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Bronte O, García-García F, Lee DJ, Urrutia I, Uranga A, Nieves M, Martínez-Minaya J, Quintana JM, Arostegui I, Zalacain R, Ruiz-Iturriaga LA, Serrano L, Menéndez R, Méndez R, Torres A, Cilloniz C, España PP. Impact of outdoor air pollution on severity and mortality in COVID-19 pneumonia. Sci Total Environ 2023; 894:164877. [PMID: 37331396 PMCID: PMC10275649 DOI: 10.1016/j.scitotenv.2023.164877] [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: 02/09/2023] [Revised: 05/23/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
The relationship between exposure to air pollution and the severity of coronavirus disease 2019 (COVID-19) pneumonia and other outcomes is poorly understood. Beyond age and comorbidity, risk factors for adverse outcomes including death have been poorly studied. The main objective of our study was to examine the relationship between exposure to outdoor air pollution and the risk of death in patients with COVID-19 pneumonia using individual-level data. The secondary objective was to investigate the impact of air pollutants on gas exchange and systemic inflammation in this disease. This cohort study included 1548 patients hospitalised for COVID-19 pneumonia between February and May 2020 in one of four hospitals. Local agencies supplied daily data on environmental air pollutants (PM10, PM2.5, O3, NO2, NO and NOX) and meteorological conditions (temperature and humidity) in the year before hospital admission (from January 2019 to December 2019). Daily exposure to pollution and meteorological conditions by individual postcode of residence was estimated using geospatial Bayesian generalised additive models. The influence of air pollution on pneumonia severity was studied using generalised additive models which included: age, sex, Charlson comorbidity index, hospital, average income, air temperature and humidity, and exposure to each pollutant. Additionally, generalised additive models were generated for exploring the effect of air pollution on C-reactive protein (CRP) level and SpO2/FiO2 at admission. According to our results, both risk of COVID-19 death and CRP level increased significantly with median exposure to PM10, NO2, NO and NOX, while higher exposure to NO2, NO and NOX was associated with lower SpO2/FiO2 ratios. In conclusion, after controlling for socioeconomic, demographic and health-related variables, we found evidence of a significant positive relationship between air pollution and mortality in patients hospitalised for COVID-19 pneumonia. Additionally, inflammation (CRP) and gas exchange (SpO2/FiO2) in these patients were significantly related to exposure to air pollution.
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Affiliation(s)
- O Bronte
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain.
| | | | - D-J Lee
- Basque Center for Applied Mathematics (BCAM), Bilbao, Spain
| | - I Urrutia
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - A Uranga
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - M Nieves
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | | | - J M Quintana
- Galdakao-Usansolo University Hospital, Research Unit, Galdakao, Spain
| | - I Arostegui
- University of the Basque Country (UPV/EHU), Department of Applied Mathematics, Statistics and Operative Research, Leioa, Spain; Basque Center for Applied Mathematics (BCAM), Bilbao, Spain
| | - R Zalacain
- Cruces University Hospital, Pulmonology Department, Baracaldo, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - L A Ruiz-Iturriaga
- Cruces University Hospital, Pulmonology Department, Baracaldo, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - L Serrano
- Cruces University Hospital, Pulmonology Department, Baracaldo, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
| | - R Menéndez
- Hospital Universitari i Politècnic La Fe de Valencia, Pulmonology Department, Valencia, Spain
| | - R Méndez
- Hospital Universitari i Politècnic La Fe de Valencia, Pulmonology Department, Valencia, Spain
| | - A Torres
- Hospital Clínic i Provincial de Barcelona, Pulmonology Department, University of Barcelona, Barcelona, Spain
| | - C Cilloniz
- Hospital Clínic i Provincial de Barcelona, Pulmonology Department, University of Barcelona, Barcelona, Spain; Faculty of Health Sciences, Continental University, Huancayo, Peru
| | - P P España
- Galdakao-Usansolo University Hospital, Pulmonology Department, Galdakao, Spain; BioCruces Bizkaia Health Research Institute, Baracaldo, Spain
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Méndez R, González-Jiménez P, Latorre A, Mengot N, Zalacain R, Ruiz LA, Serrano L, España PP, Uranga A, Cillóniz C, Hervás D, Torres A, Menéndez R. Is the long-term mortality similar in COVID-19 and community-acquired pneumonia? Front Med (Lausanne) 2023; 10:1236142. [PMID: 37886363 PMCID: PMC10598770 DOI: 10.3389/fmed.2023.1236142] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/18/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction There are no data on the association of type of pneumonia and long-term mortality by the type of pneumonia (COVID-19 or community-acquired pneumonia [CAP]) on long-term mortality after an adjustment for potential confounding variables. We aimed to assess the type of pneumonia and risk factors for long-term mortality in patients who were hospitalized in conventional ward and later discharged. Methods Retrospective analysis of two prospective and multicentre cohorts of hospitalized patients with COVID-19 and CAP. The main outcome under study was 1-year mortality in hospitalized patients in conventional ward and later discharged. We adjusted a Bayesian logistic regression model to assess associations between the type of pneumonia and 1-year mortality controlling for confounders. Results The study included a total of 1,693 and 2,374 discharged patients in the COVID-19 and CAP cohorts, respectively. Of these, 1,525 (90.1%) and 2,249 (95%) patients underwent analysis. Until 1-year follow-up, 69 (4.5%) and 148 (6.6%) patients from the COVID-19 and CAP cohorts, respectively, died (p = 0.008). However, the Bayesian model showed a low probability of effect (PE) of finding relevant differences in long-term mortality between CAP and COVID-19 (odds ratio 1.127, 95% credibility interval 0.862-1.591; PE = 0.774). Conclusion COVID-19 and CAP have similar long-term mortality after adjusting for potential confounders.
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Affiliation(s)
- Raúl Méndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Paula González-Jiménez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
| | - Ana Latorre
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Noé Mengot
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
| | - Rafael Zalacain
- Pneumology Department, Cruces University Hospital, Barakaldo, Spain
| | - Luis A. Ruiz
- Pneumology Department, Cruces University Hospital, Barakaldo, Spain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Spain
| | - Leyre Serrano
- Pneumology Department, Cruces University Hospital, Barakaldo, Spain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Spain
| | - Pedro P. España
- Pneumology Department, Galdakao-Usansolo Hospital, Galdacano, Spain
| | - Ane Uranga
- Pneumology Department, Galdakao-Usansolo Hospital, Galdacano, Spain
| | - Catia Cillóniz
- Department of Medicine, University of Barcelona, Barcelona, Spain
- Faculty of Health Sciences, Continental University, Huancayo, Peru
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - David Hervás
- Data Science, Biostatistics and Bioinformatics, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Department of Applied Statistics and Operational Research and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Antoni Torres
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
- Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Rosario Menéndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
- Respiratory Infections, Health Research Institute La Fe (IISLAFE), Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of Valencia, Valencia, Spain
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Ruiz LA, Serrano L, Pérez S, Castro S, Urrutia A, Uranga A, Artaraz A, Gómez A, España PP, Zalacain R. Impact of severe lymphopenia on the early prediction of clinical outcome in hospitalized patients with pneumococcal community-acquired pneumonia. Infection 2023; 51:1319-1327. [PMID: 36694093 PMCID: PMC9873546 DOI: 10.1007/s15010-023-01984-2] [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: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the impact of an optimal and reproducible cutoff value set according to a predefined lymphopenia scale as an early predictor of in-hospital mortality and other outcomes in patients hospitalized with pneumococcal pneumonia and positive urinary antigen at admission to the emergency department. METHODS An observational cohort study was conducted based on analysis of a prospective registry of consecutive immunocompetent adults hospitalized for pneumococcal pneumonia in two tertiary hospitals. Generalized additive models were constructed to assess the smooth relationship between in-hospital mortality and lymphopenia. RESULTS We included 1173 patients. Lymphopenia on admission was documented in 686 (58.4%). No significant differences were observed between groups regarding the presence of comorbidities. Overall, 299 (25.5%) patients were admitted to intensive care and 90 (7.6%) required invasive mechanical ventilation. Fifty-nine (5%) patients died, among them 23 (38.9%) in the first 72 h after admission. A lymphocyte count < 500/μL, documented in 282 (24%) patients, was the predefined cutoff point that best predicted in-hospital mortality. After adjustment, these patients had higher rates of intensive care admission (OR 2.9; 95% CI 1.9-4.3), invasive mechanical ventilation (OR 2.2; 95% CI 1.2-3.9), septic shock (OR 1.8; 95% CI 1.1-2.9), treatment failure (OR 2.1; 95% CI 1.2-3.5), and in-hospital mortality (OR 2.2; 95% 1.1-4.9). Severe lymphopenia outperformed PSI score in predicting early and 30-day mortality in patients classified in the higher-risk classes. CONCLUSION Lymphocyte count < 500/μL could be used as a reproducible predictor of complicated clinical course in patients with an early diagnosis of pneumococcal pneumonia.
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Affiliation(s)
- Luis A Ruiz
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain.
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
- Department of Medicine, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain.
| | - Leyre Serrano
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain
| | - Silvia Pérez
- Bioinformatic and Statistic Unit, BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Sonia Castro
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Medicine, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain
| | - Amaia Urrutia
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Department of Medicine, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Bilbao, Bizkaia, Spain
| | - Ane Uranga
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Amaia Artaraz
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ainhoa Gómez
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Pedro P España
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
- BioCruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
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Castro S, Pedrero S, Ruiz LA, Serrano L, Zalacain R, Pérez‐Fernández S, Iriberri M, Cabriada V. High-flow nasal cannula oxygen therapy for the treatment of acute respiratory failure secondary to SARS-CoV-2 pneumonia out of ICU. Clin Respir J 2023; 17:905-914. [PMID: 37537998 PMCID: PMC10500315 DOI: 10.1111/crj.13679] [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: 01/19/2023] [Revised: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION AND OBJECTIVES High-flow nasal cannula oxygen therapy (HFNC) has been successfully used for the treatment of acute hypoxaemic respiratory failure (AHRF) secondary to SARS-CoV-2 pneumonia and being effective in reducing progression to invasive mechanical ventilation. The objective of this study was to assess the usefulness of HFNC on a hospital ward for the treatment of AHRF secondary to SARS-CoV-2 pneumonia and its impact on the need for intensive care unit (ICU) admission and endotracheal intubation. Other objectives include identifying potential physiological parameters and/or biomarkers for predicting treatment failure and assessing the clinical course and survival. METHODS Observational study based on data collected prospectively between March 2020 and February 2021 in a single hospital on patients diagnosed with AHRF secondary to SARS-CoV-2 pneumonia who received HFNC outside an ICU. RESULTS One hundred and seventy-one patients out of 1090 patients hospitalised for SARS-CoV-2 infection. HFNC was set as the ceiling of treatment in 44 cases; 12 survived (27.3%). Among the other 127 patients, intubation was performed in 25.9% of cases with a mortality of 11.8%. Higher creatinine levels (OR 1.942, 95% CI 1.04; 3.732; p = 0.036) and Comorbidity-Age-Lymphocyte-LDH (CALL) score (OR 1.273, 95% CI 1.033; 1.617; p = 0.033) were associated with a higher risk of intubation. High platelet count at HFNC initiation was predictive of good treatment response (OR 0.935, 95% CI 0.884; 0.983; p = 0.012). CONCLUSIONS HFNC outside an ICU is a treatment with high success rate in patients with AHRF secondary to SARS-CoV-2 pneumonia, including in patients in whom this therapy was deemed to be the ceiling of treatment.
