level in CAP patients may suggest the possible involvement of PD-1/PD-L1axis in MDSCs mediated immune regulation on Treg at least partially in CAP patients.
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Affiliation(s)
- Haihong Gong
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University Medical College, Qingdao, China
| | - Jingquan Zhao
- Department of Respiratory and Critical Care Medicine, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wenshuai Xu
- Department of Respiratory and Critical Care Medicine, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yinghua Wan
- Department of Respiratory and Critical Care Medicine, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xiangdong Mu
- Department of Respiratory and Critical Care Medicine, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Mingqiang Zhang
- Department of Respiratory and Critical Care Medicine, Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, 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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Lorentzen MH, Rosenvinge FS, Lassen AT, Graumann O, Laursen CB, Mogensen CB, Skjøt-Arkil H. Empirical antibiotic treatment for community-acquired pneumonia and accuracy for Legionella pneumophila, Mycoplasma pneumoniae, and Clamydophila pneumoniae: a descriptive cross-sectional study of adult patients in the emergency department. BMC Infect Dis 2023; 23:580. [PMID: 37670282 PMCID: PMC10481610 DOI: 10.1186/s12879-023-08565-6] [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: 04/25/2023] [Accepted: 08/25/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Many factors determine empirical antibiotic treatment of community-acquired pneumonia (CAP). We aimed to describe the empirical antibiotic treatment CAP patients with an acute hospital visit and to determine if the current treatment algorithm provided specific and sufficient coverage against Legionella pneumophila, Mycoplasma pneumoniae, and Clamydophila pneumoniae (LMC). METHODS A descriptive cross-sectional, multicenter study of all adults with an acute hospital visit in the Region of Southern Denmark between January 2016 and March 2018 was performed. Using medical records, we retrospectively identified the empirical antibiotic treatment and the microbiological etiology for CAP patients. CAP patients who were prescribed antibiotics within 24 h of admission and with an identified bacterial pathogen were included. The prescribed empirical antibiotic treatment and its ability to provide specific and sufficient coverage against LMC pneumonia were determined. RESULTS Of the 19,133 patients diagnosed with CAP, 1590 (8.3%) patients were included in this study. Piperacillin-tazobactam and Beta-lactamase sensitive penicillins were the most commonly prescribed empirical treatments, 515 (32%) and 388 (24%), respectively. Our analysis showed that 42 (37%, 95% CI: 28-47%) of 113 patients with LMC pneumonia were prescribed antibiotics with LMC coverage, and 42 (12%, 95% CI: 8-15%) of 364 patients prescribed antibiotics with LMC coverage had LMC pneumonia. CONCLUSION Piperacillin-tazobactam, a broad-spectrum antibiotic recommended for uncertain infectious focus, was the most frequent CAP treatment and prescribed to every third patient. In addition, the current empirical antibiotic treatment accuracy was low for LMC pneumonia. Therefore, future research should focus on faster diagnostic tools for identifying the infection focus and precise microbiological testing.
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Affiliation(s)
- Morten Hjarnø Lorentzen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | | | - Annmarie Touborg Lassen
- Emergency Department, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ole Graumann
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christian B Laursen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
- Odense Respiratory Research Unit (ODIN), Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helene Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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González-Jiménez P, Méndez R, Latorre A, Mengot N, Piqueras M, Reyes S, Moscardó A, Alonso R, Amara-Elori I, Menéndez R. Endothelial Damage, Neutrophil Extracellular Traps and Platelet Activation in COVID-19 vs. Community-Acquired Pneumonia: A Case-Control Study. Int J Mol Sci 2023; 24:13194. [PMID: 37686001 PMCID: PMC10488034 DOI: 10.3390/ijms241713194] [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: 08/03/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
COVID-19 has been a diagnostic and therapeutic challenge. It has marked a paradigm shift when considering other types of pneumonia etiology. We analyzed the biomarkers related to endothelial damage and immunothrombosis in COVID-19 in comparison to community-acquired pneumonia (CAP) through a case-control study of 358 patients with pneumonia (179 hospitalized with COVID-19 vs. 179 matched hospitalized with CAP). Endothelial damage markers (endothelin and proadrenomedullin), neutrophil extracellular traps (NETs) (citrullinated-3 histone, cell-free DNA), and platelet activation (soluble P-selectin) were measured. In-hospital and 1-year follow-up outcomes were evaluated. Endothelial damage, platelet activation, and NET biomarkers are significantly higher in CAP compared to COVID-19. In-hospital mortality in COVID-19 was higher compared to CAP whereas 1-year mortality and cardiovascular complications were higher in CAP. In the univariate analysis (OR 95% CIs), proADM and endothelin were associated with in-hospital mortality (proADM: CAP 3.210 [1.698-6.070], COVID-19 8.977 [3.413-23.609]; endothelin: CAP 1.014 [1.006-1.022], COVID-19 1.024 [1.014-1.034]), in-hospital CVE (proADM: CAP 1.623 [1.080-2.439], COVID-19 2.146 [1.186-3.882]; endothelin: CAP 1.005 [1.000-1.010], COVID-19 1.010 [1.003-1.018]), and 1-year mortality (proADM: CAP 2.590 [1.644-4.080], COVID-19 13.562 [4.872-37.751]; endothelin: CAP 1.008 [1.003-1.013], COVID-19 1.026 [1.016-1.037]). In conclusion, COVID-19 and CAP showed different expressions of endothelial damage and NETs. ProADM and endothelin are associated with short- and long-term mortality.
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Affiliation(s)
- Paula González-Jiménez
- Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (P.G.-J.); (N.M.); (S.R.); (I.A.-E.); (R.M.)
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), 46026 Valencia, Spain;
- Medicine Department, University of Valencia, 46010 Valencia, Spain;
| | - Raúl Méndez
- Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (P.G.-J.); (N.M.); (S.R.); (I.A.-E.); (R.M.)
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), 46026 Valencia, Spain;
- Medicine Department, University of Valencia, 46010 Valencia, Spain;
- Center for Biomedical Research Network in Respiratory Diseases (CIBERES), 28029 Madrid, Spain
| | - Ana Latorre
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), 46026 Valencia, Spain;
| | - Noé Mengot
- Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (P.G.-J.); (N.M.); (S.R.); (I.A.-E.); (R.M.)
| | - Mónica Piqueras
- Medicine Department, University of Valencia, 46010 Valencia, Spain;
- Laboratory Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Soledad Reyes
- Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (P.G.-J.); (N.M.); (S.R.); (I.A.-E.); (R.M.)
