High Risk Of Clinical Deterioration Research Articles

Performance of 21 Early Warning System scores in predicting in-hospital deterioration among undifferentiated admitted patients managed by ambulance services

BackgroundThe optimal Early Warning System (EWS) scores for identifying patients at risk of clinical deterioration among those transported by ambulance services remain uncertain. This retrospective study compared the performance of...

Risk of early clinical deterioration and 30-day mortality in pulmonary embolism intermediate-high-risk patients with patent foramen ovale.

We assess the prognostic role of patent foramen ovale (PFO) for the estimation of 30-day mortality and risk of 48-h clinical deterioration since admission, in intermediate-high-risk pulmonary embolism (PE) patients. A post-hoc analysis of intermediate-high-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. The entire cohort was divided according to the presence or absence of PFO after transthoracic echocardiography (TTE) evaluation. Among 450 intermediate-high-risk PE patients (mean age 71.4 ± 13.8years, 298 males), PFO was diagnosed in 68 (15.1%) cases. A higher mortality rate (29.4% vs. 3.1%, p < 0.001) as well as occurrence of clinical deterioration within 48h from admission (38.2% vs. 3.6%, p < 0.001) were observed in intermediate-high-risk PE patients with PFO compared to those without multivariate Cox regression analysis showed that the presence of a PFO predicts 30-day mortality (HR: 3.21, 95% CI 3.16-3.27, p < 0.001) and was also associated with a significantly higher risk of 48-h clinical deterioration [HR: 2.24 (95% CI 2.20-2.29), p < 0.0001] in intermediate-high-risk PE patients. The presence of a PFO in intermediate-high-risk PE patients is associated with a higher risk of clinical deterioration within 48h from admission and 30-day mortality.

Effectiveness of an Artificial Intelligence–Enabled Intervention for Detecting Clinical Deterioration

Inpatient clinical deterioration is associated with substantial morbidity and mortality but may be easily missed by clinicians. Early warning scores have been developed to alert clinicians to patients at high risk of clinical deterioration, but there is limited evidence for their effectiveness. To evaluate the effectiveness of an artificial intelligence deterioration model-enabled intervention to reduce the risk of escalations in care among hospitalized patients using a study design that facilitates stronger causal inference. This cohort study used a regression discontinuity design that controlled for confounding and was based on Epic Deterioration Index (EDI; Epic Systems Corporation) prediction model scores. Compared with other observational research, the regression discontinuity design facilitates causal analysis. Hospitalized adults were included from 4 general internal medicine units in 1 academic hospital from January 17, 2021, through November 16, 2022. An artificial intelligence deterioration model-enabled intervention, consisting of alerts based on an EDI score threshold with an associated collaborative workflow among nurses and physicians. The primary outcome was escalations in care, including rapid response team activation, transfer to the intensive care unit, or cardiopulmonary arrest during hospitalization. During the study, 9938 patients were admitted to 1 of the 4 units, with 963 patients (median [IQR] age, 76.1 [64.2-86.2] years; 498 males [52.3%]) included within the primary regression discontinuity analysis. The median (IQR) Elixhauser Comorbidity Index score in the primary analysis cohort was 10 (0-24). The intervention was associated with a -10.4-percentage point (95% CI, -20.1 to -0.8 percentage points; P = .03) absolute risk reduction in the primary outcome for patients at the EDI score threshold. There was no evidence of a discontinuity in measured confounders at the EDI score threshold. Using a regression discontinuity design, this cohort study found that the implementation of an artificial intelligence deterioration model-enabled intervention was associated with a significantly decreased risk of escalations in care among inpatients. These results provide evidence for the effectiveness of this intervention and support its further expansion and testing in other care settings.

The value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism: A cross sectional analysis