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Affiliation(s)
- Sonia Castro
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Medicine and Surgery, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Sandra Pedrero
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Medicine and Surgery, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Luis Alberto Ruiz
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Leyre Serrano
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
| | - Rafael Zalacain
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
| | - Silvia Pérez‐Fernández
- Scientific Coordination FacilityBiocruces Bizkaia Health Research InstituteBarakaldoSpain
| | - Milagros Iriberri
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
| | - Valentín Cabriada
- Pneumology ServiceHospital Universitario de CrucesBarakaldoBizkaiaSpain
- Department of Medicine and Surgery, Facultad de Medicina y EnfermeríaUniversidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHULeioaBizkaiaSpain
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Serrano L, Ruiz LA, Perez-Fernandez S, España PP, Gomez A, Gonzalez B, Uranga A, Castro S, Iriberri M, Zalacain R. Short- and long-term prognosis of patients with community-acquired Legionella or pneumococcal pneumonia diagnosed by urinary antigen testing. Int J Infect Dis 2023; 134:106-113. [PMID: 37268100 DOI: 10.1016/j.ijid.2023.05.065] [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] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES To analyze the differences in short- and long-term prognosis and the predictors of survival between patients with community-acquired Legionella and Streptococcus pneumoniae pneumonia, diagnosed early by urinary antigen testing (UAT). METHODS Prospective multicenter study conducted in immunocompetent patients hospitalized with community-acquired Legionella or pneumococcal pneumonia (L-CAP or P-CAP) between 2002-2020. All cases were diagnosed based on positive UAT. RESULTS We included 1452 patients, 260 with community-acquired Legionella pneumonia (L-CAP) and 1192 with community-acquired pneumococcal pneumonia (P-CAP). The 30-day mortality was higher for L-CAP (6.2%) than for P-CAP (5%). After discharge and during the median follow-up durations of 11.4 and 8.43 years, 32.4% and 47.9% of patients with L-CAP and P-CAP died, and 82.3% and 97.4% died earlier than expected, respectively. The independent risk factors for shorter long-term survival were age >65 years, chronic obstructive pulmonary disease, cardiac arrhythmia, and congestive heart failure in L-CAP and the same first three factors plus nursing home residence, cancer, diabetes mellitus, cerebrovascular disease, altered mental status, blood urea nitrogen ≥30 mg/dl, and congestive heart failure as a cardiac complication during hospitalization in P-CAP. CONCLUSION In patients diagnosed early by UAT, the long-term survival after L-CAP or P-CAP was shorter (particularly after P-CAP) than expected, and this shorter survival was mainly associated with age and comorbidities.
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Affiliation(s)
- Leyre Serrano
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology, and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Luis Alberto Ruiz
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain; Department of Medicine. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Spain
| | - Silvia Perez-Fernandez
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Pedro Pablo España
- Pulmonology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Spain
| | - Ainhoa Gomez
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Beatriz Gonzalez
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ane Uranga
- Pulmonology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Spain
| | - Sonia Castro
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain; Department of Medicine. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea (UPV/EHU), Leioa, Spain
| | - Milagros Iriberri
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Rafael Zalacain
- Pulmonology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; BioCruces Bizkaia Health Research Institute, Barakaldo, Spain
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Cilloniz C, Ferrer M, Pericàs JM, Serrano L, Méndez R, Gabarrús A, Peroni HJ, Ruiz LA, Menéndez R, Zalacain R, Torres A. Validation of IDSA/ATS Guidelines for ICU Admission in Adults Over 80 Years Old With Community-Acquired Pneumonia. Arch Bronconeumol 2023; 59:19-26. [PMID: 36184303 DOI: 10.1016/j.arbres.2022.08.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/26/2022] [Accepted: 08/18/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The 2007 IDSA/ATS guidelines for community-acquired pneumonia (CAP) recommended intensive care unit (ICU) admission for adults meeting severe CAP criteria. We aimed to validate the accuracy of IDSA/ATS criteria in patients≥80 years old (very elderly patients, VEP) with CAP. METHODS Prospective cohort study of VEP with CAP admitted to three Spanish hospitals between 1996 and 2019. We compared patients who did and did not require ICU admission. We also assessed factors independently associated with ICU admission, as well as the accuracy of severe CAP criteria for ICU admission and mortality. Major criteria include septic shock and invasive mechanical ventilation while minor criteria encompass other variables related to hemodynamics and respiratory insufficiency as well as level of consciousness, renal function, blood parameters indicative of sepsis and body temperature. RESULTS Of the 2006 VEP with CAP, 519 (26%) met severe CAP criteria, while 204 (10%) required ICU admission. Concordance between severe CAP criteria and the decision to admit the patient to the ICU occurred in 1591 (79%) cases (k coefficient, 0.33), with a sensitivity of 75% and specificity of 80% in predicting ICU admission. All patients with invasive mechanical ventilation received care in ICUs, while 45 (44%) patients with septic shock-previously stabilized in the emergency room-did not. Thirty-day mortality of ICU-admitted patients with septic shock was lower than that of patients in wards (30% vs. 60%, p=0.013). In contrast, patients with severe CAP and only minor criteria had similar mortality. CONCLUSIONS IDSA/ATS criteria for severe CAP predict ICU admission in VEP moderately well. While patients with septic shock and invasive mechanical ventilation warrant ICU admission, severe CAP without major severity criteria in VEP may be acceptably manageable in wards.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain; Facultad de Ciencias de la Salud, Universidad Continental, Huancayo, Perú.
| | - Miquel Ferrer
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Department, Hospital Clínic of Barcelona, Spain; Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Leyre Serrano
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Immunology, Microbiology and Parasitology Department, School of Medicine and Nurse, University of the País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Raúl Méndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Albert Gabarrús
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Héctor José Peroni
- Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Alberto Ruiz
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Rosario Menéndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Rafael Zalacain
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Antoni Torres
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911 - Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
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Serrano L, Ruiz LA, Pérez S, España PP, Gomez A, Cilloniz C, Uranga A, Torres A, Zalacain R. ESTIMATING THE RISK OF BACTERAEMIA IN HOSPITALISED PATIENTS WITH PNEUMOCOCCAL PNEUMONIA. J Infect 2022; 85:644-651. [PMID: 36154852 DOI: 10.1016/j.jinf.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 10/14/2022]
Abstract
Objective To construct a prediction model for bacteraemia in patients with pneumococcal community-acquired pneumonia (P-CAP) based on variables easily obtained at hospital admission. MethodsThis prospective observational multicentre derivation-validation study was conducted in patients hospitalised with P-CAP between 2000-2020. All cases were diagnosed based on positive urinary antigen tests in the emergency department and had blood cultures taken on admission. A risk score to predict bacteraemia was developed. Results We included 1783 patients with P-CAP (1195 in the derivation and 588 in the validation cohort). A third (33.3%) of the patients had bacteraemia. In the multivariate analysis, the following were identified as independent factors associated with bacteraemia: no influenza vaccination the last year, no pneumococcal vaccination in the last 5 years, blood urea nitrogen (BUN) ≥30 mg/dL, sodium <130 mmol/L, lymphocyte count <800/µl, C-reactive protein ≥200 mg/L, respiratory failure, pleural effusion and no antibiotic treatment before admission. The score yielded good discrimination (AUC 0.732; 95% CI: 0.695-0.769) and calibration (Hosmer-Lemeshow p-value 0.801), with similar performance in the validation cohort (AUC 0.764; 95% CI:0.719-0.809). Conclusions We found nine predictive factors easily obtained on hospital admission that could help achieve early identification of bacteraemia. The prediction model provides a useful tool to guide diagnostic decisions.
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Affiliation(s)
- Leyre Serrano
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Luis Alberto Ruiz
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Department of Immunology, Microbiology and Parasitology. Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Silvia Pérez
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo. Bizkaia, Spain.
| | - Pedro Pablo España
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
| | - Ainhoa Gomez
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.
| | - Catia Cilloniz
- Pneumology Service, Hospital Clinic. Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona Spain.
| | - Ane Uranga
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain.
| | - Antoni Torres
- Pneumology Service, Hospital Clinic. Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona Spain.
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain.
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Cilloniz C, Ferrer M, Pericàs JM, Serrano L, Méndez R, Gabarrús A, Peroni HJ, Ruiz LA, Menéndez R, Zalacain R, Torres A. Validation of IDSA/ATS Guidelines for ICU Admission in Adults Over 80 Years Old With Community-acquired Pneumonia. Arch Bronconeumol 2022:S0300-2896(22)00528-2. [PMID: 36163305 DOI: 10.1016/j.arbres.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The 2007 IDSA/ATS guidelines for community-acquired pneumonia (CAP) recommended intensive care unit (ICU) admission for adults meeting severe CAP criteria. We aimed to validate the accuracy of IDSA/ATS criteria in patients ≥80 years old (very elderly patients, VEP) with CAP. METHODS Prospective cohort study of VEP with CAP admitted to three Spanish hospitals between 1996 and 2019. We compared patients who did and did not require ICU admission. We also assessed factors independently associated with ICU admission, as well as the accuracy of severe CAP criteria for ICU admission and mortality. Major criteria include septic shock and invasive mechanical ventilation while minor criteria encompass other variables related to hemodynamics and respiratory insufficiency as well as level of consciousness, renal function, blood parameters indicative of sepsis and body temperature. RESULTS Of the 2006 VEP with CAP, 519 (26%) met severe CAP criteria, while 204 (10%) required ICU admission. Concordance between severe CAP criteria and the decision to admit the patient to the ICU occurred in 1591 (79%) cases (k coefficient, 0.33), with a sensitivity of 75% and specificity of 80% in predicting ICU admission. All patients with invasive mechanical ventilation received care in ICUs, while 45 (44%) patients with septic shock-previously stabilized in the emergency room-did not. Thirty-day mortality of ICU-admitted patients with septic shock was lower than that of patients in wards (30% vs. 60%, P=0.013). In contrast, patients with severe CAP and only minor criteria had similar mortality. CONCLUSIONS IDSA/ATS criteria for severe CAP predict ICU admission in VEP moderately well. While patients with septic shock and invasive mechanical ventilation warrant ICU admission, severe CAP without major severity criteria in VEP may be acceptably manageable in wards.
