Outcome Of Pneumonia Research Articles

Factors associated with mortality in pediatric pneumonia patients supported with mechanical ventilation in developing country

BackgroundPneumonia is still a major cause of death and incurs significant morbidity and mortality in developing countries. Thus, patients care does not only focus on treatment but also identifying factors that associated with the patient's outcome. Therefore we defined factors associated with mortality in pediatric pneumonia and assessed the outcome of pneumonia supported by mechanical ventilation in children. MethodsWe performed cohort retrospective study by collecting data of pediatric pneumonia patients who admitted to Pediatric Intensive Care Unit (PICU) at Dr. Sardjito General Hospital, from 2014 to 2016. Chi square and multivariate logistic regression tests were used to analyze the variables: anemia, comorbidities, bacteremia, age between 1-6 months old, and underweight as associated factors for mortality. ResultsOne hundred and eleven children were included in this study. Those patients were diagnosed as community acquired pneumonia (79.3%), hospital acquired pneumonia (14.4%) and ventilator associated pneumonia (6.3%), with mortality rate 47.7%. Multivariate logistic regression analysis revealed that bacteremia, and underweight could be used as predictor factors of mortality for pediatric patients with pneumonia who were supported by mechanical ventilation with OR 2.5 (CI 95%: 1.03–6.1) and 2.4 (CI 95%: 1.1–5.7), respectively. ConclusionFactors associated with mortality for pediatric patients with pneumonia who were supported by mechanical ventilation were bacteremia and underweight. It is necessary to compare our findings with other centers.

Herpes Simplex Virus Type 1 Pneumonia-A Review.

Pneumonia due to herpes simplex virus (HSV) is uncommon but can be seen in immunocompromised patients and has been associated with poor prognosis in this population. The aim was to study the results, outcome and mortality of HSV pneumonia in immunocompromised patients and patients receiving mechanical ventilation. Furthermore, it has been unclear whether to initiate prophylactic treatment with acyclovir or not. We have conducted a literature search using the keywords herpes simplex pneumonia, critically ill patients and intensive care unit for identification of relevant publications. HSV pneumonia can cause severe infection or even death in immunocompromised patients and critically ill patients. A clear diagnosis of HSV pneumonia can be difficult to establish. Respiratory condition may improve after initiation of acyclovir but data is scarce. HSV pneumonia should be considered in the immunocompromised patient and/or the intensive care patient who continues to deteriorate despite appropriate treatment. The value of prophylactic treatment with acyclovir is unproven but should be considered.

Circulating microbial cell-free DNA is associated with inflammatory host-responses in severe pneumonia

Host inflammatory responses predict worse outcome in severe pneumonia, yet little is known about what drives dysregulated inflammation. We performed metagenomic sequencing of microbial cell-free DNA (mcfDNA) in 83 mechanically...

Clinical metagenomics assessments improve diagnosis and outcomes in community-acquired pneumonia

BackgroundIdentifying the causes of community-acquired pneumonia (CAP) is challenging due to the disease’s complex etiology and the limitations of traditional microbiological diagnostic methods. Recent advances in next generation sequencing (NGS)-based metagenomics allow pan-pathogen detection in a single assay, and may have significant advantages over culture-based techniques.ResultsWe conducted a cohort study of 159 CAP patients to assess the diagnostic performance of a clinical metagenomics assay and its impact on clinical management and patient outcomes. When compared to other techniques, clinical metagenomics detected more pathogens in more CAP cases, and identified a substantial number of polymicrobial infections. Moreover, metagenomics results led to changes in or confirmation of clinical management in 35 of 59 cases; these 35 cases also had significantly improved patient outcomes.ConclusionsClinical metagenomics could be a valuable tool for the diagnosis and treatment of CAP.Trial registrationTrial registration number with the Chinese Clinical Trial Registry: ChiCTR2100043628.

Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia.