IntroductionPulmonary embolism (PE) is a significant global cause of mortality, ranking third after myocardial infarction and stroke. ECG findings may play a valuable role in the prognostication of patients with PE, with various ECG abnormalities proving to be reasonable predictors of haemodynamic decompensation, cardiogenic shock, and even mortality. This study aims to assess the value of electrocardiography in predicting inpatient mortality in patients with acute pulmonary embolism, as diagnosed with computed tomography pulmonary angiogram. MethodThis study was a cross sectional analysis based at Tygerberg Hospital, Cape Town, South Africa. Eligible patients were identified from all CT-PA performed between 1 January 2017 and 31 December 2019 (2 years). The ECGs were independently screened by two blinded emergency physicians for predetermined signs that are associated with right heart strain and higher pulmonary artery pressures, and these findings were analysed to in-hospital mortality. ResultsOf the included 81 patients, 61 (75 %) were female. Of the 41 (51 %) patients with submassive PE and 8 (10 %) with massive PE, 7 (17 %) and 3 (38 %) suffered inpatient mortality (p = 0.023) respectively. Univariate ECG analysis revealed that complete right bundle branch block (OR, 8.6; 95 % CI, 1.1 to 69.9; p = 0.044) and right axis deviation (OR, 5.6; 95 % CI, 1.4 to 22.4; p = 0.015) were significant predictors of inpatient mortality. ConclusionEarly identification of patients with pulmonary embolism at higher risk of clinical deterioration and in-patient mortality remains a challenge. Even though no clinical finding or prediction tool in isolation can reliably predict outcomes in patients with pulmonary embolism, this study demonstrated two ECG findings at presentation that were associated with a higher likelihood of inpatient mortality. This single-centre observational study with a small sample precludes concrete conclusions and a large follow-up multi-centre study is advised.

Abstract TMP70: Association of Distal Hyperintense Vessel Sign and Outcomes in Patients With Symptomatic Posterior Circulation Intracranial Atherosclerotic Disease

Objectives: The Distal Hyperintense Vessel (DHV) sign on FLAIR imaging is a radiographic marker of inadequate blood flow due to poor collateral flow distal to the stenotic artery. Previous studies suggest that the DHV sign was associated with early recurrent ischemic stroke in the anterior circulation secondary to intracranial atherosclerotic disease (ICAD). However, its significance in ischemic stroke in the posterior circulation is unknown. Here, we investigate the association of DHV sign in the basilar artery and outcomes at discharge in patients with posterior circulation stroke or TIA secondary to ICAD. Methods: We retrospectively reviewed patients with ischemic strokes or TIA attributed to ICAD of the basilar or vertebral arteries admitted to two comprehensive stroke centers affiliated with UTSW Medical Center from 2010 to 2022. Patients were included if they met VERiTAS criteria (≥50% vertebrobasilar stenosis). The DHV sign was defined as positive when the increased intensity in the basilar artery distal to stenosis was higher than the surrounding CSF signal. The DHV sign was evaluated by blinded vascular neurologists and neuro-radiologists. The primary outcome was mRS at discharge. The secondary outcome was the incidence of clinical deterioration during admission, defined as any worsened neurological exam with associated new infarct or infarct expansion in the posterior circulation. Results: A total of 135 patients were included in the study. A total of 33 (24%) patients had the presence of the DHV sign on admission MRI. Compared to patients without DHV sign, patients with DHV sign had higher NIHSS scores on admission (median 7 vs 2, p&lt;0.001), higher risk of clinical deterioration during hospitalization (27% vs 2%, p&lt;0.001), higher mRS scores at discharge (median 3.45 vs 1.8, p&lt;0.001) and higher mortality rate (24% vs 0%, p&lt;0.001). In multivariate analysis, the DHV sign was an independent predictor of higher mRS scores at discharge. Conclusions: In patients with ischemic stroke or TIA secondary to basilar or vertebral artery atherosclerotic stenosis, the presence of the DHV sign in the basilar artery is associated with more severe disease and poorer outcomes at discharge compared to patients without DHV sign.

Association of non-contrast CT markers with long-term functional outcome in deep intracerebral hemorrhage.