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), 46026 Valencia, Spain;
| | - Antonio Moscardó
- Hemostasis and Thrombosis Unit, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Ricardo Alonso
- Laboratory Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain;
| | - Isabel Amara-Elori
- Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (P.G.-J.); (N.M.); (S.R.); (I.A.-E.); (R.M.)
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), 46026 Valencia, Spain;
- Medicine Department, University of Valencia, 46010 Valencia, Spain;
| | - Rosario Menéndez
- Pneumology Department, La Fe University and Polytechnic Hospital, 46026 Valencia, Spain; (P.G.-J.); (N.M.); (S.R.); (I.A.-E.); (R.M.)
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), 46026 Valencia, Spain;
- Medicine Department, University of Valencia, 46010 Valencia, Spain;
- Center for Biomedical Research Network in Respiratory Diseases (CIBERES), 28029 Madrid, Spain
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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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Wang H, Li D, Wang Y, Mao G, Lu G, Lan Q, Xiao L, Tang W, Liu Y. Clinical significance of serum S100 calcium-binding protein A12 concentrations in patients with community-acquired pneumonia. J Int Med Res 2023; 51:3000605231191021. [PMID: 37602439 PMCID: PMC10467374 DOI: 10.1177/03000605231191021] [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: 03/16/2023] [Accepted: 07/10/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVE This study aimed to investigate the clinical significance of serum S100 calcium-binding protein A12 (S100A12) concentrations in patients with community-acquired pneumonia (CAP). METHODS This was a case-control study. We selected 120 patients with CAP treated in Xichang People's Hospital from January to June 2022 as the case group. Sixty healthy adults without a history of basic diseases were selected as the control group. The patients in the case group were divided into the low S100A12 and high S100A12 subgroups. Serum S100A12, C-reactive protein (CRP), and procalcitonin (PCT) concentrations, the leukocyte count, and other study parameters were compared. RESULTS Serum S100A12, CRP, and PCT concentrations and the leukocyte count were higher in the case group than in the control group. The baseline confusion, urea, respiratory rate, blood pressure, and age ≥ 65 score, baseline pneumonia severity index score, and 30-day mortality rate were higher in the high S100A12 subgroup than in the low S100A12 subgroup. Serum CRP and PCT concentrations and the leukocyte count were higher in the high S100A12 subgroup than in the low S100A12 subgroup. CONCLUSION Patients with high serum S100A12 concentrations have more severe CAP, a more serious inflammatory reaction, and higher 30-day mortality.
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Affiliation(s)
- Haoling Wang
- Department of Respiratory and Critical Care Medicine, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Dongqiong Li
- Department of Respiratory and Critical Care Medicine, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Youli Wang
- Department of Respiratory and Critical Care Medicine, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Guangjian Mao
- Department of Respiratory and Critical Care Medicine, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Guozhou Lu
- Department of Pharmacy, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Qiqin Lan
- Department of Anesthesiology, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Lianchun Xiao
- Department of Respiratory and Critical Care Medicine, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Wenjuan Tang
- Department of Laboratory, Xichang People’s Hospital, Xichang City, Sichuan Province, China
| | - Yiqi Liu
- Department of Respiratory and Critical Care Medicine, Xichang People’s Hospital, Xichang City, Sichuan Province, China
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Lv C, Pan T, Shi W, Peng W, Gao Y, Muhith A, Mu Y, Xu J, Deng J, Wei W. Establishment of risk model for elderly CAP at different age stages: a single-center retrospective observational study. Sci Rep 2023; 13:12432. [PMID: 37528213 PMCID: PMC10393957 DOI: 10.1038/s41598-023-39542-3] [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: 04/13/2023] [Accepted: 07/26/2023] [Indexed: 08/03/2023] Open
Abstract
Community-acquired pneumonia (CAP) is one of the main reasons of mortality and morbidity in elderly population, causing substantial clinical and economic impacts. However, clinically available score systems have been shown to demonstrate poor prediction of mortality for patients aged over 65. Especially, no existing clinical model can predict morbidity and mortality for CAP patients among different age stages. Here, we aimed to understand the impact of age variable on the establishment of assessment model and explored prognostic factors and new biomarkers in predicting mortality. We retrospectively analyzed elderly patients with CAP in Minhang Hospital, Fudan University. We used univariate and multiple logistic regression analyses to study the prognostic factors of mortality in each age-based subgroup. The prediction accuracy of the prognostic factors was determined by the Receiver Operating Characteristic curves and the area under the curves. Combination models were established using several logistic regressions to save the predicted probabilities. Four factors with independently prognostic significance were shared among all the groups, namely Albumin, BUN, NLR and Pulse, using univariate analysis and multiple logistic regression analysis. Then we built a model with these 4 variables (as ABNP model) to predict the in-hospital mortality in all three groups. The AUC value of the ABNP model were 0.888 (95% CI 0.854-0.917, p < 0.000), 0.912 (95% CI 0.880-0.938, p < 0.000) and 0.872 (95% CI 0.833-0.905, p < 0.000) in group 1, 2 and 3, respectively. We established a predictive model for mortality based on an age variable -specific study of elderly patients with CAP, with higher AUC value than PSI, CURB-65 and qSOFA in predicting mortality in different age groups (66-75/ 76-85/ over 85 years).
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Affiliation(s)
- Chunxin Lv
- Oncology Department, Shanghai Punan Hospital of Pudong New District, No 279, Linyi Road, Pudong, Shanghai, China
| | - Teng Pan
- Longgang District Maternity & Child Healthcare Hospital of Shenzhen City, Shenzhen, China
- Faculty of Life Sciences and Medicine, School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Wen Shi
- Department of Dermatology, Shanghai Punan Hospital of Pudong New District, No 279, Linyi Road, Shanghai, China
| | - Weixiong Peng
- Hunan Zixing Artificial Intelligence Technology Group Co., Ltd., Hunan Province, Changsha City, China
| | - Yue Gao
- Hunan Zixing Artificial Intelligence Technology Group Co., Ltd., Hunan Province, Changsha City, China
| | - Abdul Muhith
- Department of Oncology, Royal Marsden Hospital, London, UK
| | - Yang Mu
- Hunan Zixing Artificial Intelligence Technology Group Co., Ltd., Hunan Province, Changsha City, China
| | - Jiayi Xu
- Geriatric Department, Minhang Hospital, Fudan University, No 170, Xinsong Road, Shanghai, China
| | - Jinhai Deng
- Hunan Zixing Artificial Intelligence Technology Group Co., Ltd., Hunan Province, Changsha City, China.
