Derivation and external validation of a simple prediction rule for the development of respiratory failure in hospitalized patients with influenza

BACKGROUND

Influenza viruses cause seasonal epidemics worldwide with a significant morbimortality burden. Clinical spectrum of Influenza is wide, being respiratory failure (RF) one of its most severe complications. This study aims to elaborate a clinical prediction rule of RF in hospitalized Influenza patients.

METHODS

A prospective cohort study was conducted during two consecutive Influenza seasons (December 2016-March 2017 and December 2017-April 2018) including hospitalized adults with confirmed A or B Influenza infection. A prediction rule was derived using logistic regression and recursive partitioning, followed by internal cross-validation. External validation was performed on a retrospective cohort in a different hospital between December 2018 and May 2019.

RESULTS

Overall, 707 patients were included in the derivation cohort and 285 in the validation cohort. RF rate was 6.8% and 11.6%, respectively. Chronic obstructive pulmonary disease, immunosuppression, radiological abnormalities, respiratory rate, lymphopenia, lactate dehydrogenase and C-reactive protein at admission were associated with RF. A four category-grouped seven point-score was derived including radiological abnormalities, lymphopenia, respiratory rate and lactate dehydrogenase. Final model area under the curve was 0.796 (0.714-0.877) in the derivation cohort and 0.773 (0.687-0.859) in the validation cohort (p < 0.001 in both cases). The predicted model showed an adequate fit with the observed results (Fisher's test p > 0.43).

CONCLUSION

we present a simple, discriminating, well-calibrated rule for an early prediction of the development of RF in hospitalized Influenza patients, with proper performance in an external validation cohort. This tool can be helpful in patient's stratification during seasonal Influenza epidemics.

Elevation of serum ferritin levels for predicting a poor outcome in hospitalized patients with influenza infection

OBJECTIVES

There is increasing evidence that ferritin is a key marker of macrophage activation, but its potential role in influenza infection remains unexplored. Our aim was to assess whether hyperferritinaemia (ferritin ≥500 ng/mL) could be a marker of poor prognosis in hospitalized patients with confirmed influenza A infection.

METHODS

We prospectively recruited all hospitalized adult patients who tested positive for the influenza A rRT-PCR assay performed on respiratory samples in two consecutive influenza periods (2016-17 and 2017-18). Poor outcome was defined as the presence of at least one of the following: respiratory failure, admission to the intensive care unit, or in-hospital mortality.

RESULTS

Among 494 patients, 68 (14%) developed poor outcomes; 112 patients (23%) had hyperferritinaemia (39/68, 57% in the poor-outcome group versus 73/426, 17% in the remaining patients, p < 0.0001). Median serum ferritin levels were significantly higher in the subgroup of patients with poor outcomes (609 ng/mL, range 231-967 versus 217 ng/mL, range 140-394, p < 0.0001). In multivariate analysis, hyperferritinaemia was associated with a five-fold increase in the odds ratio of developing poor outcome. After adjusting for classic influenza risk factors, ferritin remained as a significant predictive factor in all exploratory models. Ferritin levels had a good discriminative capacity with an area under the ROC curve of 0.72 (95% confidence interval (CI) 0.65-0.8, p < 0.001) and an overall diagnostic accuracy for predicting poor outcome of 79.3% (95%CI 75.4-82.7%).

CONCLUSIONS

Serum ferritin may discriminate a subgroup of patients with influenza infection who have a higher risk of developing a poor outcome.

Preliminary studies on the microbiological characterization of lactic acid bacteria in suero costeño, a Colombian traditional fermented milk product

Suero costeño is a fermented milk product from the Colombian Atlantic coast, which is produced by the spontaneous acidification of raw milk due to the action of environmental microbes during traditional and semi-industrial processes. Eleven fermentations were carried out in experimental settings replicating traditional conditions and changes in concentration among microbial groups involved during the process (Aerobic Mesophilic bacteria, Yeasts, Enterobacteriaceae and Lactic Acid Bacteria (LAB)). LAB plays an important role in the fermentation process, especially during the final stage (24 hours). In addition, yeasts seem to have an effect on fermentation, showing an increase during the first hours of the process, while Enterobacterial counts decreased during fermentation. Thirty six LAB strains were isolated from commercial samples and thirty two were identified using the API 50 CH kit (BioMCrieux). 41% of the strains identified belonged to the species Lb. plantarum, and 19% were Lb. paracasei subsp. paracasei. Sugars fermented by LAB include milk carbohydrates such as D-Lactose, D-Glucose and D-Galactose. Because of their capacity to use other carbohydrates (manose, celobiose, maltose, fructose, ribose, trehalose, salicin, gentiobiose), it would also be possible to use these strains as starter cultures for other fermentations.