IntroductionSeveral serum inflammatory markers are associated with poor clinical outcomes in community-acquired pneumonia (CAP). However, the prognosis and early treatment response in hospitalized CAP patients based on serial neutrophil-to-lymphocyte ratio (NLR) measurement has never been investigated.MethodsWe performed a retrospective observational study for 175 consecutive patients hospitalized with CAP between February 2016 and February 2018. NLR, C-reactive protein (CRP) and procalcitonin levels were measured on admission day (D1) and on hospital day 4 (D4). The Pneumonia Severity Index (PSI) was also assessed on admission. The primary endpoint was all-cause death within 30 days after admission. The secondary endpoint was early treatment response such as intensive care unit (ICU) admission during hospitalization and clinical unstability on day 4.ResultsThe 30-day mortality rate was 9.7%. In multivariate analysis, NLR D4 (OR: 1.11; 95% CI: 1.04–1.18; P = 0.003) and its incremental change (NLR D4/D1 >1) (OR: 7.10; 95% CI: 2.19–23.06; P = 0.001) were significant predictors of 30-day mortality. NLR D4 and its incremental change were significant predictors of ICU admission and clinical unstability on day 4 in multivariate analyses. Adding of incremental NLR change significantly improved the prognostic ability of the PSI. The additive value of incremental NLR change for the prognostic ability of the PSI was larger than that of incremental CRP change.ConclusionSerial NLR measurement represents useful laboratory tool to predict the prognosis and early treatment response of hospitalized CAP patients.

The role of chest CT quantitative pulmonary inflammatory index in the evaluation of the course and treatment outcome of COVID-19 pneumonia

To explore the clinical application value of chest CT quantitative pulmonary inflammation index (PII) in the evaluation of the course and treatment outcome of COVID-19 pneumonia. One hundred and eighteen patients with COVID-19 pneumonia diagnosed by RT-PCR were analyzed retrospectively. The correlation between chest CT PII, clinical symptoms and laboratory examinations during the entire hospitalization period was compared. The average age of the patients was 46.0 ± 15 (range: 1–74) years. Of the 118 patients, 62 are male (52.5%) and 56 are female (47.5%). Among them, 116 patients recovered and were discharged, 2 patients died, and the median length of hospital stay was 22 (range: 9–41) days. On admission, 76.3% of the patients presented with fever, and the laboratory studies showed a decrease in lymphocyte (LYM) count and an increase in lactate dehydrogenase (LDH) levels, C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR). Within the studies’ chest CTs, the median number of involved lung lobes was 4 (range: 0–5) and the median number of involved lung segments was 9 (range 0–20). The left lower lobe and the right lower lobe were the most likely areas to be involved (89.0% and 83.9%), and 84.7% of the patients had inflammatory changes in both lungs. The main manifestations on chest CT were ground glass opacities (31.4%), ground glass opacities and consolidation (20.3%), ground glass opacities and reticular patterns (32.2%), mixed type (13.6%), and white lungs (1.7%); common accompanying signs included linear opacities (55.9%), air bronchograms (46.6%), thick small vessel shadows (36.4%), and pleural hypertrophy (13.6%). The chest CT at discharge showed complete absorption of lesions in 19 cases (16.1%), but not in the remaining 99 cases. Lesions remained in a median of 3 lung lobes (range: 0–5). Residual lesions remained in a median of 5 lung segments (range: 0–20). The residual lesions mainly presented as ground glass opacities (61.0%), and the main accompanying sign was linear opacities (59.3%). Based on chest CT, the median maximum PII of lungs was 30.0% (range: 0–97.5%), and the median PII after discharge in the patients excluding the two deaths was 12.5% (range: 0–53.0%). PII was significantly negatively correlated with the LYM count and significantly positively correlated with body temperature, LDH, CRP, and ESR. There was no significant correlation between the PII and the white blood cell count, but the grade of PII correlated well with the clinical classification. PII can be used to monitor the severity and the treatment outcome of COVID-19 pneumonia, provide help for clinical classification, assist in treatment plan adjustments and aid assessments for discharge.