- Richard Dimbleby Department of Cancer Research, Comprehensive Cancer Centre, Kings College London, London, SE1 1UL, UK.
- Clinical Research Center (CRC), Medical Pathology Center (MPC), Cancer Early Detection and Treatment Center (CEDTC), Translational Medicine Research Center (TMRC), Chongqing University Three Gorges Hospital, Chongqing University, Wanzhou, Chongqing, China.
| | - Wei Wei
- Oncology Department, Shanghai Punan Hospital of Pudong New District, No 279, Linyi Road, Pudong, Shanghai, China.
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Talavera M, Martínez A, Vicent C, Frasquet J, Orera Á, Ramírez P. Four cases of unexpected severe community-acquired pneumonia aetiology: Group A Streptococcus pyogenes disruption. Med Intensiva 2023; 47:475-477. [PMID: 37268497 PMCID: PMC10230309 DOI: 10.1016/j.medine.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Mónica Talavera
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Almudena Martínez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carlos Vicent
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Frasquet
- Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Orera
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Paula Ramírez
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
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Chen S, Zhou Z, Wang Y, Chen S, Jiang J. Machine learning-based identification of cuproptosis-related markers and immune infiltration in severe community-acquired pneumonia. Clin Respir J 2023; 17:618-628. [PMID: 37279744 PMCID: PMC10363779 DOI: 10.1111/crj.13633] [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] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/24/2023] [Accepted: 05/06/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Severe community-acquired pneumonia (SCAP) is one of the world's most common diseases and a major etiology of acute respiratory distress syndrome (ARDS). Cuproptosis is a novel form of regulated cell death that can occur in various diseases. METHODS Our study explored the degree of immune cell infiltration during the onset of severe CAP and identified potential biomarkers related to cuproptosis. Gene expression matrix was obtained from GEO database indexed GSE196399. Three machine learning algorithms were applied: The least absolute shrinkage and selection operator (LASSO), the random forest, and the support vector machine-recursive feature elimination (SVM-RFE). Immune cell infiltration was quantified by single-sample gene set enrichment analysis (ssGSEA) scoring. Nomogram was constructed to verify the applicability of using cuproptosis-related genes to predict the onset of severe CAP and its deterioration toward ARDS. RESULTS Nine cuproptosis-related genes were differentially expressed between the severe CAP group and the control group: ATP7B, DBT, DLAT, DLD, FDX1, GCSH, LIAS, LIPT1, and SLC31A1. All 13 cuproptosis-related genes were involved in immune cell infiltration. A three-gene diagnostic model was constructed to predict the onset of severe CAP: GCSH, DLD, and LIPT1. CONCLUSION Our study confirmed the involvement of the newly discovered cuproptosis-related genes in the progression of SCAP.
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Affiliation(s)
- Shuyang Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Zheng Zhou
- Department of Pulmonary and Critical Care Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Yajun Wang
- Department of Pulmonary and Critical Care Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Shujing Chen
- Department of Pulmonary and Critical Care Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Jinjun Jiang
- Shanghai Respiratory Research Institute, Zhongshan Hospital, Fudan UniversityShanghaiChina
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Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 pandemic demonstrated broad utility of pathogen sequencing with rapid methodological progress alongside global distribution of sequencing infrastructure. This review considers implications for now moving clinical metagenomics into routine service, with respiratory metagenomics as the exemplar use-case. RECENT FINDINGS Respiratory metagenomic workflows have completed proof-of-concept, providing organism identification and many genotypic antimicrobial resistance determinants from clinical samples in <6 h. This enables rapid escalation or de-escalation of empiric therapy for patient benefit and reducing selection of antimicrobial resistance, with genomic-typing available in the same time-frame. Attention is now focussed on demonstrating clinical, health-economic, accreditation, and regulatory requirements. More fundamentally, pathogen sequencing challenges the traditional culture-orientated time frame of microbiology laboratories, which through automation and centralisation risks becoming increasingly separated from the clinical setting. It presents an alternative future where infection experts are brought together around a single genetic output in an acute timeframe, aligning the microbiology target operating model with the wider human genomic and digital strategy. SUMMARY Pathogen sequencing is a transformational proposition for microbiology laboratories and their infectious diseases, infection control, and public health partners. Healthcare systems that link output from routine clinical metagenomic sequencing, with pandemic and antimicrobial resistance surveillance, will create valuable tools for protecting their population against future infectious diseases threats.
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Affiliation(s)
- Jonathan D Edgeworth
- Department of Infectious Diseases, Guy's & St Thomas' NHS Foundation Trust & Department of Infectious Diseases, Kings College London, UK
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Hu C, Zeng Y, Zhong Z, Yang L, Li H, Zhang HM, Xia H, Jiang MY. Clinical characteristics and severity prediction score of Adenovirus pneumonia in immunocompetent adult. PLoS One 2023; 18:e0281590. [PMID: 36795764 PMCID: PMC9934457 DOI: 10.1371/journal.pone.0281590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 01/26/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Compared with children and immunocompromised patients, Adenovirus pneumonia in immunocompetent adults is less common. Evaluation of the applicability of severity score in predicting intensive care unit (ICU) admission of Adenovirus pneumonia is limited. METHODS We retrospectively reviewed 50 Adenovirus pneumonia inpatients in Xiangtan Central Hospital from 2018 to 2020. Hospitalized patients with no pneumonia or immunosuppression were excluded. Clinical characteristics and chest image at the admission of all patients were collected. Severity scores, including Pneumonia severity index (PSI), CURB-65, SMART-COP, and PaO2/FiO2 combined lymphocyte were evaluated to compare the performance of ICU admission. RESULTS Fifty inpatients with Adenovirus pneumonia were selected, 27 (54%) non-ICU and 23 (46%) ICU. Most patients were men (40 [80.00%]). Age median was 46.0 (IQR 31.0-56.0). Patients who required ICU care (n = 23) were more likely to report dyspnea (13[56.52%] vs 6[22.22%]; P = 0.002) and have lower transcutaneous oxygen saturation ([90% (IQR, 90-96), 95% (IQR, 93-96)]; P = 0.032). 76% (38/50) of patients had bilateral parenchymal abnormalities, including 91.30% (21/23) of ICU patients and 62.96% (17/27) of non-ICU patients. 23 Adenovirus pneumonia patients had bacterial infections, 17 had other viruses, and 5 had fungi. Coinfection with virus was more common in non-ICU patients than ICU patients (13[48.15%]VS 4[17.39%], P = 0.024), while bacteria and fungi not. SMART-COP exhibited the best ICU admission evaluation performance in Adenovirus pneumonia patients (AUC = 0.873, p < 0.001) and distributed similar in coinfections and no coinfections (p = 0.26). CONCLUSIONS In summary, Adenovirus pneumonia is not uncommon in immunocompetent adult patients who are susceptible to coinfection with other etiological illnesses. The initial SMART-COP score is still a reliable and valuable predictor of ICU admission in non-immunocompromised adult inpatients with adenovirus pneumonia.