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Affiliation(s)
- Catia Cilloniz
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
| | - Miquel Ferrer
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Juan M Pericàs
- Infectious Disease Department, Hospital Clínic of Barcelona, Spain; Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | - Leyre Serrano
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain; Immunology, Microbiology and Parasitology Department, School of Medicine and Nurse, University of the País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Raúl Méndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Albert Gabarrús
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain
| | - Héctor José Peroni
- Internal Medicine Department, Respiratory Medicine Unit and Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Luis Alberto Ruiz
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Rosario Menéndez
- Pulmonology Department, Hospital La Fe in Valencia, Valencia, Spain
| | - Rafael Zalacain
- Pulmonology Department, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Antoni Torres
- Pneumology Department, Respiratory Institute, Hospital Clinic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB), SGR 911, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
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Menéndez R, Méndez R, González-Jiménez P, Zalacain R, Ruiz LA, Serrano L, España PP, Uranga A, Cillóniz C, Pérez-de-Llano L, Golpe R, Torres A. Early Recognition of Low-Risk SARS-CoV-2 Pneumonia. Chest 2022; 162:768-781. [PMID: 35609674 PMCID: PMC9124046 DOI: 10.1016/j.chest.2022.05.013] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background A shortage of beds in ICUs and conventional wards during the COVID-19 pandemic led to a collapse of health care resources. Research Question Can admission data and minor criteria by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) help identify patients with low-risk SARS-CoV-2 pneumonia? Study Design and Methods This multicenter cohort study included 1,274 patients in a derivation cohort and 830 (first wave) and 754 (second wave) patients in two validation cohorts. A multinomial regression analysis was performed on the derivation cohort to compare the following patients: those admitted to the ward (assessed as low risk); those admitted to the ICU directly; those transferred to the ICU after general ward admission; and those who died. A regression analysis identified independent factors for low-risk pneumonia. The model was subsequently validated. Results In the derivation cohort, similarities existed among those either directly admitted or transferred to the ICU and those who died. These patients could, therefore, be merged into one group. Five independently associated factors were identified as being predictors of low risk (not dying and/or requiring ICU admission) (ORs, with 95% CIs): peripheral blood oxygen saturation/Fio2 > 450 (0.233; 0.149-0.364); < 3 IDSA/ATS minor criteria (0.231; 0.146-0.365); lymphocyte count > 723 cells/mL (0.539; 0.360-0.806); urea level < 40 mg/dL (0.651; 0.426-0.996); and C-reactive protein level < 60 mg/L (0.454; 0.285-0.724). The areas under the curve were 0.802 (0.769-0.835) in the derivation cohort, and 0.779 (0.742-0.816) and 0.801 (0.757-0.845) for the validation cohorts (first and second waves, respectively). Interpretation Initial biochemical findings and the application of < 3 IDSA/ATS minor criteria make early identification of low-risk SARS-CoV-2 pneumonia (approximately 80% of hospitalized patients) feasible. This scenario could facilitate and streamline health care resource allocation for patients with COVID-19.
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Affiliation(s)
- Rosario Menéndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections, Health Research Institute La Fe, Valencia, Spain; Medicine Department, University of Valencia, Valencia, Spain; Center for Biomedical Research Network in Respiratory Diseases, Madrid, Spain.
| | - Raúl Méndez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections, Health Research Institute La Fe, Valencia, Spain
| | - Paula González-Jiménez
- Pneumology Department, La Fe University and Polytechnic Hospital, Valencia, Spain; Respiratory Infections, Health Research Institute La Fe, Valencia, Spain; Medicine Department, University of Valencia, Valencia, Spain
| | - Rafael Zalacain
- Pneumology Department, Cruces University Hospital, Barakaldo, Spain
| | - Luis A Ruiz
- Pneumology Department, Cruces University Hospital, Barakaldo, Spain; Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Leyre Serrano
- Pneumology Department, Cruces University Hospital, Barakaldo, Spain; Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Pedro P España
- Pneumology Department, Galdakao-Usansolo Hospital, Galdacano, Spain
| | - Ane Uranga
- Pneumology Department, Galdakao-Usansolo Hospital, Galdacano, Spain
| | - Catia Cillóniz
- Center for Biomedical Research Network in Respiratory Diseases, Madrid, Spain; Medicine Department, University of Barcelona, Barcelona, Spain; Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | | | - Rafael Golpe
- Pneumology Department, Lucus Augusti University Hospital, Lugo, Spain
| | - Antoni Torres
- Center for Biomedical Research Network in Respiratory Diseases, Madrid, Spain; Medicine Department, University of Barcelona, Barcelona, Spain; Pneumology Department, Hospital Clinic of Barcelona, Barcelona, Spain; August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
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10
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Pérez de Llano LA, Golpe R, Pérez-Ortiz D, Menéndez R, España Yandiola PP, Artaraz A, Zalacain R, Cilloniz C, Torres A. [Early initiation of corticosteroids might be harmful in patients hospitalized with COVID-19 pneumonia: A multicenter propensity score analysis.]. Arch Bronconeumol 2021; 58:281-283. [PMID: 34720332 PMCID: PMC8541830 DOI: 10.1016/j.arbres.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Luis A Pérez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Rafael Golpe
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Spain.
| | - Diego Pérez-Ortiz
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo. C039 Biodiscovery Research Group HULA-USC, Health Research Institute of Santiago de Compostela (IDIS), Spain
| | - Rosario Menéndez
- Hospital Universitario y Politécnico la Fe, Valencia, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | | | - Amaia Artaraz
- Pneumology Service, Galdakao-Usansolo University Hospital, Galdakao, Bizkaia, Spain
| | - Rafael Zalacain
- Pneumology Service, Cruces University Hospital, Bizkaia, Spain
| | - Catia Cilloniz
- Hospital Clinic, Barcelona, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
| | - Antoni Torres
- Hospital Clinic, Barcelona, Spain; Biomedical Research Center Network for Respiratory Diseases (CIBERES), Madrid, Spain
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11
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Tabernero E, Ruiz LA, España PP, Méndez R, Serrano L, Santos B, Uranga A, González P, Garcia P, Torres A, Menendez R, Zalacain R. COVID-19 in young and middle-aged adults: predictors of poor outcome and clinical differences. Infection 2021; 50:179-189. [PMID: 34463951 PMCID: PMC8406039 DOI: 10.1007/s15010-021-01684-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022]
Abstract
Introduction Young and middle-aged adults are the largest group of patients infected with SARS-CoV-2 and some of them develop severe disease. Objective To investigate clinical manifestations in adults aged 18–65 years hospitalized for COVID-19 and identify predictors of poor outcome. Secondary objectives: to explore differences compared to the disease in elderly patients and the suitability of the commonly used community-acquired pneumonia prognostic scales in younger populations. Methods Multicenter prospective registry of consecutive patients hospitalized for COVID-19 pneumonia aged 18–65 years between March and May 2020. We considered a composite outcome of “poor outcome” including intensive care unit admission and/or use of noninvasive ventilation, continuous positive airway pressure or high flow nasal cannula oxygen and/or death. Results We identified 513 patients < 65 years of age, from a cohort of 993 patients. 102 had poor outcomes (19.8%) and 3.9% died. 78% and 55% of patients with poor outcomes were classified as low risk based on CURB and PSI scores, respectively. A multivariate Cox regression model identified six independent factors associated with poor outcome: heart disease, absence of chest pain or anosmia, low oxygen saturation, high LDH and lymphocyte count < 800/mL. Conclusions COVID-19 in younger patients carries significant morbidity and differs in some respects from this disease in the elderly. Baseline heart disease is a relevant risk factor, while anosmia and pleuritic pain are associated to better prognosis. Hypoxemia, LDH and lymphocyte count are predictors of poor outcome. We consider that CURB and PSI scores are not suitable criteria for deciding admission in this population.
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Affiliation(s)
- Eva Tabernero
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain. .,Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Luis A Ruiz
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain.,Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Pedro P España
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Raúl Méndez
- Pneumology Service, Hospital Universitari I Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Leyre Serrano
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain.,Department of Immunology, Microbiology and Parasitology, Facultad de Medicina y Enfermería, Universidad del País Vasco/Euskal Herriko Unibertsitatea UPV/EHU, Leioa, Bizkaia, Spain
| | - Borja Santos
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Ane Uranga
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Paula González
- Pneumology Service, Hospital Universitari I Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Patricia Garcia
- Pneumology Service, Hospital Universitario Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Antoni Torres
- Pneumology Service, Hospital Clinic/Institut D´Investigacions Biomediques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Rosario Menendez
- Pneumology Service, Hospital Universitari I Politècnic La Fe, Valencia, Spain.,Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, 48903, Barakaldo, Bizkaia, Spain
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12
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Serrano L, Ruiz LA, Martinez-Indart L, España PP, Gómez A, Uranga A, García M, Santos B, Artaraz A, Zalacain R. Non-bacteremic pneumococcal pneumonia: general characteristics and early predictive factors for poor outcome. Infect Dis (Lond) 2020; 52:603-611. [PMID: 32552142 DOI: 10.1080/23744235.2020.1772991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Purpose: Nowadays, most cases of pneumococcal community-acquired pneumonia (PCAP) are diagnosed by positive urinary antigen. Our aims were to analyse process of care in patients hospitalised with non-bacteremic PCAP (NB-PCAP) and identify factors associated with poor outcome (PO) in this population.Methods: We conducted a prospective study, including patients hospitalised for NB-PCAP (positive urinary antigen and negative blood culture) over a 15 year period. We performed multivariate analysis of predisposing factors for PO, defined as need for mechanical ventilation and/or shock and/or in-hospital death.Results: Of the 638 patients included, 4.1% died in hospital and 12.8% had PO. Host-related factors were similar in patients with and without PO, but patients with PO had higher illness severity on admission. Adjusted analysis revealed the following independent factors associated with PO: being a nursing home resident (OR: 6.156; 95% CI: 1.827-20.750; p = .003), respiratory rate ≥30 breaths/min (OR: 3.030; 95% CI: 1.554-5.910; p = .001), systolic blood pressure <90 mmHg (OR: 4.789; 95% CI: 1.967-11.660; p = .001), diastolic blood pressure <60 mmHg (OR: 2.820; 95% CI: 1.329-5.986; p = .007), pulse rate ≥125 beats/min (OR: 3.476; 95% CI: 1.607-7.518; p = .002), pH <7.35 (OR: 9.323; 95% CI: 3.680-23.622; p < .001), leukocytes <4000/µL (OR: 10.007; 95% CI: 2.960-33.835; p < .001), and severe inflammation (OR: 2.364; 95% CI 1.234-4.526; p = .009). The area under the curve for predicting PO was 0.890 (95% CI: 0.851-0.929).Conclusions: Since patients with PO seem different and had worse in-hospital course, we identified eight independent risk factors for PO measurable on admission.