Incidence and Outcomes of Pneumonia in Patients With Heart Failure

BackgroundThe incidence of pneumonia and subsequent outcomes has not been compared in patients with heart failure and reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). ObjectivesThis study aimed to examine the rate and impact of pneumonia in the PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in Heart Failure with Preserved Ejection Fraction) trials. MethodsThe authors analyzed the incidence of investigator-reported pneumonia and the rates of HF hospitalization, cardiovascular death, and all-cause death before and after the occurrence of pneumonia, and estimated risk after the first occurrence of pneumonia in unadjusted and adjusted analyses (the latter including N-terminal pro–B-type natriuretic peptide). ResultsIn PARADIGM-HF, 528 patients (6.3%) developed pneumonia after randomization, giving an incidence rate of 29 (95% CI: 27 to 32) per 1,000 patient-years. In PARAGON-HF, 510 patients (10.6%) developed pneumonia, giving an incidence rate of 39 (95% CI: 36 to 42) per 1,000 patient-years. The subsequent risk of all trial outcomes was elevated after the occurrence of pneumonia. In PARADIGM-HF, the adjusted hazard ratio (HR) for the risk of death from any cause was 4.34 (95% CI: 3.73 to 5.05). The corresponding adjusted HR in PARAGON-HF was 3.76 (95% CI: 3.09 to 4.58). ConclusionsThe incidence of pneumonia was high in patients with HF, especially HFpEF, at around 3 times the expected rate. A first episode of pneumonia was associated with 4-fold higher mortality. (Prospective Comparison of Angiotensin Receptor–Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF], NCT01035255; Prospective Comparison of ARNI [Angiotensin Receptor–Neprilysin Inhibitor] With ARB [Angiotensin Receptor Blocker] Global Outcomes in Heart Failure With Preserved Ejection Fraction [PARAGON-HF], NCT01920711)

Clinical Features and Outcomes of Community-Acquired Pneumonia Caused by Haemophilus Influenza.

BackgroundLong regarded as the second most common cause of community-acquired pneumonia (CAP), Haemophilus influenzae has recently been identified with almost equal frequency as pneumococcus in patients hospitalized for CAP. The literature lacks a detailed description of the presentation, clinical features, laboratory and radiologic findings, and outcomes in Haemophilus pneumonia.MethodsDuring 2 prospective studies of patients hospitalized for CAP, we identified 33 patients with Haemophilus pneumonia. In order to provide context, we compared clinical findings in these patients with findings in 36 patients with pneumococcal pneumonia identified during the same period. We included and analyzed separately data from patients with viral coinfection. Patients with coinfection by other bacteria were excluded.ResultsHaemophilus pneumonia occurred in older adults who had underlying chronic lung disease, cardiac conditions, and alcohol use disorder, the same population at risk for pneumococcal pneumonia. However, in contrast to pneumococcal pneumonia, patients with Haemophilus pneumonia had less severe infection as shown by absence of septic shock on admission, less confusion, fewer cases of leukopenia or extreme leukocytosis, and no deaths at 30 days. Viral coinfection greatly increased the severity of Haemophilus, but not pneumococcal pneumonia.ConclusionsWe present the first thorough description of Haemophilus pneumonia, show that it is less severe than pneumococcal pneumonia, and document that viral coinfection greatly increases its severity. These distinctions are lost when the label CAP is liberally applied to all patients who come to the hospital from the community for pneumonia.

Development and performance assessment of novel machine learning models to predict pneumonia after liver transplantation

BackgroundPneumonia is the most frequently encountered postoperative pulmonary complications (PPC) after orthotopic liver transplantation (OLT), which cause high morbidity and mortality rates. We aimed to develop a model to predict postoperative pneumonia in OLT patients using machine learning (ML) methods.MethodsData of 786 adult patients underwent OLT at the Third Affiliated Hospital of Sun Yat-sen University from January 2015 to September 2019 was retrospectively extracted from electronic medical records and randomly subdivided into a training set and a testing set. With the training set, six ML models including logistic regression (LR), support vector machine (SVM), random forest (RF), adaptive boosting (AdaBoost), extreme gradient boosting (XGBoost) and gradient boosting machine (GBM) were developed. These models were assessed by the area under curve (AUC) of receiver operating characteristic on the testing set. The related risk factors and outcomes of pneumonia were also probed based on the chosen model.Results591 OLT patients were eventually included and 253 (42.81%) were diagnosed with postoperative pneumonia, which was associated with increased postoperative hospitalization and mortality (P < 0.05). Among the six ML models, XGBoost model performed best. The AUC of XGBoost model on the testing set was 0.734 (sensitivity: 52.6%; specificity: 77.5%). Pneumonia was notably associated with 14 items features: INR, HCT, PLT, ALB, ALT, FIB, WBC, PT, serum Na+, TBIL, anesthesia time, preoperative length of stay, total fluid transfusion and operation time.ConclusionOur study firstly demonstrated that the XGBoost model with 14 common variables might predict postoperative pneumonia in OLT patients.