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Affiliation(s)
- Chao Hu
- Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Ying Zeng
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Zhi Zhong
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Li Yang
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Hui Li
- Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Huan Ming Zhang
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
| | - Hong Xia
- Department of Orthopedics, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
- * E-mail: (MYJ); (HX)
| | - Ming Yan Jiang
- Department of Respiratory and Critical Medicine, Xiangtan Central Hospital, Xiangtan, Hunan, People’s Republic of China
- * E-mail: (MYJ); (HX)
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Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a common cause of hospitalization, characterized by high mortality, morbidity, and cost and has serious human health implications. Various scoring criteria have been used to predict the severity of pneumonia, including the CURB-65 score, Pneumonia Severity Index (PSI) score, and Severe Community-Acquired Pneumonia (SCAP) score. However, these scoring criteria have shortcomings such as low sensitivity, cumbersome clinical application, and limited application. This study aimed to construct a nomogram model to predict the severity of CAP patients by blood indicators. METHODS This is a retrospective study. Patients with CAP were enrolled and then tested by routine blood, coagulation series, biochemical and inflammatory indicators, and general information such as imaging findings and disease history of the patients were recorded. The main observation was the progression of the patients' disease. Univariate analysis and binary logistic regression analysis were used to explore the independent risk factors for the severity of CAP patients, followed by plotting a nomogram to obtain the prediction model and constructing calibration curves to assess the authenticity and accuracy of the prediction model. Finally, the sensitivity, specificity, and other evaluation indexes were calculated by the receiver operating characteristic curve (ROC) to evaluate the clinical application value of the nomogram prediction model. RESULTS Univariate analysis and binary logistic regression analysis of 277 hospitalized patients yielded platelet to lymphocyte ratio (PLR) and serum amyloid A (SAA) as independent risk factors for the severity of CAP patients. The AUC of the nomogram model for PLR and SAA was 0.889 (95% CI 0.845 - 0.932). The sensitivity was 77.3%, and the specificity was 85.3%, which had an excellent predictive value. CONCLUSIONS The nomogram model based on PLR and SAA to predict the severity of CAP patients has a high specificity and sensitivity.
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Barreto JV, Dias CC, Cardoso T. Does etiological investigation have an impact on the outcomes of community-acquired pneumonia? - A prospective cohort study. Eur J Intern Med 2023; 108:85-92. [PMID: 36494307 DOI: 10.1016/j.ejim.2022.11.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION There is lack of evidence that etiological investigation influences outcomes in community-acquired pneumonia (CAP). Guidelines recommend diverse approaches to this matter. Our aim was to find if etiological investigation has an impact on CAP management and outcomes. METHODS Prospective cohort study, conducted over a two years' period, in a community-based hospital, including all adult patients with CAP. Univariate and multivariate logistic regression modeling were performed to understand the association of etiological identification with CAP outcomes, particularly hospital mortality. RESULTS A total of 660 cases of CAP were included, with a mean±sd age of 74±15 years and 58.9% of males. Etiology was documented in 33% of cases. Antibiotic (ATB) was modified in 148 patients, in 51 (34%) motivated by microbiological results. There was no significant impact on hospital mortality of microbiological documentation (35.5% vs 31.2%, p=0.352), or the fact that ATB was modified due to microbiological findings (27.0% vs 36.9%, p=0.272). When stratified by 3 subgroups of risk for drug-resistant pathogens (zero, one or two risk factors: being bed-ridden and/or ATB use within 90 days), etiology identification still did not influence mortality. When adjusted for CURB-65, Charlson's index, being bed-ridden, having had ATB or hospitalization within 90 days or coming from long-term care facilities, microbial identification was not associated with lower mortality. CONCLUSION Etiological investigation of patients with CAP does not have an association with hospital mortality, irrespective of the risk for drug-resistant pathogens.
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Affiliation(s)
- J Vasco Barreto
- Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Internal Medicine Service, Rua Dr. Eduardo Torres, Senhora da Hora 4464-513, Portugal; ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal.