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Affiliation(s)
- Leyre Serrano
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Luis A Ruiz
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Lorea Martinez-Indart
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Pedro P España
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Ainhoa Gómez
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Ane Uranga
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Marta García
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
| | - Borja Santos
- Bioinformatics and Statistics Unit, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Amaia Artaraz
- Unit of Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Rafael Zalacain
- Unit of Pneumology Service, Hospital Universitario Cruces, Barakaldo, Spain
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Ruiz LA, Serrano L, España PP, Martinez-Indart L, Gómez A, Uranga A, Castro S, Artaraz A, Zalacain R. Factors influencing long-term survival after hospitalization with pneumococcal pneumonia. J Infect 2019; 79:542-549. [DOI: 10.1016/j.jinf.2019.10.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 12/28/2022]
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Pedrero S, Tabernero E, Arana-Arri E, Urra E, Larrea M, Zalacain R. Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country. ERJ Open Res 2019; 5:00110-2018. [PMID: 31720298 PMCID: PMC6826251 DOI: 10.1183/23120541.00110-2018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 09/02/2019] [Indexed: 01/15/2023] Open
Abstract
Recent studies suggest an increasing prevalence of nontuberculous mycobacteria (NTM) lung disease. The aim of the present study was to describe incidence rates of NTM lung disease and trends therein in our area over a 20-year period. This was a retrospective study of all cases of NTM lung disease between 1997 and 2016 that met the 2007 American Thoracic Society criteria. We analysed the annual incidence rates, species of mycobacteria isolated, trends over time and annual mortality in 327 patients. Mycobacterium kansasii was the most common mycobacterium isolated (84%), followed by Mycobacterium avium complex (MAC) (13%). We compared two periods: 1997-2006 (257 cases, 79%) and 2007-2016 (70 cases, 21%). The incidence rates tended to decrease across these years, with a peak of incidence in 2000 with 10.6 cases per 100 000. There was a clearly decreasing trend in M. kansasii infection, not only in the first period (incident rate ratio (IRR) 0.915, 95% CI 0.88-0.90; p<0.0001) but also in the second (IRR 0.869, 95% CI 0.780-1.014; p=0.080), reaching 1.8 per 100 000 in 2016. In contrast, MAC infection tended to increase across the two periods (IRR 1.251, 95% CI 1.081-1.447; p=0.003). In our region, the incidence of NTM lung disease has notably decreased in recent years. M. kansasii had high incidence rates in the first decade but clearly decreased in the second decade.
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Affiliation(s)
- Sandra Pedrero
- Dept of Respiratory Medicine, Hospital Universitario Cruces, Barakaldo, Spain
| | - Eva Tabernero
- Dept of Respiratory Medicine, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Elena Urra
- Dept of Microbiology, Hospital Universitario Cruces, Barakaldo, Spain
| | - Maialen Larrea
- Dept of Microbiology, Hospital Universitario Cruces, Barakaldo, Spain
| | - Rafael Zalacain
- Dept of Respiratory Medicine, Hospital Universitario Cruces, Barakaldo, Spain
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España PP, Uranga A, Ruiz LA, Quintana JM, Bilbao A, Aramburu A, Serrano L, Ayarza R, Martinez AP, Zalacain R. Evolution of serotypes in bacteremic pneumococcal adult pneumonia in the period 2001-2014, after introduction of the pneumococcal conjugate vaccine in bizkaia (spain). Vaccine 2019; 37:3840-3848. [PMID: 31153692 DOI: 10.1016/j.vaccine.2019.05.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/13/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
The introduction of pneumococcal conjugate vaccines (PCV7 and PCV13) in children has led to a change in the pattern of pneumococcal serotypes causing pneumococcal disease in adults. The aim of this study is to analyze the distribution of pneumococcal serotypes in adults with bacteremic pneumococcal community-acquired pneumonia (BPP) after the introduction of PCVs in childhood, and the impact of age and comorbidity on this distribution. We conducted an observational study of all adults hospitalized with BPP between 2001 and 2014, in two tertiary hospitals. Overall, we identified 451 cases of BPP (2001-2005: 194, 2006-2010: 134, 2011-2014: 123). The rate of appearance of new cases decreased over the study period. In 70% of the cases, the serotypes found were among those included in PCV13. The most prevalent serotypes were 3 (23.1%), 7F (14.6%), 19A (8.4%) and 1 (7.5%). There was a significant trend to decrease in the percentage of BPP cases due to PCV7 from period 2001-2005 to 2011-2014 (p = 0.0166) and a significant trend to increase in the six serotypes added to form PCV 13 (p = 0.0003). Serotype 3 was the most frequent in patients who developed complications during hospitalization. We did not detect a significant increase in cases caused by non-PCV13 serotypes. The most frequent non-PCV13 serotype was 22F. In conclusion, a significant proportion of adults continue to develop BPP with vaccine serotypes despite infant pneumococcal vaccination. There is a need for further strategies to reduce the current burden of this disease on adults.
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Affiliation(s)
- Pedro P España
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Bizkaia, Spain.
| | - Ane Uranga
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Bizkaia, Spain
| | - Luis Alberto Ruiz
- Department of Respiratory Medicine, Cruces University Hospital, Bizkaia, Spain
| | - Jose María Quintana
- Research Unit, Galdakao-Usansolo Hospital - Health Services Research on Chronic Patients Network (REDISSEC), Bizkaia, Spain
| | - Amaia Bilbao
- Research Unit, Basurto Hospital - Health Services Research on Chronic Patients Network (REDISSEC), Bizkaia, Spain
| | - Amaia Aramburu
- Department of Respiratory Medicine, Galdakao-Usansolo Hospital, Bizkaia, Spain
| | - Leyre Serrano
- Department of Respiratory Medicine, Cruces University Hospital, Bizkaia, Spain
| | - Rafael Ayarza
- Department of Microbiology, Galdakao-Usansolo Hospital, Bizkaia, Spain
| | | | - Rafael Zalacain
- Department of Respiratory Medicine, Cruces University Hospital, Bizkaia, Spain
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Ruiz LA, España PP, Gómez A, Bilbao A, Jaca C, Arámburu A, Capelastegui A, Restrepo MI, Zalacain R. Age-related differences in management and outcomes in hospitalized healthy and well-functioning bacteremic pneumococcal pneumonia patients: a cohort study. BMC Geriatr 2017. [PMID: 28633626 PMCID: PMC5477680 DOI: 10.1186/s12877-017-0518-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Limited data are available regarding fit and healthy patients with pneumonia at different ages. We evaluated the association of age with clinical presentation, serotype and outcomes among healthy and well-functioning patients hospitalized for bacteremic pneumococcal community–acquired pneumonia. Methods We performed a prospective cohort study of consecutive healthy and well-functioning patients hospitalized for this type of pneumonia. Patients were stratified into younger (18 to 64 years) and older (≥65 years) groups. Results During the study period, 399 consecutive patients were hospitalized with bacteremic pneumococcal pneumonia. We included 203 (50.8%) patients who were healthy and well-functioning patients, of whom 71 (35%) were classified as older. No differences were found in antibiotic treatment, treatment failure rate, antibiotic resistance, or serotype, except for serotype 7F that was less common in older patients. In the adjusted multivariate analysis, the older patients had higher 30-day mortality (OR 6.83; 95% CI 1.22–38.22; P = 0.028), but were less likely to be admitted to the ICU (OR 0.14; 95% CI 0.05–0.39; P < 0.001) and had shorter hospital stays (OR 0.71; 95% CI 0.54–0.94; P = 0.017). Conclusions Healthy and well-functioning older patients have higher mortality than younger patients, but nevertheless, ICU admission was less likely and hospital stays were shorter. These results suggest that the aging process is a determinant of mortality, beyond the functional status of patients with bacteremic pneumococcal pneumonia.
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Affiliation(s)
- Luis A Ruiz
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain.
| | - Pedro P España
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ainhoa Gómez
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain
| | - Amaia Bilbao
- Research Unit, Hospital Universitario Basurto - Research Network on Health Services for Chronic Diseases (REDISSEC), Bilbao, Bizkaia, Spain
| | - Carmen Jaca
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain
| | - Amaia Arámburu
- Pneumology Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | | | - Marcos I Restrepo
- Division Pulmonary/Critical Care Medicine, South Texas Veterans Health Care System and University of Texas health Science Center, San Antonio, TX, USA
| | - Rafael Zalacain
- Pneumology Service, Hospital Universitario Cruces, E-48903, Barakaldo, Bizkaia, Spain
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Sahuquillo-Arce JM, Menéndez R, Méndez R, Amara-Elori I, Zalacain R, Capelastegui A, Aspa J, Borderías L, Martín-Villasclaras JJ, Bello S, Alfageme I, de Castro FR, Rello J, Molinos L, Ruiz-Manzano J, Torres A. Age-related risk factors for bacterial aetiology in community-acquired pneumonia. Respirology 2016; 21:1472-1479. [PMID: 27417291 DOI: 10.1111/resp.12851] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/01/2016] [Accepted: 05/09/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to evaluate the effect of age and comorbidities, smoking and alcohol use on microorganisms in patients with community-acquired pneumonia (CAP). METHODS A prospective multicentre study was performed with 4304 patients. We compared microbiological results, bacterial aetiology, smoking, alcohol abuse and comorbidities in three age groups: young adults (<45 years), adults (45-64 years) and seniors (>65 years). RESULTS Bacterial aetiology was identified in 1522 (35.4%) patients. In seniors, liver disease was independently associated with Gram-negative bacteria (Haemophilus influenzae and Enterobacteriaceae), COPD with Pseudomonas aeruginosa (OR = 2.69 (1.46-4.97)) and Staphylococcus aureus (OR = 2.8 (1.24-6.3)) and neurological diseases with S. aureus. In adults, diabetes mellitus (DM) was a risk factor for Streptococcus pneumoniae and S. aureus, and COPD for H. influenzae (OR = 3.39 (1.06-10.83)). In young adults, DM was associated with S. aureus. Smoking was a risk factor for Legionella pneumophila regardless of age. Alcohol intake was associated with mixed aetiology and Coxiella burnetii in seniors, and with S. pneumoniae in young adults. CONCLUSION It should be considered that the bacterial aetiology may differ according to the patient's age, comorbidities, smoking and alcohol abuse. More extensive microbiological testing is warranted in those with risk factors for infrequent microorganisms.