Blood parameters, symptoms at presentation and adverse in-hospital outcomes of COVID-19 pneumonia in patients with hypertension

Background: We aimed to explore the association of clinical symptoms of COVID-19 pneumonia, blood parameters on admission, and anti-hypertensive drugs with in-hospital outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury, and in-hospital death among patients with hypertension. Material and methods: This retrospective study conducted in patients with newly diagnosed COVID-19 pneumonia from August 20, 2020 to September 25, 2020. Results: A total of 182 patients with COVID-19 pneumonia were included in the present study. The patients were categorized into those with hypertension (n = 82) or without hypertension (n = 100). Patients on angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme inhibitors (ACEIs) showed no significant increase in the risk for all in-hospital outcomes. Old age [0.6 (0.5–2) p &lt; 0.00], fever [0.3 (0.2–1.8), p &lt; 0.00] and low lymphocytes percentage [0.3 (0.2–1.2), p &lt; 0.00] were associated with increased risk for extensive lung injury. Old age [0.4 (0.1 = 0.7) p &lt; 0.01], high neutrophil count [0.3 (0.2–2), p = 0.02] and low lymphocyte percentage [0.3 (0.1–0.7), p = 0.01] were associated with prolonged hospital stay while low lymphocytes percentage [0.7 (0.6–0.9), p &lt; 0.00], old age [1.2 (1–1.4), p = 0.01] and fatigue [2 (1–4), p = 0.04] showed significant association with prolonged length of ICU stay. Low lymphocytes percentage [0.7 (0.6–1), p &lt; 0.00], old age [1.1 (1–1.2), p = 0.01] and fatigue [2 (1.7–4), p = 0.02] were associated with increased risk for receiving mechanical ventilation. Risk for in-hospital death was associated with increased neutrophil percentage [1.2 (1–1.5), p = 0.01] and old age [1.1 (1–1.2), p = 0.03]. Conclusions: ARBs and ACEIs showed no significant association with adverse in-hospital outcomes. Old age, low lymphocytes percentage and high neutrophils percentage on admission were independent predictors for increased risk of in-hospital mortality and morbidity among COVID-19 pneumonia patients with hypertension.

ASSESSMENT OF THE LUNG NEUTROPHILS AND MACROPHAGES FUNCTIONAL STATE IN COMMUNITY-ACQUIRED PNEUMONIA

The progression of the inflammatory process and the outcome in community-acquired pneumonia (CAP) depend on the functional activity of innate immune cells - neutrophils and macrophages. Purpose: to establish the relationship between the morphofunctional state of neutrophils and macrophages of induced sputum (inflammation focus) and the severity of community-acquired pneumonia (CAP). Materials and methods: cells were removed from the induced sputum (IS) of healthy individuals and patients with CAP. In the «in vitro» model, upon contact with S. aureus the phagocytic index (PI), number (PN), and index of phagocytosis completion (ICP) were determined. A spectrophotometric method was used to assess the enzymatic activity of cells. Results. The dependence of phagocytosis indices on the severity of CAP was established (p &lt;0.05). A sharp decrease in the phagocytic and functional activity of cells was recorded in the focus of inflammation in patients with severe pneumonia. It was found that in patients with CAP, compared with the control group, a significant decrease in the relative content of cells capable of reducing nitro-blue tetrazolium was found. In all groups of patients with this disease, the reserve capacity for myeloperoxidase (MPO) had negative values, which proved a decrease in the reactivity of local immunity cells. The MPO values for the cells of patients with a moderate course of the disease were higher than in the rest of the examined individuals, which indicated the activation of the bactericidal activity of neutrophils in MI. In patients with severe CAP in the spontaneous test, the mean values of MPO activity were 2.2 times higher than in the control group. Conclusion: a comprehensive study of innate immunity cells functional activity in induced sputum, including the quantitative determination of phagocytic parameters with an assessment of the absorption capacity and completeness of phagocytosis, makes it possible to assess the severity of community-acquired pneumonia.

Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality.

Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. We included all children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

Oral 5-Day Lefamulin for Outpatient Management of Community-Acquired Bacterial Pneumonia: Post-hoc Analysis of the Lefamulin Evaluation Against Pneumonia (LEAP) 2 Trial.

Safe and effective oral antibiotics are needed for outpatient management of moderate to severe community-acquired bacterial pneumonia (CABP). We describe a post-hoc analysis of adults with CABP managed as outpatients from the Lefamulin Evaluation Against Pneumonia (LEAP) 2 double-blind, noninferiority, phase 3 clinical trial. LEAP 2 compared the efficacy and safety of oral lefamulin 600mg every 12h (5days) vs. oral moxifloxacin 400mg every 24h (7days) in adults (inpatients and outpatients) with Pneumonia Outcomes Research Team (PORT) risk classes II‒IV. Overall, 41% (151 of 368) of patients receiving lefamulin and 43% (159 of 368) of patients receiving moxifloxacin started treatment as outpatients-44% and 40%, respectively, were PORT risk class III/IV, and 21% in both groups had CURB-65 scores of 2‒3. Early clinical response (at 96±24h) and investigator assessment of clinical response success rates at test of cure (5‒10days after last study drug dose) were high and similar in both groups among all (lefamulin, 91% vs. moxifloxacin, 89‒90%), PORT risk class III/IV (89‒91% vs. 88‒91%), and CURB-65 score 2‒3 (87‒90% vs. 82‒88%) outpatients. Few outpatients (lefamulin, 2.6%; moxifloxacin, 2.5%) discontinued the study drug because of treatment-emergent adverse events (TEAEs). No outpatient in the lefamulin group was hospitalized for a TEAE, compared with 5 patients (3%), including two deaths, in the moxifloxacin group. These data suggest that 5days of oral lefamulin can be given in lieu of fluoroquinolones for outpatient treatment of adults with CABP and PORT risk class III/IV or CURB-65 scores of 2‒3.

Clinical characteristics and risk factors for mortality in patients with coronavirus disease 2019 in intensive care unit: a single- center, retrospective, observational study in China.

Coronavirus disease 2019 (COVID-19) is a potentially life-threatening contagious disease which has spread all over the world. Risk factors associated with the clinical outcomes of COVID-19 pneumonia in intensive care unit (ICU) have not yet been well determined. This was a retrospective, single-centered, observational study, in which 47 patients with confirmed COVID-19 were consecutively enrolled from February 24 to April 5, 2020. The patients were registered from the ICU of Leishenshan Hospital in Wuhan, China. Clinical characteristics and outcomes were collected and compared between survivors and non-survivors. Multivariable logistic regression was performed to analyze the risk factors of death in patients with COVID-19. The study cohort included 47 adult patients with an average age of 70.55±12.52 years, and 30 (63.8%) patients were men. Totally 15 (31.9%) patients died. When compared to survivors, nonsurvivors showed a higher proportion of septic shock [6 (40%) patients vs. 3 (9.4%) patients], disseminated intravascular coagulation [3 (21.4%) vs. 0], and had higher score of APACHE II (25.07±8.03 vs. 15.56±5.95), CURB-65 {3 [2-4] vs. 2 [1-3]}, Sequential Organ Failure Assessment (SOFA) {7 [5-9] vs. 3 [1-6]}, higher level of D-dimer {5.74 [2.32-18] vs 2.05 [1.09-4.00]} and neutrophil count {9.4 [7.68-14.54] vs. 5.32 [3.85-9.34]}. SOFA score (OR 1.47; 95% CI: 1.01-2.13; P=0.0042) and the lymphocyte count (OR 0.02; 95% CI: 0.00-0.86; P=0.042) on admission were independently risk factors for mortality. Patients with higher lymphocyte count (>0.63×109 /L) and lower SOFA score (≤4) on admission had a significantly better prognosis than those with lower lymphocyte count (≤0.63×109 /L) and higher SOFA score (>4) in overall survival. Higher SOFA score and lower lymphocyte count at admission were connected with poor prognosis of patients with COVID-19 in ICU. Lymphocyte count may serve as a promising prognostic biomarker.