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal; CINTESIS@RISE - Health Research Netwok - From Lab to the Community, Alameda Prof. Hernâni Monteiro, Porto 4200-319, Portugal
| | - Teresa Cardoso
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, Porto 4050-313, Portugal; Intensive Care Unit (UCIP) and Hospital Infection Control Committee, Hospital de Santo António, Oporto University Hospital Center, University of Porto, Largo Prof. Abel Salazar, Porto 4099-001, Portugal
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Patton MJ, Orihuela CJ, Harrod KS, Bhuiyan MAN, Dominic P, Kevil CG, Fort D, Liu VX, Farhat M, Koff JL, Lal CV, Gaggar A, Richter RP, Erdmann N, Might M, Gaggar A. COVID-19 bacteremic co-infection is a major risk factor for mortality, ICU admission, and mechanical ventilation. Crit Care 2023; 27:34. [PMID: 36691080 PMCID: PMC9868503 DOI: 10.1186/s13054-023-04312-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Recent single-center reports have suggested that community-acquired bacteremic co-infection in the context of Coronavirus disease 2019 (COVID-19) may be an important driver of mortality; however, these reports have not been validated with a multicenter, demographically diverse, cohort study with data spanning the pandemic. METHODS In this multicenter, retrospective cohort study, inpatient encounters were assessed for COVID-19 with community-acquired bacteremic co-infection using 48-h post-admission blood cultures and grouped by: (1) confirmed co-infection [recovery of bacterial pathogen], (2) suspected co-infection [negative culture with ≥ 2 antimicrobials administered], and (3) no evidence of co-infection [no culture]. The primary outcomes were in-hospital mortality, ICU admission, and mechanical ventilation. COVID-19 bacterial co-infection risk factors and impact on primary outcomes were determined using multivariate logistic regressions and expressed as adjusted odds ratios with 95% confidence intervals (Cohort, OR 95% CI, Wald test p value). RESULTS The studied cohorts included 13,781 COVID-19 inpatient encounters from 2020 to 2022 in the University of Alabama at Birmingham (UAB, n = 4075) and Ochsner Louisiana State University Health-Shreveport (OLHS, n = 9706) cohorts with confirmed (2.5%), suspected (46%), or no community-acquired bacterial co-infection (51.5%) and a comparison cohort consisting of 99,170 inpatient encounters from 2010 to 2019 (UAB pre-COVID-19 pandemic cohort). Significantly increased likelihood of COVID-19 bacterial co-infection was observed in patients with elevated ≥ 15 neutrophil-to-lymphocyte ratio (UAB: 1.95 [1.21-3.07]; OLHS: 3.65 [2.66-5.05], p < 0.001 for both) within 48-h of hospital admission. Bacterial co-infection was found to confer the greatest increased risk for in-hospital mortality (UAB: 3.07 [2.42-5.46]; OLHS: 4.05 [2.29-6.97], p < 0.001 for both), ICU admission (UAB: 4.47 [2.87-7.09], OLHS: 2.65 [2.00-3.48], p < 0.001 for both), and mechanical ventilation (UAB: 3.84 [2.21-6.12]; OLHS: 2.75 [1.87-3.92], p < 0.001 for both) across both cohorts, as compared to other risk factors for severe disease. Observed mortality in COVID-19 bacterial co-infection (24%) dramatically exceeds the mortality rate associated with community-acquired bacteremia in pre-COVID-19 pandemic inpatients (5.9%) and was consistent across alpha, delta, and omicron SARS-CoV-2 variants. CONCLUSIONS Elevated neutrophil-to-lymphocyte ratio is a prognostic indicator of COVID-19 bacterial co-infection within 48-h of admission. Community-acquired bacterial co-infection, as defined by blood culture-positive results, confers greater increased risk of in-hospital mortality, ICU admission, and mechanical ventilation than previously described risk factors (advanced age, select comorbidities, male sex) for COVID-19 mortality, and is independent of SARS-CoV-2 variant.
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Affiliation(s)
- Michael John Patton
- Medical Scientist Training Program, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
- Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL USA
| | - Carlos J. Orihuela
- Department of Microbiology, University of Alabama at Birmingham, Birmingham, AL USA
| | - Kevin S. Harrod
- Department of Anesthesiology and Perioperative Medicine, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL USA
| | - Mohammad A. N. Bhuiyan
- Department of Internal Medicine, Division of Clinical Informatics, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA USA
| | - Paari Dominic
- Department of Medicine, Division of Cardiovascular Sciences, University of Iowa, Iowa City, IA USA
| | - Christopher G. Kevil
- Departments of Pathology, Molecular and Cellular Physiology, and Cellular Biology and Anatomy, Louisiana State University Health Sciences Center at Shreveport, Shreveport, LA USA
| | | | | | - Maha Farhat
- Harvard University Medical School, Boston, MA USA
| | - Jonathan L. Koff
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, USA
| | - Charitharth V. Lal
- Department of Pediatrics, Neonatology Division, University of Alabama at Birmingham, Birmingham, AL USA
| | | | - Robert P. Richter
- Department of Pediatrics, Division of Pediatric Critical Care, University of Alabama at Birmingham, Birmingham, AL USA
| | - Nathaniel Erdmann
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL USA
| | - Matthew Might
- Hugh Kaul Precision Medicine Institute, University of Alabama at Birmingham, Birmingham, AL USA
| | - Amit Gaggar
- Department of Medicine, Pulmonary, Allergy, and Critical Care Medicine Division, University of Alabama at Birmingham, Birmingham, AL USA
- Birmingham VA Medical Center, Pulmonary Section, Birmingham, AL USA
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Corica B, Tartaglia F, Oliva A, Raparelli V, Cangemi R, Basili S, Lip GYH, Proietti M, Romiti GF. Prevalence of new-onset atrial fibrillation in hospitalized patients with community-acquired pneumonia: a systematic review and meta-analysis. Intern Emerg Med 2023; 18:127-135. [PMID: 36333574 PMCID: PMC9638315 DOI: 10.1007/s11739-022-03135-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
Community-acquired pneumonia (CAP) is a common lower respiratory tract infection, often complicated by cardiovascular events, including cardiac arrhythmias. New-onset atrial fibrillation (newAF) has been associated with increased mortality in CAP patients, especially in those critically ill; however, limited data on the prevalence of newAF in patients with CAP are available. We aim to estimate the pooled prevalence of newAF and its impact on adverse outcomes in patients with CAP, through a systematic review and meta-analysis. MEDLINE and EMBASE were systematically searched from inception to 27 January 2022. All studies reporting the prevalence of newAF in CAP patients were included and all-cause mortality was extracted when available. The pooled prevalence of newAF, 95% Confidence Intervals (CI), and 95% Prediction Intervals (PI) were computed. The inconsistency index (I2) was calculated to measure heterogeneity. Subgroup analyses were also performed. A protocol for this study was registered on PROSPERO (CRD42022307422). Among 7,655 records retrieved, 10 studies were included, with a total of 280,589 CAP patients. Pooled prevalence of newAF in CAP patients was 7.6% (95% CI 6.4-9.0%, 95% PI 4.3-13.1%, I2 = 95%). Subgroup analyses showed no significant differences according to geographical location or study design. Patients with newAF had a higher risk of mortality among the studies included in the systematic review. NewAF is a common complication, occurring in 7.6% of CAP patients, with prediction intervals suggesting an even higher burden. CAP patients who develop newAF during hospitalization may be at higher risk of mortality in both short- and long-term follow-up.