[Diagnosing eating disorders: presentation of a new diagnostic test and an initial epidemiological study of eating disorders in adolescents]

Precise diagnosis of eating disorders has long been problematic. First off, although the DSM IV provides clear criteria, these are applicable to a very narrow range of disorders. Subclinical disorders, although well defined in the literature, are difficult to diagnose as no tool has been previously available. These subclinical disorders are particularly important if one considers that they are often precursors to more serious and life-threatening eating disorders. In addition, choice of diagnostic tool for eating disorders has also long been the cause of difficulty for both researchers and clinicians. Although interviews are favored for their in-depth approach, they are sometimes difficult to implement and often too long and costly to use on a regular basis. Most available questionnaires are limited by their approach to one or two diagnostic categories, and again, until now, no tool has fully addressed the issue of subclinical disorders. The goal of this work was to translate and use a new questionnaire, The Questionnaire for Eating Disorders (Q-EDD), which was developed in the United States and based on both DSM IV criteria as well as carefully developed subclinical disorder criteria. The Q-EDD can identify the major eating disorder categories while at the same time distinguishing between different qualities in each (for example restricting versus compensatory anorexia). Moreover, the Q-EDD can identify several subclinical disorder categories, providing useful insight into potentially dangerous evolution of these disorders. In collaboration with one of the original authors, the questionnaire was translated into French with careful attention to DSM IV criteria in order to preserve its original validity. The questionnaire was read by several professionals in psychology as well as lay people to assure its face validity and ease of use. Once the questionnaire was adequately translated and corrected, it was used for an epidemiological study with a large sample of adolescents and young adults (n=1 001) from several Junior High and High Schools in the greater metropolitan area of Toulouse, France. The schools were located in a variety of neighborhoods and represented a wide range of population, some of them being more academic oriented, others being more oriented towards practical training. The population was composed of 703 females and 298 males, with an average age of 17.06 years. In addition, the population included several different ethnic categories, all of which are similarly represented in the general French population. The results from the Q-EDD showed levels of various clinical disorders to replicate data from previous epidemiological studies with 1.5% of the population suffering from a serious clinical DSM IV disorder; 7.9% suffering from DSM IV disorders NOS; and 20.9% suffering subclinical disorders. In addition to this finding of 30% of the population with an eating disorder, it was noted that a large number of these young people fell into the severe underweight and low weight categories. Indeed, nearly 10% of this group were within the weight criteria for anorexia, despite the fact that they did not meet the other criteria. This finding seemed to warrant additional investigation, and as a result, a different cut-off for severe underweight was established using literature references; this cut-off was set at the 10(th) percentile for BMI based on age. Yet, even with this new cut-off, 6% of this population still met a severe underweight criteria suggestive of anorexic pathology. These results led to the formulation of 2 hypotheses to explain this finding, the first of which examines morphological differences, the second of which suggests cultural differences in terms of eating habits and diet. The French version of the Q-EDD appears to follow the psychometric properties of the original version, moreover it provides useful and rich data regarding eating disorders in a format that is simple and efficient.

Factors in the evaluation of 200 National Cancer Institute carcinogen bioassays

In determining the carcinogenicity of chemical tested in a National Cancer Institute (NCI) bioassay, the following criteria are considered: (1) the adequacy of the bioassay data, (2) the presence of significantly increased incidences of tumor, (3) the adequacy of the number of animals at risk of developing tumors, (4) the adequacy of the dose of chemical administered, (5) the etiology and pathogenesis of the lesions, and (6) other factors that may influence an evaluation, such as a shortened latency period for tumor formation in dosed animals or the stability of the chemical. A decision tree for evaluating these factors is presented. A summary of the results of 200 NCl carcinogen bioassays is also reported. These procedures are presented in the hope that they may serve as discussion points for future developments in the field.

Toward a classification scheme for degrees of experimental evidence for the carcinogenicity of chemicals for animals

A classification scheme is proposed for degrees of experimental evidence for the carcinogenicity of chemicals for animals. The classification stems from the suggestions of an IARC Working Group that the evaluation of bioassays include consideration of whether an increase in malignant tumours occurred and whether it occurred to an unusual degree or in multiple experiments. We extended the evaluative process to chemical experiments with no evidence of carcinogenicity and gave increased emphasis to results from more than one animal species. Although the proposed classification was developed for a group of NCI bioassays which were similar in design and conduct, it may provide a general framework for the evaluation of carcinogenesis bioassays and stimulate development and application of evaluative methods.

Consideration of the possible carcinogenicity of some pesticides

The sophistication, sensitivity, and the predictability of carcinogenesis bioassays using small rodents is reviewed. Bioassays were conducted using both sexes of mice (B6C3F1:C57BL/6xC3H F1 hybrid) and rats (Osborne-Mendel or Fisher 344). Chemicals tested included three acaracides, two fungicides, two fumigants, four herbicides, twelve chlorinated insecticides, and five organo-phosphorus insecticides. The tumor response of each test strain and sex to the above chemicals is discussed, as well as the spontaneous tumor incidence of each strain. The results suggest caution when interpreting the data from bioassays.

Biochemical effects in the rabbit of repeated administration of a mixture of DDT, carbaryl, and parathion

Some biochemical effects of the repeated administration to rabbits of DDT (5 mg/kg), carbaryl (5 mg/kg), and parathion (0.5 mg/kg) were studied during 222 days. No significant changes were found in the blood or urine levels of amino acids. The tubular phosphorus reabsorption remained unaltered. The blood coagulation time was considerably shortened in the treated animals. The urinary excretion of 5-hydroxy-3-indoleacetic acid (5-HIAA) and 4-hydroxy-3-methoxymandelic acid (VMA) was higher in treated animals as compared to that of controls, indicating an increased rate of metabolism of serotonin and catecholamines, respectively. This increased metabolism is in turn believed to be a consequence of increased biosynthesis and release of biogenic amines caused by a “stress mechanism” induced by the administered pesticides. The amounts of 5-HIAA and VMA returned to normal 45 days after cessation of treatment.