Multicenter Assessment of CT Pneumonia Analysis Prototype for Predicting Disease Severity and Patient Outcome.

To perform a multicenter assessment of the CT Pneumonia Analysis prototype for predicting disease severity and patient outcome in COVID-19 pneumonia both without and with integration of clinical information. Our IRB-approved observational study included consecutive 241 adult patients (> 18 years; 105 females; 136 males) with RT-PCR-positive COVID-19 pneumonia who underwent non-contrast chest CT at one of the two tertiary care hospitals (site A: Massachusetts General Hospital, USA; site B: Firoozgar Hospital Iran). We recorded patient age, gender, comorbid conditions, laboratory values, intensive care unit (ICU) admission, mechanical ventilation, and final outcome (recovery or death). Two thoracic radiologists reviewed all chest CTs to record type, extent of pulmonary opacities based on the percentage of lobe involved, and severity of respiratory motion artifacts. Thin-section CT images were processed with the prototype (Siemens Healthineers) to obtain quantitative features including lung volumes, volume and percentage of all-type and high-attenuation opacities (≥ −200 HU), and mean HU and standard deviation of opacities within a given lung region. These values are estimated for the total combined lung volume, and separately for each lung and each lung lobe. Multivariable analyses of variance (MANOVA) and multiple logistic regression were performed for data analyses. About 26% of chest CTs (62/241) had moderate to severe motion artifacts. There were no significant differences in the AUCs of quantitative features for predicting disease severity with and without motion artifacts (AUC 0.94–0.97) as well as for predicting patient outcome (AUC 0.7–0.77) (p > 0.5). Combination of the volume of all-attenuation opacities and the percentage of high-attenuation opacities (AUC 0.76–0.82, 95% confidence interval (CI) 0.73–0.82) had higher AUC for predicting ICU admission than the subjective severity scores (AUC 0.69–0.77, 95% CI 0.69–0.81). Despite a high frequency of motion artifacts, quantitative features of pulmonary opacities from chest CT can help differentiate patients with favorable and adverse outcomes.

Radiomics analysis enables fatal outcome prediction for hospitalized patients with coronavirus disease 2019 (COVID-19).

In December 2019, a rare respiratory disease named coronavirus disease 2019 (COVID-19) broke out, leading to great concern around the world. To develop and validate a radiomics nomogram for predicting the fatal outcome of COVID-19 pneumonia. The present study consisted of a training dataset (n = 66) and a validation dataset (n = 30) with COVID-19 from January 2020 to March 2020. A radiomics signature was generated using the least absolute shrinkage and selection operator (LASSO) Cox regression model. A radiomics score (Rad-score) was developed from the training cohort. The radiomics model, clinical model, and integrated model were built to assess the association between radiomics signature/clinical characteristics and the mortality of COVID-19 cases. The radiomics signature combined with the Rad-score and the independent clinical factors and radiomics nomogram were constructed. Seven stable radiomics features associated with the mortality of COVID-19 were finally selected. A radiomics nomogram was based on a combined model consisting of the radiomics signature and the clinical risk factors indicating optimal predictive performance for the fatal outcome of patients with COVID-19 with a C-index of 0.912 (95% confidence interval [CI] 0.867-0.957) in the training dataset and 0.907 (95% CI 0.849-0.966) in the validation dataset. The calibration curves indicated optimal consistency between the prediction and the observation in both training and validation cohorts. The CT-based radiomics nomogram indicated favorable predictive efficacy for the overall survival risk of patients with COVID-19, which could help clinicians intensively follow up high-risk patients and make timely diagnoses.