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Affiliation(s)
- Bernadette Corica
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
- Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, Liverpool, UK
| | - Francesco Tartaglia
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza - University of Rome, Rome, Italy
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Faculty of Nursing, University of Alberta, Edmonton, Canada
- University Center for Studies On Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto Cangemi
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Stefania Basili
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Marco Proietti
- Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, Liverpool, UK.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy.
| | - Giulio Francesco Romiti
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
- Liverpool Centre for Cardiovascular Science, at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom, Liverpool, UK
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Zan YM, Zheng TP, Wang Y, Shao JF, Wang ZY, Zhao WH, Wu JQ, Xu W. Combining a Frailty Index Based on Laboratory Data and Pneumonia Severity Assessments to Predict In-Hospital Outcomes in Older Adults with Community-Acquired Pneumonia. J Nutr Health Aging 2023; 27:270-276. [PMID: 37170434 DOI: 10.1007/s12603-023-1905-1] [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] [Indexed: 05/13/2023]
Abstract
OBJECTIVES Due to the increased morbidity, mortality, and cost of community-acquired pneumonia (CAP) in older people, strategies directed at improving disease evaluation and prevention are imperative. We independently compared the 30-day in-hospital mortality prediction ability of a frailty index based on laboratory data (FI-Lab) with that of the CURB-65 and the Pneumonia Severity Index (PSI) and then proposed combining them to further improve prediction efficiency. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS Patients aged ≥ 65 years (n = 2039) with CAP who were admitted to Jiangsu Provincial People's Hospital of Nanjing Medical University and Jiangsu Provincial Hospital of Chinese Medicine from January 2019 to June 2022. MEASURES The 29-item FI-Lab, PSI and, CURB-65 were administered at admission. We defined frailty by the cut-off value of the FI-Lab score (> 0.43). Multivariable logistic regression analysis, together with the calculation of the area under the receiver operating characteristic curve (ROC-AUC), was conducted to identify stratified risks and relationships between the three indices and 30-day mortality. Participants were divided into the following three groups based on age: 65-74 years, 75-84 years, and ≥ 85 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality due to frailty were calculated. RESULTS A total of 495 participants ranging from 65 to 100 years of age were ultimately included and divided into age groups (65-74 years, n = 190, 38.4%; 75-84 years, n = 183, 37.0%; ≥ 85 years, n = 122, 24.6%). A total of 142 (28.7%) of the 495 patients were defined as having frailty. All three scores tested in this study were significantly associated with 30-day mortality in the total sample. The ORs were as follows: 1.06 (95% CI: 1.03-1.09, P < 0.001) and 2.33 (95% CI: 1.26-4.31, P = 0.007) for the FI-Lab when the score was treated as a continuous and categorical variable, respectively; 1.04 (95% CI: 1.02-1.05, P < 0.001) for the PSI; and 3.70 (95% CI: 2.48-5.50, P < 0.001) for the CURB-65. In the total sample, the ROC-AUCs were 0.783 (95% CI: 0.744-0.819) for the FI-Lab, 0.812 (95% CI: 0.775-0.845) for the PSI, and 0.799 (95% CI: 0.761-0.834) for the CURB-65 (P < 0.001). The ROC-AUC slightly improved when the FI-Lab was added to the PSI (AUC 0.850, 95% CI: 0.809-0.892, P = 0.031) and to the CURB-65 (AUC 0.839, 95% CI: 0.794-0.885, P = 0.002). Older patients with frailty showed a higher risk of in-hospital mortality, with an HR of 2.25 (95% CI: 1.14-3.58, P < 0.001). CONCLUSION AND IMPLICATIONS The FI-Lab seems to generate simple and readily available data, suggesting that it could be a useful complement to the CURB-65 and the PSI as effective predictors of 30-day mortality due to CAP in older populations.
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Affiliation(s)
- Y M Zan
- Wei Xu, MD, Key Laboratory of Geriatrics of Jiangsu Province, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, China. Email address: (Wei Xu). Tel: 86-25-68305111. Fax: 86-25-68305111
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McGonagle EA, Karavite DJ, Grundmeier RW, Schmidt SK, May LS, Cohen DM, Cruz AT, Tu SP, Bajaj L, Dayan PS, Mistry RD. Evaluation of an Antimicrobial Stewardship Decision Support for Pediatric Infections. Appl Clin Inform 2023; 14:108-118. [PMID: 36754066 PMCID: PMC9908419 DOI: 10.1055/s-0042-1760082] [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: 05/07/2022] [Accepted: 11/16/2022] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES Clinical decision support (CDS) has promise for the implementation of antimicrobial stewardship programs (ASPs) in the emergency department (ED). We sought to assess the usability of a newly developed automated CDS to improve guideline-adherent antibiotic prescribing for pediatric community-acquired pneumonia (CAP) and urinary tract infection (UTI). METHODS We conducted comparative usability testing between an automated, prototype CDS-enhanced discharge order set and standard order set, for pediatric CAP and UTI antibiotic prescribing. After an extensive user-centered design process, the prototype CDS was integrated into the electronic health record, used passive activation, and embedded locally adapted prescribing guidelines. Participants were randomized to interact with three simulated ED scenarios of children with CAP or UTI, across both systems. Measures included task completion, decision-making and usability errors, clinical actions (order set use and correct antibiotic selection), as well as objective measures of system usability, utility, and workload using the National Aeronautics and Space Administration Task Load Index (NASA-TLX). The prototype CDS was iteratively refined to optimize usability and workflow. RESULTS Usability testing in 21 ED clinical providers demonstrated that, compared to the standard order sets, providers preferred the prototype CDS, with improvements in domains such as explanations of suggested antibiotic choices (p < 0.001) and provision of additional resources on antibiotic prescription (p < 0.001). Simulated use of the CDS also led to overall improved guideline-adherent prescribing, with a 31% improvement for CAP. A trend was present toward absolute workload reduction. Using the NASA-TLX, workload scores for the current system were median 26, interquartile ranges (IQR): 11 to 41 versus median 25, and IQR: 10.5 to 39.5 for the CDS system (p = 0.117). CONCLUSION Our CDS-enhanced discharge order set for ED antibiotic prescribing was strongly preferred by users, improved the accuracy of antibiotic prescribing, and trended toward reduced provider workload. The CDS was optimized for impact on guideline-adherent antibiotic prescribing from the ED and end-user acceptability to support future evaluative trials of ED ASPs.