Hematoma expansion (HE) is the most important therapeutic target during acute care of patients with intracerebral hemorrhage (ICH). Imaging biomarkers such as non-contrast CT (NCCT) markers have been associated with increasing risk for HE. The aim of the present study was to evaluate the influence of NCCT markers with functional long-term outcome and with HE in patients with deep (basal ganglia and thalamus) ICH who represent an important subgroup of patients at the highest risk for functional deterioration with HE due to the eloquence of the affected brain region. From our prospective institutional database, all patients maximally treated with deep ICH were included and retrospectively analyzed. NCCT markers were recorded at diagnostic imaging, ICH volume characteristics were volumetrically evaluated, and all patients received follow-up imaging within 0-48 h. We explored associations of NCCT makers with unfavorable functional outcome, defined as modified Rankin scale 4-6, after 12 months and with HE. Bias and confounding were addressed by multivariable regression modeling. In 322 patients with deep ICH, NCCT markers were distributed as follows: irregular shape: 69.6%, heterogenous density: 55.9%, hypodensities: 52.5%, island sign: 19.3%, black hole sign: 11.5%, and blend sign: 4.7%. Upon multivariable regression analyses, independent associations were documented with the functional outcome for irregular shape (aOR: 2.73, 95%CI: 1.42-5.22, p = 0.002), heterogenous density (aOR: 2.62, 95%CI: 1.40-4.90, p = 0.003) and island sign (aOR: 2.54, 95%CI: 1.05-6.14, p = 0.038), and with HE for heterogenous density (aOR: 5.01, 95%CI: 1.93-13.05, p = 0.001) and hypodensities (aOR: 3.75, 95%CI: 1.63-8.62, p = 0.002). NCCT markers are frequent in deep ICH patients and provide important clinical implications. Specifically, markers defined by diverging intra-hematomal densities provided associations with a 5-times higher risk for HE and a 2.5-times higher likelihood for unfavorable functional long-term outcome. Hence, these markers allow the identification of patients with deep ICH at high risk for clinical deterioration due to HE.

Lung Ultrasound: A Useful Prognostic Tool in the Management of Bronchiolitis in the Emergency Department.

Lung ultrasound, a non-invasive bedside technique for assessing paediatric patients with acute respiratory diseases, is becoming increasingly widespread. The aim of this prospective, observational cohort study was to evaluate the effectiveness of a clinical ultrasound score in assessing infants with acute bronchiolitis in the emergency department and its ability to accurately identify patients at a higher risk of clinical deterioration. Infants under 6 months of age with clinical symptoms compatible with acute bronchiolitis were enrolled and underwent clinical and lung ultrasound evaluations. The study included 50 patients, the median age of which was 2.2 months (IQR: 1-5), and the primary outcome was respiratory support. Infants requiring invasive or non-invasive ventilation showed higher scores (5 points [IQR: 3.5-5.5] vs. 2.5 [IQR: 1.5-4]). The outcome had an AUC of 0.85 (95%CI: 0.7-0.98), with a sensitivity of 87%, specificity of 64%, and negative predictive value of 96.4% for a score <3.5 points. Children who scored ≥3.5 points were more likely to require respiratory support within the next 24 h (estimated event-free survival of 82.9% compared to 100%, log-rank test p-value = 0.02). The results suggest that integrating lung ultrasound findings into clinical scores when evaluating infants with acute bronchiolitis could be a promising tool for improving prognosis.

Early predictors of clinical deterioration in intermediate-high risk pulmonary embolism: clinical needs, research imperatives, and pathways forward.

A subset of intermediate-high risk pulmonary embolism (PE) patients will suffer clinical deterioration in the early hours following the acute event. Current evidence-based guidelines for the management of acute PE have provided limited direction for identification of which intermediate-high risk PE patients will go on to develop haemodynamic decompensation. Furthermore, a paucity of data further hampers guideline recommendations regarding the optimal approach and duration of intensive monitoring, best methods to assess the early response to anticoagulation, and the ideal window for reperfusion therapy, if decompensation threatens. The aim of the present article is to identify the current unmet needs related to the early identification of intermediate-high risk PE patients at higher risk of clinical deterioration and mortality during the early hours after the acute cardiovascular event and suggest some potential strategies to further explore gaps in the literature.

The potential of cystatin C as a predictive biomarker in pulmonary hypertension

BackgroundCystatin C is a novel biomarker to identify renal dysfunction and cardiovascular risk.ObjectiveThe aim of this study was to investigate the role of cystatin C in non-invasive risk prediction in a large cohort of patients with pre-capillary pulmonary hypertension (PH).MethodWe retrospectively analyzed pre-capillary PH patients with available cystatin C and hemodynamic data derived from right heart catheterization.ResultsA total of 398 consecutive patients with confirmed pre-capillary PH were recruited from Fuwai Hospital between November 2020 and November 2021. Over a median duration of 282 days, 72 (18.1%) of these patients experienced clinical worsening. Cystatin C levels significantly correlated with cardiac index (r = -0.286, P < 0.001), mixed venous oxygen saturation (r = -0.216, P < 0.001), and tricuspid annular plane systolic excursion (r = -0.236, P < 0.001), and high cystatin C levels independently predicted a poor prognosis after adjusting potential confounders in different models (all P < 0.05). A three-group non-invasive risk model was constructed based on the combined assessment of the cystatin C and WHO-FC using dichotomous cut-off value. Those patients with higher cystatin C (≥ 1.0 mg/L) and a worse WHO-FC experienced the highest risk of endpoint occurrence. The predictive capacity of this model was comparable to that of an existing invasive risk stratification model (area under curve: 0.657 vs 0.643, P = 0.619).ConclusionsCystatin C levels were associated with disease severity and prognosis in patients with pre-capillary PH. A combination of high cystatin C and advanced WHO-FC identifies patients at particularly high risk of clinical deterioration.