Association of Inclusion of Medicare Advantage Patients in Hospitals’ Risk-Standardized Readmission Rates, Performance, and Penalty Status

The Hospital Readmissions Reduction Program publicly reports and financially penalizes hospitals according to 30-day risk-standardized readmission rates (RSRRs) exclusively among traditional Medicare (TM) beneficiaries but not persons with Medicare Advantage (MA) coverage. Exclusively reporting readmission rates for the TM population may not accurately reflect hospitals' readmission rates for older adults. To examine how inclusion of MA patients in hospitals' performance is associated with readmission measures and eligibility for financial penalties. This is a retrospective cohort study linking the Medicare Provider Analysis and Review file with the Healthcare Effectiveness Data and Information Set at 4070 US acute care hospitals admitting both TM and MA patients. Participants included patients admitted and discharged alive with a diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia between 2011 and 2015. Data analyses were conducted between April 1, 2018, and November 20, 2020. Admission to an acute care hospital. The outcome was readmission for any reason occurring within 30 days after discharge. Each hospital's 30-day RSRR was computed on the basis of TM, MA, and all patients and estimated changes in hospitals' performance and eligibility for financial penalties after including MA beneficiaries for calculating 30-day RSRRs. There were 748 033 TM patients (mean [SD] age, 76.8 [83] years; 360 692 [48.2%] women) and 295 928 MA patients (mean [SD] age, 77.5 [7.9] years; 137 422 [46.4%] women) hospitalized and discharged alive for AMI; 1 327 551 TM patients (mean [SD] age, 81 [8.3] years; 735 855 [55.4%] women) and 457 341 MA patients (mean [SD] age, 79.8 [8.1] years; 243 503 [53.2%] women) for CHF; and 2 017 020 TM patients (mean [SD] age, 80.7 [8.5] years; 1 097 151 [54.4%] women) and 610 790 MA patients (mean [SD] age, 79.6 [8.2] years; 321 350 [52.6%] women) for pneumonia. The 30-day RSRRs for TM and MA patients were correlated (correlation coefficients, 0.31 for AMI, 0.40 for CHF, and 0.41 for pneumonia) and the TM-based RSRR systematically underestimated the RSRR for all Medicare patients for each condition. Of the 2820 hospitals with 25 or more admissions for at least 1 of the outcomes of AMI, CHF, and pneumonia, 635 (23%) had a change in their penalty status for at least 1 of these conditions after including MA data. Changes in hospital performance and penalty status with the inclusion of MA patients were greater for hospitals in the highest quartile of MA admissions. In this cohort study, the inclusion of data from MA patients changed the penalty status of a substantial fraction of US hospitals for at least 1 of 3 reported conditions. This suggests that policy makers should consider including all hospital patients, regardless of insurance status, when assessing hospital quality measures.

The association between body mass index and severity of Coronavirus Disease 2019 (COVID-19): A cohort study.

ObjectivesThe coronavirus disease 2019 (COVID-19) has become a worst pandemic. The clinical characteristics vary from asymptomatic to fatal. This study aims to examine the association between body mass index (BMI) levels and the severity of COVID-19.Methods and study designA cohort study included 147 adult patients with confirmed COVID-19 were categorized into 4 groups by BMI levels on admission: <18.5 (underweight), 18.5–22.9 (normal weight), 23.0–24.9 (overweight), and ≥25.0 kg/m2 (obese). Rates of pneumonia, severe pneumonia, acute kidney injury (AKI), and ICU stay during hospitalization across BMI group was determined. Logistic regression analysis was used to determine the association between BMI and severe pneumonia.ResultsOf the totals, patients having a BMI <18.5, 18.5–22.9, 23.0–24.9, and ≥25.0 kg/m2 were 12.9%, 38.1%, 17.7%, and 31.3%, respectively. The rates of pneumonia and severe pneumonia tended to be higher in patients with higher BMI, whereas the rates of AKI and ICU stay were higher in patients with BMI <18.5 kg/m2 and ≥ 25 kg/m2, when compared to patients with normal BMI. After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI ≥25.0 kg/m2 was associated with higher risk of severe pneumonia (OR 4.73; 95% CI, 1.50–14.94; p = 0.003) compared to having a BMI 18.5–22.9 kg/m2. During admission, elevated hemoglobin and alanine aminotransferase levels on day 7 and 14 of illness were associated with higher BMI levels. In contrast, rising of serum creatinine levels was observed in underweight patients on days 12 and 14 of illness.ConclusionsObesity in patients with COVID-19 was associated with severe pneumonia and adverse outcomes such as AKI, transaminitis and ICU stay. Underweight patients should be closely monitored for AKI. Further studies in body composition are warranted to explore the links between adiposity and COVID-19 pathogenesis.