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Affiliation(s)
- Erin A. McGonagle
- Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Dean J. Karavite
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Robert W. Grundmeier
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Sarah K. Schmidt
- Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Larissa S. May
- Department of Emergency Medicine, University of California at Davis School of Medicine, Davis, California, United States
| | - Daniel M. Cohen
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, Ohio, United States
| | - Andrea T. Cruz
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
| | - Shin-Ping Tu
- Department of Medicine, University of California at Davis School of Medicine, Davis, California, United States
| | - Lalit Bajaj
- Department of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Peter S. Dayan
- Department of Emergency Medicine and Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, United States
| | - Rakesh D. Mistry
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, United States
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Meng F, Kottlors J, Shahzad R, Liu H, Fervers P, Jin Y, Rinneburger M, Le D, Weisthoff M, Liu W, Ni M, Sun Y, An L, Huai X, Móré D, Giannakis A, Kaltenborn I, Bucher A, Maintz D, Zhang L, Thiele F, Li M, Perkuhn M, Zhang H, Persigehl T. AI support for accurate and fast radiological diagnosis of COVID-19: an international multicenter, multivendor CT study. Eur Radiol 2022; 33:4280-4291. [PMID: 36525088 PMCID: PMC9755771 DOI: 10.1007/s00330-022-09335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 11/03/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Differentiation between COVID-19 and community-acquired pneumonia (CAP) in computed tomography (CT) is a task that can be performed by human radiologists and artificial intelligence (AI). The present study aims to (1) develop an AI algorithm for differentiating COVID-19 from CAP and (2) evaluate its performance. (3) Evaluate the benefit of using the AI result as assistance for radiological diagnosis and the impact on relevant parameters such as accuracy of the diagnosis, diagnostic time, and confidence. METHODS We included n = 1591 multicenter, multivendor chest CT scans and divided them into AI training and validation datasets to develop an AI algorithm (n = 991 CT scans; n = 462 COVID-19, and n = 529 CAP) from three centers in China. An independent Chinese and German test dataset of n = 600 CT scans from six centers (COVID-19 / CAP; n = 300 each) was used to test the performance of eight blinded radiologists and the AI algorithm. A subtest dataset (180 CT scans; n = 90 each) was used to evaluate the radiologists' performance without and with AI assistance to quantify changes in diagnostic accuracy, reporting time, and diagnostic confidence. RESULTS The diagnostic accuracy of the AI algorithm in the Chinese-German test dataset was 76.5%. Without AI assistance, the eight radiologists' diagnostic accuracy was 79.1% and increased with AI assistance to 81.5%, going along with significantly shorter decision times and higher confidence scores. CONCLUSION This large multicenter study demonstrates that AI assistance in CT-based differentiation of COVID-19 and CAP increases radiological performance with higher accuracy and specificity, faster diagnostic time, and improved diagnostic confidence. KEY POINTS • AI can help radiologists to get higher diagnostic accuracy, make faster decisions, and improve diagnostic confidence. • The China-German multicenter study demonstrates the advantages of a human-machine interaction using AI in clinical radiology for diagnostic differentiation between COVID-19 and CAP in CT scans.
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Affiliation(s)
- Fanyang Meng
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Jonathan Kottlors
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rahil Shahzad
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Innovative Technology, Philips Healthcare, Aachen, Germany
| | - Haifeng Liu
- Department of Radiology, Wuhan No. 1 Hospital, Wuhan, China
| | - Philipp Fervers
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Yinhua Jin
- Department of Radiology, Ningbo Hwamei Hospital, University of Chinese Academy of Sciences, Wuhan, China
| | - Miriam Rinneburger
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Dou Le
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Mathilda Weisthoff
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Wenyun Liu
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Mengzhe Ni
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Ye Sun
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Liying An
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | | | - Dorottya Móré
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Athanasios Giannakis
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Isabel Kaltenborn
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany
| | - Andreas Bucher
- Institute for Diagnostic and Interventional Radiology, Frankfurt University Hospital, Frankfurt, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lei Zhang
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Frank Thiele
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Innovative Technology, Philips Healthcare, Aachen, Germany
| | - Mingyang Li
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China
| | - Michael Perkuhn
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Innovative Technology, Philips Healthcare, Aachen, Germany
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Ji Lin University, No. 1 Xinmin Street, Changchun, 130012, China.
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Zhang Y, Li Y, Sun N, Tang H, Ye J, Liu Y, He Q, Fu Y, Zhu H, Jiang C, Xu J. NETosis is critical in patients with severe community-acquired pneumonia. Front Immunol 2022; 13:1051140. [PMID: 36466920 PMCID: PMC9709478 DOI: 10.3389/fimmu.2022.1051140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 09/22/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2023] Open
Abstract
Pneumonia is the fourth leading cause of death globally, and the reason for the high mortality rate of patients with severe community-acquired pneumonia (SCAP) remains elusive. Corticosteroid treatment reduces mortality in adults with SCAP but can cause numerous adverse events. Therefore, novel therapeutic targets need to be explored and new adjunctive immune drugs are urgently required. We analyzed the transcriptome data of peripheral blood leukocytes from patients with SCAP and healthy controls from three perspectives: differentially expressed genes, predicted functions of differentially expressed long non-coding RNAs, and transcriptional read-through. We discovered that the NETosis pathway was top-ranked in patients with SCAP caused by diverse kinds of pathogens. This provides a potential therapeutic strategy for treating patients. Furthermore, we calculated the correlation between the expression of genes involved in NETosis and the ratio of arterial oxygen partial pressure to fractional inspired oxygen. We identified four novel potential therapeutic targets for NETosis in patients with SCAP, including H4C15, H3-5, DNASE1, and PRKCB. In addition, a higher occurrence of transcriptional read-through is associated with a worse outcome in patients with SCAP, which probably can explain the high mortality rate of patients with SCAP.