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Affiliation(s)
| | - Rosario Menéndez
- Pneumology Service, IIS/ University and Politechnic Hospital La Fe, Valencia, Spain. .,CIBERES, Valencia, Spain.
| | - Raúl Méndez
- Pneumology Service, IIS/ University and Politechnic Hospital La Fe, Valencia, Spain.,CIBERES, Valencia, Spain
| | - Isabel Amara-Elori
- Pneumology Service, IIS/ University and Politechnic Hospital La Fe, Valencia, Spain.,CIBERES, Valencia, Spain
| | - Rafael Zalacain
- Pneumology Service, University Hospital Cruces, Bilbao, Spain
| | | | - Javier Aspa
- Pneumology Service, University Hospital of Princesa, Madrid, Spain
| | | | | | - Salvador Bello
- Pneumology Service, University Hospital Miguel Servet, Zaragoza, Spain
| | | | | | - Jordi Rello
- Critical Care Unit, University Hospital Joan XXIII, Tarragona, Spain.,Critical Care Unit, University Hospital Vall Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Luis Molinos
- Pneumology Service, University Hospital Central, Oviedo, Spain
| | | | - Antoni Torres
- CIBERES, Valencia, Spain.,Pneumology Service, Clinic Hospital, IDIBAPS, University of Barcelona, Barcelona, Spain
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18
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Zalacain R. [Practical use of pneumococcal antigen assessment in urine]. Med Clin (Barc) 2016; 146:348-9. [PMID: 26897502 DOI: 10.1016/j.medcli.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/01/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Rafael Zalacain
- Servicio de Neumología, Hospital Universitario Cruces, Cruces-Baracaldo, Bizkaia, España.
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19
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Ruiz LA, Gómez A, Zalacain R. Bacterial Pneumonia in Older People. J Gerontol A Biol Sci Med Sci 2015; 70:663. [DOI: 10.1093/gerona/glv021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Bello S, Menéndez R, Antoni T, Reyes S, Zalacain R, Capelastegui A, Aspa J, Borderías L, Martin-Villasclaras JJ, Alfageme I, Rodríguez de Castro F, Rello J, Luis M, Ruiz-Manzano J. Tobacco smoking increases the risk for death from pneumococcal pneumonia. Chest 2014; 146:1029-1037. [PMID: 24811098 DOI: 10.1378/chest.13-2853] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Active smoking increases the risk of developing community-acquired pneumonia (CAP) and invasive pneumococcal disease, although its impact on mortality in pneumococcal CAP outcomes remains unclear. The aim of this study was to investigate the influence of current smoking status on pneumococcal CAP mortality. METHODS We performed a multicenter, prospective, observational cohort study in 4,288 hospitalized patients with CAP. The study group consisted of 892 patients with pneumococcal CAP: 204 current smokers (22.8%), 387 nonsmokers (43.4%), and 301 exsmokers (33.7%). RESULTS Mortality at 30 days was 3.9%: 4.9% in current smokers vs 4.3% in nonsmokers and 2.6% in exsmokers. Current smokers with CAP were younger (51 years vs 74 years), with more alcohol abuse and fewer cardiac, renal, and asthma diseases. Current smokers had lower CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) scores, although 40% had severe sepsis at diagnosis. Current smoking was an independent risk factor (OR, 5.0; 95% CI, 1.8-13.5; P = .001) for 30-day mortality of pneumococcal CAP after adjusting for age (OR, 1.06; P = .001), liver disease (OR, 4.5), sepsis (OR, 2.3), antibiotic adherence to guidelines, and first antibiotic dose given < 6 h. The independent risk effect of current smokers remained when compared only with nonsmokers (OR, 4.0; 95% CI, 1.3-12.6; P = .015) or to exsmokers (OR, 3.9; 95% CI, 1.09-4.95; P = .02). CONCLUSIONS Current smokers with pneumococcal CAP often develop severe sepsis and require hospitalization at a younger age, despite fewer comorbid conditions. Smoking increases the risk of 30-day mortality independently of tobacco-related comorbidity, age, and comorbid conditions. Current smokers should be actively targeted for preventive strategies.
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Affiliation(s)
- Salvador Bello
- The Servicio de Neumología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
| | - Rosario Menéndez
- Servicio de Neumología, IIS Hospital Universitario la Fe, Valencia, Spain
| | - Torres Antoni
- Servei de Pneumologia, Institut Clinic del Torax, Universitat de Barcelona, Ciberes GRS, Barcelona, Spain
| | - Soledad Reyes
- Servicio de Neumología, IIS Hospital Universitario la Fe, Valencia, Spain
| | | | | | - Javier Aspa
- Servicio de Neumología, Hospital de la Princesa Spain, Madrid, Spain
| | - Luis Borderías
- Servicio de Neumología, Hospital San Jorge, Huesca, Spain
| | | | | | | | - Jordi Rello
- Critical Care, Hospital Vall d'Hebron, Institut de Recerca Vall d'Hebron-UAB, CIBERES, Barcelona, Spain
| | - Molinos Luis
- Servicio de Neumología, Hospital Central de Asturias, Oviedo, Spain
| | - Juan Ruiz-Manzano
- Servicio de Neumología, Hospital Germans Trias i Pujol, Badalona, Spain
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Capelastegui A, Zalacain R, Bilbao A, Egurrola M, Iturriaga LAR, Quintana JM, Gomez A, Esteban C, España PP. Pneumococcal pneumonia: differences according to blood culture results. BMC Pulm Med 2014; 14:128. [PMID: 25096919 PMCID: PMC4127038 DOI: 10.1186/1471-2466-14-128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/24/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bacteremia by Streptococcus pneumoniae has been traditionally associated with poor outcomes in patients with pneumonia; however, data on its impact on outcomes are limited and are sometimes contradictory. METHODS We performed a prospective study in two hospitals in northern Spain in which cases diagnosed with pneumococcal pneumonia were selected from a cohort of hospitalized patients with pneumonia between January 2001 and July 2009. We compared patients with pneumococcal bacteremic pneumonia with those with pneumococcal non-bacteremic pneumonia. RESULTS We compared 492 patients with negative blood culture and 399 with positive culture results. Host related factors were very similar in both groups. Severity of illness on admission measured by CURB-65 score was similar in both groups. Adjusted analysis showed a greater likelihood of septic shock during in-hospital course among patients with pneumococcal bacteremia (OR, 2.1; 95% CI, 1.2-3.5; P=0.006). Likewise, patients with positive blood culture had greater in-hospital mortality (OR 2.1; 95% CI, 1.1- -3.9; P=0.02), 15-day mortality (OR 3.6; 95% CI, 1.7-7.4; P=0.0006), and 30-day mortality (OR, 2.7; 95% CI, 1.5-5; P=0.002). CONCLUSIONS Although host related factors and severity on admission were very similar in the two groups, bacteremic patients had worse in-hospital course and outcomes. Bacteraemia in pneumococcal pneumonia is of prognostic significance.
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Affiliation(s)
- Alberto Capelastegui
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| | - Rafael Zalacain
- From the Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Amaia Bilbao
- From the Research Unit, Hospital Universitario Basurto - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Bizkaia, Spain
| | - Mikel Egurrola
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| | | | - Jose M Quintana
- From the Research Unit - Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ainhoa Gomez
- From the Pneumology Service, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Cristobal Esteban
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
| | - Pedro P España
- Service of Pneumology, Hospital de Galdakao-Usansolo, Galdakao, Bizkaia E-48960, Spain
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Zalacain R, Capelastegui A, Ruiz LA, Bilbao A, Gomez A, Uranga A, España PP. Streptococcus pneumoniae antigen in urine: diagnostic usefulness and impact on outcome of bacteraemic pneumococcal pneumonia in a large series of adult patients. Respirology 2014; 19:936-43. [PMID: 24976113 DOI: 10.1111/resp.12341] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 03/13/2014] [Accepted: 04/27/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary pneumococcal antigen detection provides good results in the diagnosis of pneumococcal pneumonia but has rarely been used in bacteraemic pneumococcal pneumonia and it is not known whether it is associated with outcome in this type of pneumonia. Our objectives were to assess the usefulness of an immunochromatographic technique for detecting the pneumococcal antigen in urine in a large prospective study of patients with bacteraemic pneumococcal pneumonia and explore any potential association with outcomes. METHODS This study, carried out over 8 years, included all adult immunocompetent patients admitted for bacteraemic pneumococcal pneumonia. An immunochromatographic test for the Streptococcus pneumoniae antigen in urine was performed in the first 24 h. The sensitivity of test was assessed and patients were divided into two groups according to test results to explore differences on admission and during the course of the illness using logistic regression models. RESULTS Of the 350 patients with bacteraemic pneumococcal pneumonia included, 261 (74.6%) were positive for the antigen. Patient characteristics were very similar on admission and differences in severity (Pneumonia Severity Index) were not statistically significant. In the adjusted analysis, antigen-positive patients had a higher risk of intensive care unit admission, treatment failure and adverse outcome. CONCLUSIONS The sensitivity of the immunochromatographic urinary antigen test was 74.6% and positive results were associated with poorer clinical outcome. We therefore recommend systematic use of this test when pneumonia is diagnosed in the emergency department.
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Affiliation(s)
- Rafael Zalacain
- Department of Respiratory Medicine, Cruces University Hospital, Barakaldo, Bizkaia, Spain
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Ruiz LA, Zalacain R, Capelastegui A, Bilbao A, Gomez A, Uranga A, Espana PP. Bacteremic Pneumococcal Pneumonia in Elderly and Very Elderly Patients: Host- and Pathogen-Related Factors, Process of Care, and Outcome. J Gerontol A Biol Sci Med Sci 2014; 69:1018-24. [DOI: 10.1093/gerona/glt288] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Polverino E, Torres A, Menendez R, Cillóniz C, Valles JM, Capelastegui A, Marcos MA, Alfageme I, Zalacain R, Almirall J, Molinos L, Bello S, Rodríguez F, Blanquer J, Dorado A, Llevat N, Rello J. Microbial aetiology of healthcare associated pneumonia in Spain: a prospective, multicentre, case-control study. Thorax 2013; 68:1007-14. [PMID: 24130227 DOI: 10.1136/thoraxjnl-2013-203828] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Healthcare-associated pneumonia (HCAP) is actually considered a subgroup of hospital-acquired pneumonia due to the reported high risk of multidrug-resistant pathogens in the USA. Therefore, current American Thoracic Society/Infectious Diseases Society of America guidelines suggest a nosocomial antibiotic treatment for HCAP. Unfortunately, the scientific evidence supporting this is contradictory. METHODS We conducted a prospective multicentre case-control study in Spain, comparing clinical presentation, outcomes and microbial aetiology of HCAP and community-acquired pneumonia (CAP) patients matched by age (±10 years), gender and period of admission (±10 weeks). RESULTS 476 patients (238 cases, 238 controls) were recruited for 2 years from June 2008. HCAP cases showed significantly more comorbidities (including dysphagia), higher frequency of previous antibiotic use in the preceding month, higher pneumonia severity score and worse clinical status (Charslon and Barthel scores). While microbial aetiology did not differ between the two groups (HCAP and CAP: Streptococcus pneumoniae: 51% vs 55%; viruses: 22% vs 12%; Legionella: 4% vs 9%; Gram-negative bacilli: 5% vs 4%; Pseudomonas aeruginosa: 4% vs 1%), HCAP patients showed worse mortality rates (1-month: HCAP, 12%; CAP 5%; 1-year: HCAP, 24%; CAP, 9%), length of hospital stay (9 vs 7 days), 1-month treatment failure (5.5% vs 1.5%) and readmission rate (18% vs 11%) (p<0.05, each). CONCLUSIONS Despite a similar clinical presentation, HCAP was more severe due to patients' conditions (comorbidities) and showed worse clinical outcomes. Microbial aetiology of HCAP did not differ from CAP indicating that it is not related to increased mortality and in Spain most HCAP patients do not need nosocomial antibiotic coverage.