Clinical characteristics, CT features and perinatal outcome of COVID-19 pneumonia in pregnant women and comparison with non-pregnant women

Background and Objective: To evaluate the clinical course and CT findings of pregnant womenMethods: Fourthy (25 pregnant and 15 non-pregnant) patients were entered to the study. Chest CT features and clinical findings were evaluated between two groups. Data related to pregnancy and fetal status evaluated in the pregnant group.Result: The average age of pregnant patients was 33.1±5.75 years and the non-pregnant group was 35.4±6.88 years. The gestational age ranged from 7 weeks to 39weeks+2days (mean =31weeks+5days). No significant difference was seen between the two groups about clinical findings except the duration of symptoms before CT which was more in pregnant patients (6.71 ± 5.5 days vs 3.53 ± 1.92 days). Two mortalities in pregnant and one in non-pregnant patients , 2(8%) cases of premature rupture of membranes (PROM), 3 (12%) cases of intra-uterine fetal death (IUFD), 3 (12%) cases of fetal distress and 2 (8%) cases of IUGR in pregnant group. Fifteen pregnant patients gave birth .No positive PCR result was detected in newborns. Unlike the control group, the common CT findings were ground-glass pattern.Conclusion: In summary, although we found the clinical findings in pregnant and control group were similar but pattern of CT involvement was different in pregnant patients and rate of ICU admission and mortality rate were more than control group. This viral pneumonia was associated with some important complications such as IUFD in severely involved mothers. CT could be an efficient tool for the early detection and severity assessment in the pregnant patients with COVID-19 pneumonia.

Frailty and hospitalization-associated disability after pneumonia: A prospective cohort study

BackgroundPneumonia is a major cause of morbidity and mortality in older adults. The role of frailty assessment in older adults with pneumonia is not well defined. Our purpose of the study was to investigate 30-day clinical course and functional outcomes of pneumonia in older adults with different levels of frailty.MethodsA prospective cohort was conducted at a university hospital in Seoul, Korea with 176 patients who were 65 years or older and hospitalized with pneumonia. A 50-item deficit-accumulation frailty index (FI) (range: 0–1; robust < 0.15, pre-frail 0.15–0.24, mild-to-moderately frail 0.25–0.44, and severely frail ≥ 0.45) and the pneumonia severity CURB-65 score (range: 0–5) were measured. Primary outcome was death or functional decline, defined as worsening dependencies in 21 daily activities and physical tasks in 30 days. Secondary outcomes were intensive care unit admission, psychoactive drug use, nasogastric tube feeding, prolonged hospitalization (length of stay > 15 days), and discharge to a long-term care institution.ResultsThe population had a median age 79 (interquartile range, 75–84) years, 68 (38.6 %) female, and 45 (25.5 %) robust, 36 (47.4 %) pre-frail, 37 (21.0 %) mild-to-moderately frail, and 58 (33.0 %) severely frail patients. After adjusting for age, sex, and CURB-65, the risk of primary outcome for increasing frailty categories was 46.7 %, 61.1 %, 83.8 %, and 86.2 %, respectively (p = 0.014). The risk was higher in patients with frailty (FI ≥ 0.25) than without (FI < 0.25) among those with CURB-65 0–2 points (75 % vs. 52 %; p = 0.022) and among those with CURB-65 3–5 points (93 % vs. 65 %; p = 0.007). In addition, patients with greater frailty were more likely to require nasogastric tube feeding (robust vs. severe frailty: 13.9 % vs. 60.3 %) and prolonged hospitalization (18.2 % vs. 50.9 %) and discharge to a long-term care institution (4.4 % vs. 59.3 %) (p < 0.05 for all). Rates of intensive care unit admission and psychoactive drug use were similar.ConclusionsOlder adults with frailty experience high rates of death or functional decline in 30 days of pneumonia hospitalization, regardless of the pneumonia severity. These results underscore the importance of frailty assessment in the acute care setting.