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Affiliation(s)
- Yiming Zhang
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yan Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Na Sun
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Hanqi Tang
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jun Ye
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yang Liu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Quan He
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Yangyang Fu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Huadong Zhu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chengyu Jiang
- State Key Laboratory of Medical Molecular Biology, Department of Biochemistry, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jun Xu
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Tocut M, Schamroth Pravda M, Ilgiyaev E, Rosman Z, Schamroth Pravda N, Soroksky A. COVID-19 and seasonal influenza infection outcomes in the ICU: a retrospective comparison study. Eur Rev Med Pharmacol Sci 2022; 26:8172-8179. [PMID: 36394766 DOI: 10.26355/eurrev_202211_30170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To compare the characteristics and outcomes of critically ill patients admitted to the intensive care unit (ICU) due to COVID-19 or influenza- associated pneumonia. PATIENTS AND METHODS We conducted a two-center retrospective study on patients admitted to the ICU due to either COVID-19 associated pneumonia (CAP) or influenza-associated pneumonia (IAP). Baseline characteristics, therapy during hospitalization and clinical outcomes were assessed. RESULTS Our study included 86 patients admitted to the ICU. Twenty-four patients (28%) had IAP and 62 patients (72%) had CAP. Those with IAP had more comorbidities of cardiac disease (p=0.005) and chronic obstructive lung disease (p=0.03) compared to those with CAP. Non-invasive ventilation was used significantly more in patients with IAP (p=0.001). The use of neuromuscular blockade was significantly higher in CAP patients (p=0.001). CAP patients had less favourable ventilation parameters. PEEP was significantly higher in those with CAP on the first day of admission (p=0.002). There was no difference in mortality (p=0.61) between the groups. CONCLUSIONS Patients admission to the ICU with CAP had less comorbidity than those with IAP. Patients with CAP had poorer ventilatory parameters patterns, requiring more aggressive ventilation and ECMO support. The overall mortality did not differ significantly between the groups.
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Affiliation(s)
- M Tocut
- Department of Medicine C, Intensive Care Unit, Wolfson Medical Center, Holon, Israel.
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Hua DX, Ma KS, Cheng JY, Liu Y, Sun J, He QY, Deng YP, Yang J, Fu L, Zhao H. Serum TRAIL predicts severity and prognosis in patients with community-acquired pneumonia: a prospective cohort study. Intern Emerg Med 2022; 17:2279-2290. [PMID: 36241932 PMCID: PMC9569003 DOI: 10.1007/s11739-022-03086-7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/16/2022] [Indexed: 11/20/2022]
Abstract
Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) can trigger the apoptosis pathways through binding to relative death receptors. However, the relationship of TRAIL with community-acquired pneumonia (CAP) was unclear. This study aims at exploring the relationships between circulatory TRAIL with severity and prognosis in CAP patients through a prospective cohort study. The whole of 239 CAP patients was enrolled. Demographic characteristics and clinical information were analyzed. TRAIL and inflammatory cytokines were measured using enzyme-linked immunosorbent assay (ELISA). Circulatory TRAIL was gradually increased in accord with CAP severity scores. Spearman or Pearson correlative analysis indicated that circulatory TRAIL was strongly associated with physiologic indicators among CAP patients. Mixed logistic and linear regression models revealed that circulatory TRAIL was positively correlated with the severity scores in CAP patients. After adjusting for confounders, higher levels of circulatory TRAIL on admission significantly elevated the risks of ICU admission, mechanical ventilation, longer hospital stays, or even death during hospitalization. The predictive capacities of serum TRAIL for death were higher compared with CAP severity scores, inflammatory and infectious indicators. There are obviously positive dose-response relationships between circulatory TRAIL on admission with the severity and poor prognostic outcomes in CAP patients. Circulatory TRAIL on admission may be used as a potential biomarker in predicting the severity and poor prognosis for CAP patients.
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Affiliation(s)
- Dong-Xu Hua
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - Kai-Shu Ma
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
- Department of Respiratory and Critical Care Medicine, Funan County People's Hospital, Fuyang, 236300, Anhui, China
| | - Jia-Yi Cheng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - Ying Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - Jing Sun
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - Qi-Yuan He
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - You-Peng Deng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - Jin Yang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China
| | - Lin Fu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China.
- Department of Toxicology, Anhui Medical University, Hefei, 230032, Anhui, China.
| | - Hui Zhao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Furong Road no 678, Hefei, 230601, Anhui, China.
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Lee KR, Hong DY, Paik JH, Jung HM. Prognostic Value of Plasma Presepsin and Pneumonia Severity Index in Patients with Community-Acquired Pneumonia in the Emergency Department. Medicina (Kaunas) 2022; 58:medicina58111504. [PMID: 36363461 PMCID: PMC9692405 DOI: 10.3390/medicina58111504] [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: 09/06/2022] [Revised: 10/07/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Background and Objectives: Presepsin (PSS) is an independent predictor for estimating disease severity and prognosis in septic patients. Few studies have reported the associations between plasma PSS and the severity and prognosis in patients with community-acquired pneumonia (CAP). We investigated whether a high plasma PSS level was associated with 30-day mortality in CAP patients. Materials and Methods: This retrospective single-center study was conducted in an emergency department. The PSS level was measured in 211 adult CAP patients admitted to the hospital and followed for up to 30 days. We recorded the pneumonia severity index (PSI) and the CURB-65 score. The primary outcome was death from any cause within 30 days. Results: The plasma PSS levels were significantly elevated in the high-risk group (PSI > 130) compared with the low- (PSI < 91) or moderate-risk groups (PSI 91−130). Forty-four patients (20.9%) died within 30 days of admission. Non-survivors had significantly higher plasma PSS levels than survivors among CAP patients: 1083 (697−1736) pg/mL vs. 385 (245−554) pg/mL (p < 0.001). The area under the curve (AUC) to predict 30-day mortality was highest for PSS (0.867), followed by procalcitonin (0.728) and lactate (0.616). The cutoff level of plasma PSS for 30-day mortality was >754 pg/mL. The combination of PSI and plasma PSS level improved the predictive ability for 30-day mortality (AUC = 0.892). Cox regression analysis showed that higher PSS levels (>754 pg/mL) and higher PSI (>126) were associated with 30-day mortality in CAP patients (hazard ratios of 19.472 and 6.375, respectively). Conclusion: Elevated plasma PSS is associated with severity and 30-day mortality in hospitalized CAP patients. Combining plasma PSS level and PSI could significantly improve the predictive ability of PSS for 30-day mortality.
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Affiliation(s)
- Kyeong-Ryong Lee
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
| | - Dae-Young Hong
- Department of Emergency Medicine, Konkuk University School of Medicine, Seoul 05030, Korea
- Correspondence: ; Tel.: +82-2-2030-5790
| | - Jin-Hui Paik
- Department of Emergency Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Hyun-Min Jung
- Department of Emergency Medicine, Inha University School of Medicine, Incheon 22332, Korea
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