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Affiliation(s)
- Eva Polverino
- Servicio de Pneumologia, Hospital Clínic i Provincial de Barcelona, IDIBAPS, Barcelona, Spain
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Miravitlles M, Zalacain R, Murio C, Ferrer M, Alvarez-Sala JL, Masa JF, Verea H, Ros F, Vidal R. Speed of recovery from acute exacerbations of chronic obstructive pulmonary disease after treatment with antimicrobials : results of a two-year study. Clin Drug Investig 2012; 23:439-50. [PMID: 17535055 DOI: 10.2165/00044011-200323070-00003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE We performed a multicentre study under a 2-year observational protocol that included data on time to recovery from acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) in patients receiving moxifloxacin and comparator antimicrobials. PATIENTS AND METHODS Outpatients with moderate or severe COPD were recruited from respiratory clinics throughout Spain. Moxifloxacin was available in year 2, and was to be prescribed to 50% of patients in that period in a non-randomised allocation. Time to recovery was compared in successfully treated AE-COPD; cross-sectionally for all AE-COPD over 2 years, first AE-COPD and all AE-COPD in year 2, and longitudinally in patients receiving comparator antimicrobials for AE-COPD in year 1 and moxifloxacin in year 2. RESULTS 614 AE-COPD were treated in 441 patients over 2 years (mean age 66.7 +/- 8.3 years, 98% males, mean forced expiratory volume in 1 second [FEV(1)] 35.9 +/- 8.8%). Mean time to recovery overall was 4.6 days (SD 3.3) with moxifloxacin 400 mg/day for 5 days, and 5.8 days (SD 4.6) with comparators (p < 0.01), which were most frequently amoxicillin/clavulanic acid 500/125mg/8h, clarithromycin 500mg/12h and cefuroxime axetil 500mg/12h for 7-10 days. Longitudinal analysis showed that 27 patients treated with moxifloxacin in the second year of the study recovered in a mean of 3.7 days (SD 3.1), and the same patients treated with comparator antimicrobials in year one recovered in a mean of 6.8 days (SD 4.6) [p = 0.02]. In contrast, in 66 patients treated with comparator antimicrobials in both years, mean time to recovery was 7.4 days (SD 7.3) in year one and 5.5 days (SD 3.5) in year two (p = 0.24). All subgroup analyses showed a statistically significant reduction of 18-25% in time to recovery with moxifloxacin compared with other antibiotics. CONCLUSIONS Moxifloxacin significantly reduced time to recovery from AE-COPD in patients with moderate to severe disease by approximately 20% (>1 day) compared with other antimicrobials. Faster recovery should result in earlier return to work or normal activities, and to social and economic savings.
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Affiliation(s)
- Marc Miravitlles
- Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clinic i Provincial, Barcelona, Spain
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Menendez R, Torres A, Reyes S, Zalacain R, Capelastegui A, Aspa J, Borderias L, Martin-Villasclaras JJ, Bello S, Alfageme I, de Castro FR, Rello J, Molinos L, Ruiz-Manzano J. Initial management of pneumonia and sepsis: factors associated with improved outcome. Eur Respir J 2011; 39:156-62. [DOI: 10.1183/09031936.00188710] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Zalacain R. La escala CRB 65 en las neumonías de los pacientes ancianos. Med Clin (Barc) 2010; 135:115-7. [DOI: 10.1016/j.medcli.2009.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 11/18/2009] [Accepted: 11/24/2009] [Indexed: 11/29/2022]
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Alberto ruiz L, Zalacain R, Gómez A, Camino J, Jaca C, Manuel núñez J. Escherichia coli: An unknown and infrequent cause of community acquired pneumonia. ACTA ACUST UNITED AC 2009; 40:424-7. [DOI: 10.1080/00365540701732913] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Carrera Revilla S, Muñoz A, Zalacain R, López-Vivanco G, Uribarri M, Simón L, Calvo B, Jangi M, Rubio I, Ruiz de Lobera A. Potential diagnostic markers in bronchial fluid of small cell lung cancer (SCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22221 Background: Lung cancer is a major cause of mortality worldwide and overall survival rate has not improved significantly over the past 20 years. An early diagnosis could improve prognosis and survival among these patients. The aim of this study was to identify protein markers obtained from bronchial fluids of SCLC patients which may differ from non-pathological bronchoscopy samples. Methods: We have included 43 patients with SCLC diagnosed using bronchoscope and 49 consecutive patients with non pathological bronchoscopy. Bronquial fluid was obtained from each patient and potential protein markers were studied. After being centrifuged, supernatant proteins were analysed using bidimensional electrophoresis with poliacrilamid gel stained with silver nitrate. Gel was scanned and analysed with Progenesis PG6220 program, which measures intensity of each spot. Resultant intensities in each group of patients (SCLC/non pathological bronchoscopy) were compared using T-Student method. We selected as potential markers those spots with a p value of less than 0.05. We calculated “fold change” of each spot as the ratio between mean intensity in SCLC bronchoscopy samples and non pathological bronchoscopy samples. Results: Optimal bidimensional gels of each sample were obtained. Among 300 comparable spots, 10 of them were expressed with a different intensity in both groups of patients; 6 of these potential markers were over expressed in SCLC samples, whereas 4 of them were underexpressed. The “fold change” of these 10 spots ranges from 1.5 to 8.67. Conclusions: Different protein markers can be detected in bronchial fluid obtained from SCLC samples. Significant differences in expression of these biomarkers were detected between SCLC patients and non pathological bronchoscopy patients. The development of an early diagnostic test using these proteins must be validated in future studies. No significant financial relationships to disclose.
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Affiliation(s)
| | - A. Muñoz
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - R. Zalacain
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - G. López-Vivanco
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - M. Uribarri
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - L. Simón
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - B. Calvo
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - M. Jangi
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
| | - I. Rubio
- Hospital de Cruces, Barakaldo, Spain; Proteomika, Zamudio, Spain
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Lopez-Vivanco G, Muñoz A, Carrera S, Zalacain R, Uribarri M, Algorta J, Calvo B, Aresti U, Buque A, Mielgo X. Identification of potential diagnostic markers in bronchial fluid of patients with non small cell lung cancer (NSCLC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22216 Background: Early diagnosis in lung cancer could improve its treatment and, subsequently, its prognosis and survival. New proteomic techniques can identify potential diagnostic and prognostic markers. The aim of this study was to find protein markers in bronchial fluid which could enable early diagnosis in NSCLC. Methods: We have included 96 patients with NSCLC diagnosed using bronchoscope (64 scamous/29 adenocarcinoma/3 others) and 49 consecutive patients with non pathological bronchoscope. Bronchial fluid was obtained from each patient and potential protein markers were studied. Bronchial fluid was centrifuged and supernatant proteins were analysed using bidimensional electrophoresis with poliacrilamid gel stained with silver nitrate. Gel was scanned and analysed with Progenesis PG6220 program, which measures intensity of each spot. Resultant intensities in each group of patients (NSCLC/non pathological bronchoscope) were compared using T-Student method. We selected as potential markers those spots with a p value of less than 0.05. We calculated “fold change” of each spot as the ratio between mean intensity in NSCLC bronchoscopes samples and non pathological bronchoscopes samples. Results: We analysed 300 spots in each sample and we found 31 potential markers whose fold-change ranges from 1.49 to 7.41; 15 of the markers were expressed in a higher level in NSCLC samples and the other 16 were expressed in a lower level. Conclusions: We have identified 31 differential protein markers in bronchial fluid among our patients. These results could lead in an early diagnostic test which must be validated in future studies. No significant financial relationships to disclose.
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Affiliation(s)
| | - A. Muñoz
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - S. Carrera
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - R. Zalacain
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - M. Uribarri
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - J. Algorta
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - B. Calvo
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - U. Aresti
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - A. Buque
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
| | - X. Mielgo
- Hospital of Cruces, Bilbao, Spain; Proteomika, Zamudio, Spain
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Capelastegui A, Espana PP, Quintana JM, Bilbao A, Menendez R, Zalacain R, Torres A. Development of a prognostic index for 90-day mortality in patients discharged after admission to hospital for community-acquired pneumonia. Thorax 2009; 64:496-501. [DOI: 10.1136/thx.2008.098814] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Yandiola PPE, Capelastegui A, Quintana J, Diez R, Gorordo I, Bilbao A, Zalacain R, Menendez R, Torres A. Prospective comparison of severity scores for predicting clinically relevant outcomes for patients hospitalized with community-acquired pneumonia. Chest 2009; 135:1572-1579. [PMID: 19141524 DOI: 10.1378/chest.08-2179] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The comparative accuracy and discriminatory power of three validated rules for predicting clinically relevant outcomes other than mortality in patients hospitalized with community-acquired pneumonia (CAP) are unknown. METHODS We prospectively compared the newly developed severe community-acquired pneumonia (SCAP) score, pneumonia severity index (PSI), and the British Thoracic Society confusion, urea > 7 mmol/L, respiratory rate > or = 30 breaths/min, BP < 90 mm Hg systolic or < 60 mm Hg diastolic, age > or = 65 years (CURB-65) rule in an internal validation cohort of 1,189 consecutive adult inpatients with CAP from one hospital and an external validation cohort of 671 consecutive adult inpatients from three other hospitals. Major adverse outcomes were admission to ICU, need for mechanical ventilation, progression to severe sepsis, or treatment failure. Mean hospital length of stay (LOS) was also evaluated. The rules were compared based on sensitivity, specificity, and area under the curve (AUC) of the receiver operating characteristic. RESULTS The rate of all adverse outcomes and hospital LOS increased directly with increasing SCAP, PSI, or CURB-65 scores (p < 0.001) in both cohorts. Patients classified as high risk by the SCAP score showed higher rates of adverse outcomes (ICU admission, 35.8%; mechanical ventilation, 16.4%; severe sepsis, 98.5%; treatment failure, 22.4%) than PSI and CURB-65 high-risk classes. The discriminatory power of SCAP, as measured by AUC, was 0.75 for ICU admission, 0.76 for mechanical ventilation, 0.79 for severe sepsis, and 0.61 for treatment failure in the external validation cohort. AUC differences with PSI or CURB-65 were found. CONCLUSIONS The SCAP score is as accurate or better than other current scoring systems in predicting adverse outcomes in patients hospitalized with CAP while helping classify patients into different categories of increasing risk for potentially closer monitoring.