Support vector machine with optimized parameters for the classification of patients with COVID-19

Introduction. The COVID-19 pandemic has had a significant impact worldwide, especially in health, where it is crucial to identify patients at high risk of clinical deterioration early. Objective. This study aimed to design a model based on the support vector machine (SVM) algorithm, optimizing its parameters to classify patients with suspected COVID-19. Methodology. One thousand patient records from two health establishments in Peru were used. After applying data preprocessing and variable engineering, the sample was reduced to 700 records. The construction of the model followed a machine learning methodology, using the linear, polynomial, sigmoid, and radial kernel functions, along with their estimated optimal parameters, to ensure the best performance. Results. The results revealed that the SVM model with the linear and sigmoid kernels presented an accuracy of 95%, surpassing the polynomial kernel with 94% and the radial kernel (RBF) with 94%. In addition, a value of 0.92 was obtained for Cohen's kappa, which measures the degree of agreement between the predictions of the machine learning model and the actual results, which indicates an excellent deal for the linear and sigmoid kernel. Conclusions. In conclusion, the SVM model with linear and sigmoid kernels could be a valuable tool for identifying patients at high risk of clinical deterioration in the context of the COVID-19 pandemic.

Tenecteplase: A Review of Its Pharmacology and Uses.

Tenecteplase: A Review of Its Pharmacology and Uses.

Development of a dynamic prediction model for unplanned ICU admission and mortality in hospitalized patients.

Frequent assessment of the severity of illness for hospitalized patients is essential in clinical settings to prevent outcomes such as in-hospital mortality and unplanned admission to the intensive care unit (ICU). Classical severity scores have been developed typically using relatively few patient features. Recently, deep learning-based models demonstrated better individualized risk assessments compared to classic risk scores, thanks to the use of aggregated and more heterogeneous data sources for dynamic risk prediction. We investigated to what extent deep learning methods can capture patterns of longitudinal change in health status using time-stamped data from electronic health records. We developed a deep learning model based on embedded text from multiple data sources and recurrent neural networks to predict the risk of the composite outcome of unplanned ICU transfer and in-hospital death. The risk was assessed at regular intervals during the admission for different prediction windows. Input data included medical history, biochemical measurements, and clinical notes from a total of 852,620 patients admitted to non-intensive care units in 12 hospitals in Denmark's Capital Region and Region Zealand during 2011-2016 (with a total of 2,241,849 admissions). We subsequently explained the model using the Shapley algorithm, which provides the contribution of each feature to the model outcome. The best model used all data modalities with an assessment rate of 6 hours, a prediction window of 14 days and an area under the receiver operating characteristic curve of 0.898. The discrimination and calibration obtained with this model make it a viable clinical support tool to detect patients at higher risk of clinical deterioration, providing clinicians insights into both actionable and non-actionable patient features.

Prognostic significance of thyroid hormone T3 in patients with septic shock: a retrospective cohort study.

The role of thyroid hormones is crucial in the response to stress and critical illness, which has been reported to be closely associated with a poor prognosis in patients admitted to the intensive care unit (ICU). This study aimed to explore the relationship between thyroid hormone and prognosis in septic shock patients. A total of 186 patients with septic shock were enrolled in the analytical study between December 2014 and September 2022. The baseline variables and thyroid hormone were collected. The patients were divided into survivor group and non-survivor group according to whether they died during the ICU hospitalization. Among 186 patients with septic shock, 123 (66.13%) were in the survivor group and 63 (33.87%) were in the non-survivor group. There were significant differences in the indictors of free triiodothyronine (FT3) (p=0.000), triiodothyronine (T3) (p=0.000), T3/FT3 (p=0.000), acute physiology and chronic health evaluation II score (APACHE II) (p=0.000), sequential organ failure assessment score (SOFA) (p=0.000), pulse rate (p=0.020), creatinine (p=0.008), PaO2/FiO2 (p=0.000), length of stay (p=0.000) and hospitalization expenses (p=0.000) in ICU between the two groups. FT3 [odds ratio (OR): 1.062, 95% confidence interval(CI): (0.021, 0.447), p=0.003], T3 (OR: 0.291, 95% CI: 0.172-0.975, p=0.037) and T3/FT3 (OR: 0.985, 95% CI:0.974-0.996, p=0.006) were independent risk factors of the short-term prognosis of septic shock patients after adjustment. The areas under the receiver operating characteristic curves for T3 was associated with ICU mortality (AUC = 0.796, p<0.05) and was higher than that for FT3 (AUC = 0.670, p<0.05) and T3/FT3 (AUC = 0.712, p<0.05). A Kaplan-Meier curve showed that patients with T3 greater than 0.48 nmol/L had a significantly higher survival rate than the patients with T3 less than 0.48 nmol/L. The decrease in serum level of T3 in patients with septic shock is associated with ICU mortality. Early detection of serum T3 level could help clinicians to identify septic shock patients at high risk of clinical deterioration.

Prognostic role of different temporal patterns of dyspnoea onset in patients with acute pulmonary embolism.

Dyspnoea is a well known symptom of acute pulmonary embolism (PE). We assess the prognostic role of different patterns of dyspnoea onset regarding in-hospital mortality, clinical deterioration and the composite of the outcomes in PE patients, according to their haemodynamic status at admission. Patients from the prospective Italian Pulmonary Embolism Registry (IPER) were included in the study. At admission, patients were stratified, according to their haemodynamic status, as high- (haemodynamically unstable) and non-high-risk (haemodynamically stable) patients. Overall, 1623 consecutive patients (mean age 70.2 ± 15.2 years, 696 males), with confirmed acute PE, were evaluated for the features of dyspnoea. Among these, 1353 (83.3%) experienced dyspnoea at admission. No significant differences were observed regarding in-hospital mortality and the composite outcome of in-hospital mortality and clinical deterioration between patients with and without dyspnoea. However, in non-high-risk patients, clinical deterioration was more frequently observed when dyspnoea was present compared with absence of dyspnoea ( P = 0.002). Multivariate Cox regression analyses showed that non-high-risk patients had an increased risk of clinical deterioration when experiencing dyspnoea within 24 h [hazard ratio (HR): 1.57, 95% confidence interval (CI): 1.49-1.65, P < 0.0001] and between 25 h and 7 days before admission (HR: 1.66, 95% CI: 1.58-1.77, P < 0.0001), independently of age, sex, right ventricular dysfunction, positive cardiac troponin and thrombolysis. Non-high-risk PE patients experiencing dyspnoea within 7 days before hospitalization had a higher risk of clinical deterioration compared with those without and, therefore, they may require more aggressive management.

Randomized phase II clinical trial of ruxolitinib plus simvastatin in COVID19 clinical outcome and cytokine evolution.

Managing the inflammatory response to SARS-Cov-2 could prevent respiratory insufficiency. Cytokine profiles could identify cases at risk of severe disease. We designed a randomized phase II clinical trial to determine whether the combination of ruxolitinib (5 mg twice a day for 7 days followed by 10 mg BID for 7 days) plus simvastatin (40 mg once a day for 14 days), could reduce the incidence of respiratory insufficiency in COVID-19. 48 cytokines were correlated with clinical outcome. Patients admitted due to COVID-19 infection with mild disease. Up to 92 were included. Mean age was 64 ± 17, and 28 (30%) were female. 11 (22%) patients in the control arm and 6 (12%) in the experimental arm reached an OSCI grade of 5 or higher (p = 0.29). Unsupervised analysis of cytokines detected two clusters (CL-1 and CL-2). CL-1 presented a higher risk of clinical deterioration vs CL-2 (13 [33%] vs 2 [6%] cases, p = 0.009) and death (5 [11%] vs 0 cases, p = 0.059). Supervised Machine Learning (ML) analysis led to a model that predicted patient deterioration 48h before occurrence with a 85% accuracy. Ruxolitinib plus simvastatin did not impact the outcome of COVID-19. Cytokine profiling identified patients at risk of severe COVID-19 and predicted clinical deterioration. https://clinicaltrials.gov/, identifier NCT04348695.