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Affiliation(s)
| | | | - José Quintana
- Research Unit, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Rosa Diez
- Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Inmaculada Gorordo
- Service of Pneumology, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Amaia Bilbao
- Basque Foundation for Health Innovation and Research, Sondika, Bizkaia, Spain
| | | | - Rosario Menendez
- Service of Pneumonology, Hospital Universitario La Fe, Valencia, Spain
| | - Antonio Torres
- Hospital Clinic Institut d'Investigacions Biomédiques August Pi i Sunyer, Universita de Barcelona, Barcelona, Spain
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Miravitlles M, Ferrer M, Pont A, Zalacain R, Alvarez-Sala JL, Masa F, Verea H, Murio C, Ros F, Vidal R. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study. Thorax 2004; 59:387-95. [PMID: 15115864 PMCID: PMC1746989 DOI: 10.1136/thx.2003.008730] [Citation(s) in RCA: 389] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND A study was undertaken to evaluate exacerbations and their impact on the health related quality of life (HRQL) of patients with chronic obstructive pulmonary disease (COPD). METHODS A 2 year follow up study was performed in 336 patients with COPD of mean (SD) age 66 (8.2) years and mean (SD) forced expiratory volume in 1 second (FEV(1)) 33 (8)% predicted. Spirometric tests, questions regarding exacerbations of COPD, and HRQL measurements (St George's Respiratory Questionnaire (SGRQ) and SF-12 Health Survey) were conducted at 6 month intervals. RESULTS A total of 1015 exacerbations were recorded, and 103 (30.7%) patients required at least one hospital admission during the study. After adjustment for baseline characteristics and season of assessment, frequent exacerbations had a negative effect on HRQL in patients with moderate COPD (FEV(1) 35-50% predicted); the change in SGRQ total score of moderate patients with > or =3 exacerbations was almost two points per year greater (worse) than those with <3 exacerbations during the follow up (p = 0.042). For patients with severe COPD (FEV(1) <35% predicted) exacerbations had no effect on HRQL. The change in SGRQ total score of patients admitted to hospital was almost 2 points per year greater (worse) than patients not admitted, but this effect failed to show statistical significance in any severity group. There was a significant and independent seasonal effect on HRQL since SGRQ total scores were, on average, 3 points better in measurements performed in spring/summer than in those measured in the winter (p<0.001). CONCLUSIONS Frequent exacerbations significantly impair HRQL of patients with moderate COPD. A significant and independent effect of seasonality was also observed.
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Affiliation(s)
- M Miravitlles
- Servei de Pneumologia, Institut Clínic de Pneumologia i Cirurgia Toràcica (IDIBAPS), Hospital Clinic, Barcelona, Spain.
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Abstract
OBJECTIVE The objective of this study has been the description of the cases of carcinoid tumor diagnosed in our Pneumology Service along the last 15 years. METHODS The study has been conducted retrospectively, including the period between January 1, 1987 and December 31, 2001. The clinical histories of all patients with a diagnosis of carcinoid tumor have been reviewed, collecting the demographic clinical, radiological, bronchoscopic, therapeutic, and evolutionary data. RESULTS. On the whole, 41 cases were diagnosed, 36 typical (88%) and 5 atypical (12%), representing 2% of the total of lung neoplasms. The average age was 50 years, and 66% patients were males, with 61% of smokers and ex-smokers. The most relevant clinical parameter was cough with 68% of cases. Chest X-ray was pathological in 88% and CAT in 100%. Bronchoscopy was done in 40 patients, being the localization of the tumor peripheral in 10% and central in 90%. In 37.5% the classical endoscopic image suggestive of this tumor was observed. The definitive diagnosis was obtained in 26 cases by bronchial biopsy, in 14 cases through thoracotomy, and in 1 case by CAT-guided fine-needle aspiration biopsy. Surgical treatment was carried out in 36 patients (88%). Five year follow-up has been completed in 16 (39%) patients, with 5 recurrences (2 local and 3 systemic). Five patients were lost for follow-up (12%), and in the 20 patients remaining (49%) the evolution is less than 5 years, with no recurrences up to now. There has not been any death. CONCLUSIONS We conclude that carcinoid tumors are infrequent, most of them central in location, and are diagnosed preferably by bronchoscopy, although the number of cases with suggestive findings is less than 50%. The treatment is surgical except for contraindications, and the percentage of recurrences has been limited.
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Affiliation(s)
- A Gómez
- Servicio de Neumología, Hospital de Cruces, Vizcaya
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Aspa J, Rajas O, Rodríguez de Castro F, Blanquer J, Zalacain R, Fenoll A, de Celis R, Vargas A, Rodríguez Salvanés F, España PP, Rello J, Torres A. Drug‐Resistant Pneumococcal Pneumonia: Clinical Relevance and Related Factors. Clin Infect Dis 2004; 38:787-98. [PMID: 14999620 DOI: 10.1086/381886] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Accepted: 11/03/2003] [Indexed: 11/03/2022] Open
Abstract
A multicenter study of 638 cases of community-acquired pneumonia due to Streptococcus pneumoniae (SP-CAP) was performed to assess current levels of resistance. Of the pneumococcal strains, 35.7% had an minimum inhibitory concentration (MIC) of penicillin of > or =0.12 microg/mL (3 isolates had an MIC of 4 microg/mL), 23.8% had an MIC of erythromycin of 128 microg/mL, and 22.2% were multidrug resistant. Logistic regression determined that chronic pulmonary disease (odds ratio [OR], 1.44], human immunodeficiency virus infection (OR, 1.98), clinically suspected aspiration (OR, 2.12), and previous hospital admission (OR, 1.69) were related to decreased susceptibility to penicillin, and previous admission (OR, 1.89) and an MIC of penicillin of MIC > or =0.12 microg/mL (OR, 15.85) were related to erythromycin resistance (MIC, > or =1 microg/mL). The overall mortality rate was 14.4%. Disseminated intravascular coagulation, empyema, and bacteremia were significantly more frequent among patients with penicillin-susceptible SP-CAP. Among isolates with MICs of penicillin of > or =0.12 microg/mL, serotype 19 was predominant and was associated with a higher mortality rate. In summary, the rate of resistance to beta -lactams and macrolides among S. pneumoniae that cause CAP remains high, but such resistance does not result in increased morbidity.
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Affiliation(s)
- Javier Aspa
- Servicio de Neumologia, Hospital de la Princesa, Madrid, Spain.
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Zalacain R, Torres A, Celis R, Blanquer J, Aspa J, Esteban L, Menéndez R, Blanquer R, Borderías L. Community-acquired pneumonia in the elderly: Spanish multicentre study. Eur Respir J 2003; 21:294-302. [PMID: 12608444 DOI: 10.1183/09031936.03.00064102] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Community-acquired pneumonia (CAP) in the elderly has increased as a consequence of an overall increase of the elderly population. A controversy about the aetiology and outcome of CAP in this population still exists and more epidemiological studies are needed. A prospective, 12-month, multicentre study was carried out to assess the clinical characteristics, aetiology, evolution and prognostic factors of elderly patients (> or = 65 yrs) admitted to hospital for CAP. The study included 503 patients (age 76 +/- 7 yrs). The clinical picture lasted < or = 5 days in 318 (63%) and the main clinical features were cough (n = 407, 81%) and fever (n = 380, 76%). Aetiological diagnosis was achieved in 199 (40%) cases, with a definite diagnosis obtained in 164 (33%). Of the 223 microorganisms isolated the main agents found were Streptococcus pneumoniae in 98 (49%) and Haemophilus influenzae in 27 (14%). A total of 53 patients died (11%) and the multivariate analysis showed the following factors of bad prognosis: previous bed confinement, alteration in mental status, absence of chills, plasma creatinine > or = 1.4 mg x dL(-1), oxygen tension in arterial blood/inspiratorv oxygen fraction ratio < 200 at the time of admission, and shock and renal failure during the evolution. The results of this study may aid in the management of empiric antibiotic treatment in elderly patients with community-acquired pneumonia and the patients who have a greater probability of bad evolution may be identified based on the risk factors.
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Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Bilbao, Spain.
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Miravitlles M, Alvarez-Sala JL, Lamarca R, Ferrer M, Masa F, Verea H, Zalacain R, Murio C, Ros F. Treatment and quality of life in patients with chronic obstructive pulmonary disease. Qual Life Res 2002; 11:329-38. [PMID: 12086118 DOI: 10.1023/a:1015520110663] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Treatments administered to patients with chronic obstructive pulmonary disease (COPD), especially when used in multiple combinations, are not free of interactions and side effects that can potentially impair health-related quality of life (HRQL). We studied HRQL and its relationship with treatment in a group of 441 patients with stage II or III COPD (age: 66.6 (SD: 8.3) years; FEV1: 32.4% (SD: 8.1%)) using the St George's Respiratory Questionnaire (SGRQ) and the 12-item short form (SF-12) Health Survey. The most prescribed drugs were ipratropium bromide (87.5%), inhaled corticosteroids (69.4%) and short-acting beta-2 agonists (64.9%). Patients with stage III of the disease were receiving more drugs, particularly short-acting beta-2 agonists (p = 0.002) and inhaled corticosteroids (p = 0.031). The use of theophyllines was associated with a worse total SGRQ score (beta = 4.49; p < 0.001), although this negative association decreased with advanced age. A trend towards worse SGRQ scores was observed with the use of high doses of long-acting beta-2 agonists (beta = 3.22; p = 0.072). Patients receiving three drugs or more presented worse total SGRQ scores than patients receiving fewer drugs (beta = 6.1, p < 0.001; and beta = 7.64, p < 0.001, respectively). These findings suggest that the use of multiple drugs in the treatment of patients with COPD is associated with worse total SGRQ scores. The effect of drugs, their dosages and associations with other drugs on HRQL merit further research.
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Affiliation(s)
- M Miravitlles
- Servei de Pneumologia, Hospital General Vall d'Hebron, Barcelona, Spain.
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Abstract
Liposarcomas are malignant mesenchymal tumors whose primary location in the mediastinum is rare. We report two cases of mediastinal liposarcoma, describing the clinical signs and radiologic features found and the diagnostic procedures performed. The significance of histologic variability as a factor that conditions treatment and prognosis is underlined.
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Affiliation(s)
- L A Ruiz
- Servicio de Neumología, Hospital de Cruces, Baracaldo, Vizcaya
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Zalacain R, Sobradillo V, Amilibia J, Barrón J, Achótegui V, Pijoan JI, Llorente JL. Predisposing factors to bacterial colonization in chronic obstructive pulmonary disease. Eur Respir J 1999; 13:343-8. [PMID: 10065679 DOI: 10.1034/j.1399-3003.1999.13b21.x] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this prospective observational study was to determine those factors influencing bacterial colonization in patients with stable chronic obstructive pulmonary disease (COPD). Eighty-eight outpatients with stable COPD and 20 patients with normal spirometry and chest radiography (controls) had a fibreoptic bronchoscopy performed with topical aerosol anaesthesia. Bacterial colonization was determined using the protected specimen brush (PSB) with a cut-off > or = 10(3) colony-forming units (CFU x mL(-1)). The influence of age, degree of airflow obstruction, smoking habit, pack-yrs of smoking, and chest radiographic findings on bacterial colonization were assessed by univariate and multivariate analysis. Significant bacterial growth was found in 40% of patients and in none of the controls. Haemophilus influenzae, Streptococcus viridans, S. pneumoniae and Moraxella catarrhalis were the most frequent pathogens. After adjustment for other variables, severe airflow limitation (odds ratio (OR) 5.11, 95% confidence interval (CI) 1.45-17.9) and current smoking (OR 3.17, 95% CI 2.5-8) remained associated with positive bacterial cultures. When only potentially pathogenic micro-organisms were considered, significant bacterial growth was found in 30.7% of patients, with severe airflow obstruction (OR 9.28, 95% CI 2.19-39.3) being the only variable independently associated with positive bacterial cultures. Our results show that stable chronic obstructive pulmonary disease patients have a high prevalence of bacterial colonization of distal airways which is mainly related to the degree of airflow obstruction and cigarette smoking.
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Affiliation(s)
- R Zalacain
- Service of Pneumology, Hospital de Cruces, Cruces-Barakaldo, Vizcaya, Spain
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Zalacain R, Camino J, Cabriada V. [Pneumonia in the elderly]. Arch Bronconeumol 1998; 34 Suppl 2:63-7. [PMID: 9846215] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Vizcaya
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Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Vizcaya
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Ruiz LA, Gil P, Zalacain R, Cabriada V, Barrón J, García-Riego A, Llorente JL. [Usefulness of bronchoalveolar lavage in the renal transplant patient with suspected respiratory infection]. Arch Bronconeumol 1998; 34:388-93. [PMID: 9803276 DOI: 10.1016/s0300-2896(15)30384-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this retrospective study we aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in kidney transplant patients who were suspected of having severe respiratory infection or in whom empirical antibiotic treatment had failed. All BAL procedures performed on kidney transplanted patients suspected of having respiratory infections between January 1, 1988 and July 31, 1996 were analyzed. BAL was carried out in the standard way and samples were sent for cytologic and bacteriologic study. Thirty-three patients with a mean age of 48.5 years were enrolled. All had been receiving immunosuppressive treatment and the mean time following transplantation was 320 days. Thirty-one had received antibiotic treatment before BAL. BAL was positive for 21 of the 33 patients (64%). Twenty-two pathogens were identified: 6 Pneumocystis carinii, 4 Cytomegalovirus, 3 Mycobacterium tuberculosis, 2 Aspergillus fumigatus, 2 Herpes simplex type I, 1 Streptococcus pneumoniae, 1 Staphylococcus aureus, 1 Streptococcus mitis, 1 Legionella pneumophila, 1 Legionella longbeachae. BAL was negative for 12 patients, of whom 8 were tentatively diagnosed of bacterial infection, 3 of acute pulmonary edema and one of pulmonary infarction. Based on the results, therapy was changed for 20 patients (61%), 19 (58%) because an unsuspected pathogen was identified and 1 because treatment could be simplified. The diagnostic yield of BAL is high (64%) in kidney transplant patients suspected of respiratory infection and is useful for managing such cases, as evidenced by the fact that a high proportion (19/33) of our patients were infected by pathogens not covered by empirical treatment.
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Affiliation(s)
- L A Ruiz
- Servicio de Neumología, Hospital de Cruces, Baracaldo, Vizcaya
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Dorca J, Bello S, Blanquer J, de Celis R, Molinos L, Torres A, Verano A, Zalacain R. [The diagnosis and treatment of community-acquired pneumonia. SEPAR. Sociedad Española de Neumología y Cirugía Torácica]. Arch Bronconeumol 1997; 33:240-6. [PMID: 9254171 DOI: 10.1016/s0300-2896(15)30614-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- J Dorca
- Hospital Prínceps d'Espanya, L'Hospitalet de Llobregat, Barcelona
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Abstract
We report three cases of thoracic actinomycosis whose symptoms were cutaneous tumors on the thorax. Clinical signs and images are described, along with diagnostic procedures. The excellent outcome after antibiotic treatment, which must last at least 6 months, is emphasized as well as the need to keep this disease in mind when certain symptoms and images coincide.
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Affiliation(s)
- P Gil
- Servicio de Neumología, Hospital de Cruces, Baracaldo, Vizcaya
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Zalacain R, Talayero N, Achótegui V, Corral J, Barreña I, Sobradillo V. [Community acquired pneumonia. Reliability of the criteria for deciding ambulatory treatment]. Arch Bronconeumol 1997; 33:74-9. [PMID: 9091117 DOI: 10.1016/s0300-2896(15)30657-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To determine whether criteria for not admitting community-acquired pneumonia (CAP) patients diagnosed in the emergency room are appropriate, and to characterize the symptoms, etiology and course of CAP. This one-year prospective, protocol study of immunocompetent CAP patients diagnosed in the emergency room of our hospital enrolled patients not considered to require hospital admission according to the recommendations of the Spanish Society of Respiratory Disease (SEPAR). Medical histories, chest X-rays and blood analysis were obtained for all patients. Blood cultures were analyzed for antibodies against Legionella pneumophila, Mycoplasma pneumoniae, Coxiella burnetii, Chlamydia pneumoniae, Chlamydia psittaci and influenza virus types A and B. The patients received erythromycin for 14 days and were regularly checked by the pulmonologist in the outpatient clinic until signs and symptoms had disappeared. One hundred six patients were enrolled. Mean age was 36 +/- 13 years. Only 3 patients had to be admitted to hospital, after which outcome was good. The main symptoms were fever (106, 100%) and cough (83, 78%). In 46 (43.4%) chest sounds were normal. Microbiologic diagnoses were achieved for 28 (26.4%) and Coxiella burnetii was the agent most often found (19, 17.9%). Outcome was good in all cases, with faster disappearance of symptoms than of radiological signs. The SEPAR criteria for admitting patients with CAP are appropriate. The clinical symptoms of such patients are non specific, a noteworthy finding being that many patients had normal chest sounds. Coxiella burnetii was the most common causative agent. Both clinical and radiological outcomes were excellent.
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Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Barakaldo, Vizcaya
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Abstract
To determine the presence of germs and their concentration in a group of patients with severe chronic obstructive pulmonary disease (COPD) (FEV1 < 50%), some of whom were in stable condition and others of whom were in acute phase. Twenty-six patients with severe COPD (14 stable and 12 acute phase) were enrolled. None had received prior antibiotic or corticoid treatment. The stable patients had no signs or symptoms of exacerbation, whereas the acute-phase patients had increased dyspnea, sputum volume and purulence. The patients received aerosol rather than liquid anesthesia when PSB sampling was performed. A PSB finding was considered positive at a level > or = 10(3) CFU/ml. There were no significant differences between the groups with respect to age, sex, proportion of smokers and ex-smokers or packs per year. The only spirometric measure that was significantly different was (FEV1/FVC, which was lower in the acute-phase group (p < 0.05). Positive PSB findings were recorded for 57.1% of the stable patients and for 66.7% of the acute-phase patients (p = NS). H. influenzae was the microorganism found most often in both groups. The mean CFU/ml level was 8,625 in stable patients and 17,375 in acute-phase patients (p = NS). A large proportion of stable patients (57.1%) with severe COPD harbor significant concentrations of germs as revealed by PSB sampling. Germ concentrations were found in a non significantly greater number of acute-phase patients, confirming the lack of congruence between clinical status and bacteriological condition.
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Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Vizcaya
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Pascal I, Camino J, Ansola P, Zalacain R. [Dog bite and Pasteurella multocida pneumonia]. Med Clin (Barc) 1996; 106:757. [PMID: 8801392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Zalacain R, Llorente JL, Gaztelurrutia L, Pijoan JI, Sobradillo V. Influence of three factors on the diagnostic effectiveness of transthoracic needle aspiration in pneumonia. Chest 1995; 107:96-100. [PMID: 7813320 DOI: 10.1378/chest.107.1.96] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Prior antibiotic therapy, size of the infiltrate, and the person who performed the technique were the three factors that we studied to assess their influence on the effectiveness of transthoracic needle aspiration (TNA). Ninety-one patients with a diagnosis of severe bacterial pneumonia, who underwent TNA, have been included in the study. The technique was carried out with an ultrathin needle gauge 25 and without fluoroscopic control. A univariate (UA) and a multivariate statistical analysis were made. The sensitivity of TNA was 34.1%. Fifty-seven of 91 (62.6%) had received antibiotic therapy prior to TNA; sensitivity was higher in nontreated patients than in treated patients (p = 0.0033; UA). There were 34 patients with an infiltrate that was smaller than a lobe (MINLOB); 39 cases affected a complete lobe (LOB) and 18 more than one lobe (MAJLOB). The TNA sensitivity was higher in LOB cases than in MINLOB cases (p = 0.0004; UA) while when comparing LOB cases and MAJLOB cases, sensitivity was higher in the former (p = NS; UA). In 28 of 91 cases (30.8%), the TNA was performed by A (a trained physician who regularly carries out the technique) and in 63 of 91 cases (69.2%) by B (other physicians, 10 in our study, who sporadically perform the technique). The TNA sensitivity was higher when the technique was performed by A, although this difference was not significant; if we add negative TNA with leukocytes present in Gram stains (which would indicate that aspiration was done in the correct area) to positive TNA, the difference between A and B was higher (p = 0.0248). The multivariate statistical analysis confirmed that there are two variables that are independently connected to a positive TNA (prior antibiotic therapy and size of the infiltrate). As regards the variable "person who carries out the technique," a significant association with a positive TNA was not established, although the estimations we obtained show a possible clinical relevance.
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Affiliation(s)
- R Zalacain
- Servicio de Neumología, Hospital de Cruces, Vizcaya, Spain
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