Comparison of Machine Learning Algorithms for Predicting Patients with Suspected COVID-19

The coronavirus disease (COVID-19) outbreak has infected millions of people, causing a high death rate worldwide. Patients suspected of having COVID-19 are transferred to different health facilities, which has caused a saturation in care, for which it is necessary to have a prediction model to classify patients at high risk of clinical deterioration. The objective of the research was to compare classification algorithms based on automatic learning machines, for the prediction of clinical diagnosis in patients with COVID-19. 1000 records of patients with suspected SARS-CoV-2 infection who were admitted by the emergency service in health establishments in Peru were collected. After pre-processing the data and engineering the attributes, a sample of 700 records was determined. Models were designed and algorithms were compared: Logistic Regression, Support Vector Machine, Nearest Neighbors, Decision Tree, Random Forest, and Navie Bayes. The evaluation of the results of each algorithm was carried out using Accuracy, precision, sensitivity and Chohen's Kappa to know the degree of agreement between the prediction by the learning machine and the results of reality, that is, to what extent both results agree in their measurement. The algorithm that presented the best results was the Support Vector Machine and Random Forest, which predicted the patients with an accuracy of 97%, and Cohen's Kappa of 0.95, with figures higher than the other models evaluated.

Awake proning in patients with COVID-19-related hypoxemic acute respiratory failure: A rapid practice guideline.

This rapid practice guideline provides evidence-based recommendations for the use of awake proning in adult patients with acute hypoxemic respiratory failure due to COVID-19. The panel included 20 experts from 12 countries, including one patient representative, and used a strict conflict of interest policy for potential financial and intellectual conflicts of interest. Methodological support was provided by the guidelines in intensive care, development, and evaluation (GUIDE) group. Based on an updated systematic review, and the grading of recommendations, assessment, development, and evaluation (GRADE) method we evaluated the certainty of evidence and developed recommendations using the Evidence-to-Decision framework. We conducted an electronic vote, requiring >80% agreement amongst the panel for a recommendation to be adopted. The panel made a strong recommendation for a trial of awake proning in adult patients with COVID-19 related hypoxemic acute respiratory failure who are not invasively ventilated. Awake proning appears to reduce the risk of tracheal intubation, although it may not reduce mortality. The panel judged that most patients would want a trial of awake proning, although this may not be feasible in some patients and some patients may not tolerate it. However, given the high risk of clinical deterioration amongst these patients, awake proning should be conducted in an area where patients can be monitored by staff experienced in rapidly detecting and managing clinical deterioration. This RPG panel recommends a trial of awake prone positioning in patients with acute hypoxemic respiratory failure due to COVID-19.

Clinical Observational Study of the Rapid Response System in General Ward in China

Rapid Response Systems (RRS) had emerged as an approach to identify hospitalized patients who are at high risk of clinical deterioration. We performed a retrospective observational study and included inpatients from May, 2016 to December, 2019. This study aimed to observe and analyze the effect of introducing RRS in general wards, and discuss the main problems occurring in hospital in China. The critical rapid response team was called to 312 cases in 44 months. The top three reasons for calling them were unconsciousness (29.79%), respiratory distress (19.17%), and hypotension (18.60%). The effective call rate was 91.99%, and only 68.27% of cases were transferred to the ICU. The top three advanced life supports used for patients transferred to ICU were mechanical ventilation (89.67%), blood purification (85.92%), and vasoactive drugs application (82.16%). After the introduction of the RRS, the rate of unplanned admissions to the ICU increased, but the incidence of cardiac arrest decreased significantly. The RRS can improve the safety of inpatients in general wards, but the criteria for calling the rapid response team, and scoring tool used, are worthy of further discussion.

MACHINE LEARNING PREDICTION OF IN-HOSPITAL DISEASE PROGRESSION IN COMMUNITY-ACQUIRED PNEUMONIA: DERIVATION AND VALIDATION OF CLINICAL DETERIORATION IN PNEUMONIA (CDIP)

MACHINE LEARNING PREDICTION OF IN-HOSPITAL DISEASE PROGRESSION IN COMMUNITY-ACQUIRED PNEUMONIA: DERIVATION AND VALIDATION OF CLINICAL DETERIORATION IN PNEUMONIA (CDIP)

EXPLORING THE ROLE OF ADJUNCT CORTICOSTEROID THERAPY TO DECREASE COMMUNITY-ACQUIRED PNEUMONIA-RELATED COMPLICATIONS: A SYSTEMATIC REVIEW AND META-ANALYSIS

SESSION TITLE: Outcomes in Pneumonia and NTMSESSION TYPE: Rapid Fire Original InvPRESENTED ON: 10/17/2022 12:15 pm - 1:15 pmPURPOSE: Adjunct corticosteroid therapy to patients with community-acquired pneumonia (CAP) remains controversial in clinical practice. We performed an updated systematic review and meta-analysis to assess the efficacy of corticosteroids in decreasing complications of CAP such as ARDS, empyema, shock, and pleural effusion.METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials (RCT) from each database’s inception to February 2022. We estimated the summary risk ratios (RR) with their corresponding 95% confidence interval (CI) through random effects Mental-Haenszel model. Subgroup analyses were also conducted. I-squared statistics (I2) were used to evaluate heterogeneity. Publication bias was assessed with Begg’s tests.RESULTS: We included 11 RCTs containing 3,509 patients with CAP. Adjunctive corticosteroid therapy was associated with significant reduction in CAP-related complications (RR = 0.73, CI 0.55 – 0.97, p = 0.015, I2 = 56.9%). In subgroup analysis, patients who received higher dose of steroids (> 50 mg prednisone equivalents/day) had a more significant reduction in CAP-related complications (RR = 0.46, CI = 0.31 – 0.68, p = 0.001, I2 = 12.2%). No significant publication bias was observed with Begg’s test (p = 0.087).CONCLUSIONS: This meta-analysis indicates that adjunctive corticosteroids significantly reduce CAP-related complications.CLINICAL IMPLICATIONS: Adjunctive corticosteroid therapy is a plausible option to limit complications such as ARDS, empyema, shock, and pleural effusion in CAP patients with co-morbidities and who are at high risk for clinical deterioration.DISCLOSURES: No relevant relationships by Mubashir Ayaz AhmedNo relevant relationships by Shayet Hossain EshanNo relevant relationships by Sami HusseinNo relevant relationships by Mohammed HusseinNo relevant relationships by Jose Medina InojosaNo relevant relationships by Wasey Ali Yadullahi MirNo relevant relationships by Sudha MisraNo relevant relationships by Kamalnath Sankaran RajagopalanNo relevant relationships by Chenyu Sun SESSION TITLE: Outcomes in Pneumonia and NTM SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: Adjunct corticosteroid therapy to patients with community-acquired pneumonia (CAP) remains controversial in clinical practice. We performed an updated systematic review and meta-analysis to assess the efficacy of corticosteroids in decreasing complications of CAP such as ARDS, empyema, shock, and pleural effusion. METHODS: We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus for randomized controlled trials (RCT) from each database’s inception to February 2022. We estimated the summary risk ratios (RR) with their corresponding 95% confidence interval (CI) through random effects Mental-Haenszel model. Subgroup analyses were also conducted. I-squared statistics (I2) were used to evaluate heterogeneity. Publication bias was assessed with Begg’s tests. RESULTS: We included 11 RCTs containing 3,509 patients with CAP. Adjunctive corticosteroid therapy was associated with significant reduction in CAP-related complications (RR = 0.73, CI 0.55 – 0.97, p = 0.015, I2 = 56.9%). In subgroup analysis, patients who received higher dose of steroids (> 50 mg prednisone equivalents/day) had a more significant reduction in CAP-related complications (RR = 0.46, CI = 0.31 – 0.68, p = 0.001, I2 = 12.2%). No significant publication bias was observed with Begg’s test (p = 0.087). CONCLUSIONS: This meta-analysis indicates that adjunctive corticosteroids significantly reduce CAP-related complications. CLINICAL IMPLICATIONS: Adjunctive corticosteroid therapy is a plausible option to limit complications such as ARDS, empyema, shock, and pleural effusion in CAP patients with co-morbidities and who are at high risk for clinical deterioration. DISCLOSURES: No relevant relationships by Mubashir Ayaz Ahmed No relevant relationships by Shayet Hossain Eshan No relevant relationships by Sami Hussein No relevant relationships by Mohammed Hussein No relevant relationships by Jose Medina Inojosa No relevant relationships by Wasey Ali Yadullahi Mir No relevant relationships by Sudha Misra No relevant relationships by Kamalnath Sankaran Rajagopalan No relevant relationships by Chenyu Sun