Pneumonia Severity Index Research Articles

Prognostic value of CURB-65 and pneumonia severity index (PSI) in COVID-19 pneumonia: A retrospective cohort study

Objective: To validate a better scoring system between CURB-65 and the pneumonia severity index (PSI) to predict the need for intensive care unit admission and 30-day mortality in patients with COVID-19 pneumonia. Methods: A retrospective cohort study was conducted on patients in a tertiary care hospital in Kota, Rajasthan. Relevant data about history, and general and systemic examination with laboratory investigations was collected. Patients were categorized into different risk groups for ICU admission and 30-day mortality according to CURB-65 and PSI. Sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve were calculated. Continuous variables, means and percentages were compared using the t-test for numerical data and the Chi-square test for nominal data. Results: 100 patients who tested positive for SARS-CoV-2 by RT-PCR were included; 67 were male and 33 were female. 58 patients had severe disease (SpO2≤90%) and 30 patients died. CURB-65 had an area under the curve (AUC) of 0.81 for predicting ICU admission, with a sensitivity of 92% and a specificity of 54% for high risk patients. Meanwhile, PSI had an AUC of 0.88, with a sensitivity of 83% and a specificity of 73% in high risk patients. In addition, CURB-65 had an AUC of 0.79 for predicting 30-day mortality, with a sensitivity of 60% and a specificity of 89% in high risk patients. PSI had an AUC of 0.71 for predicting 30-day mortality, with a sensitivity of 90% and a specificity of 46% in high risk patients. Conclusions: This single-centre retrospective study involving a cohort of COVID-19 patients demonstrates that CURB-65 and PSI are powerful tools for predicting mortality. However, PSI appears to be slightly better at predicting the need for intensive care unit admission in high-risk patients.

The SpO2/FiO2 Ratio Combined with Prognostic Scores for Pneumonia and COVID-19 Increases Their Accuracy in Predicting Mortality of COVID-19 Patients

Background: Identifying high-risk COVID-19 patients is critical for emergency department decision-making. Our study’s primary objective was to identify new independent predictors of mortality and their predictive utility in combination with traditional pneumonia risk assessment scores and new risk scores for COVID-19 developed during the pandemic. Methods: A retrospective study was performed in two Italian University Hospitals. A multivariable logistic model was used to locate independent parameters associated with mortality. Results: Age, PaO2/FiO2, and SpO2/FiO2 ratios were found to be independent parameters associated with mortality. This study found that the Pneumonia Severity Index (PSI) was superior to many of the risk scores developed during the pandemic, for example, the International Severe Acute Respiratory Infection Consortium Coronavirus Clinical Characterisation Consortium (ISARIC 4C) (AUC 0.845 vs. 0.687, p < 0.001), and to many of the risk scores already in use, for example, the National Early Warning Score 2 (NEWS2) (AUC 0.845 vs. 0.589, p < 0.001). Furthermore, our study found that the Pneumonia Severity Index had a similar performance to other risk scores, such as CRB-65 (AUC 0.845 vs. 0.823, p = 0.294). Combining the PaO2/FiO2 or SpO2/FiO2 ratios with the risk scores analyzed improved the prognostic accuracy. Conclusions: Adding the SpO2/FiO2 ratio to the traditional, validated, and already internationally known pre-pandemic prognostic scores seems to be a valid and rapid alternative to the need for developing new prognostic scores. Future research should focus on integrating these markers into existing pneumonia scores to improve their prognostic accuracy.

Patients with influenza admitted to a tertiary-care hospital in Riyadh between 2018 and 2022: characteristics, outcomes and factors associated with ICU admission and mortality

BackgroundInfluenza is a common cause of hospital admissions globally with regional variations in epidemiology and clinical profile. We evaluated the characteristics and outcomes of patients with influenza admitted to a tertiary-care center in Riyadh, Saudi Arabia.MethodsThis was a retrospective cohort of adult patients admitted with polymerase chain reaction-confirmed influenza to King Abdulaziz Medical City-Riyadh between January 1, 2018, and May 31, 2022. We compared patients who required intensive care unit (ICU) admission to those who did not and performed multivariable logistic regression to assess the predictors of ICU admission and hospital mortality.ResultsDuring the study period, 675 adult patients were hospitalized with influenza (median age 68.0 years, females 53.8%, hypertension 59.9%, diabetes 55.1%, and chronic respiratory disease 31.1%). Most admissions (83.0%) were in the colder months (October to March) in Riyadh with inter-seasonal cases even in the summertime (June to August). Influenza A was responsible for 79.0% of cases, with H3N2 and H1N1 subtypes commonly circulating in the study period. Respiratory viral coinfection occurred in 12 patients (1.8%) and bacterial coinfection in 42 patients (17.4%). 151 patients (22.4%) required ICU admission, of which 62.3% received vasopressors and 48.0% mechanical ventilation. Risk factors for ICU admission were younger age, hypertension, bilateral lung infiltrates on chest X-ray, and Pneumonia Severity Index. The overall hospital mortality was 7.4% (22.5% for ICU patients, p < 0.0001). Mortality was 45.0% in patients with bacterial coinfection, 30.9% in those requiring vasopressors, and 29.2% in those who received mechanical ventilation. Female sex (odds ratio [OR], 2.096; 95% confidence interval [CI] 1.070, 4.104), ischemic heart disease (OR, 3.053; 95% CI 1.457, 6.394), immunosuppressed state (OR, 7.102; 95% CI 1.803, 27.975), Pneumonia Severity Index (OR, 1.029; 95% CI, 1.017, 1.041), leukocyte count and serum lactate level (OR, 1.394; 95% CI, 1.163, 1.671) were independently associated with hospital mortality.ConclusionsInfluenza followed a seasonal pattern in Saudi Arabia, with H3N2 and H1N1 being the predominant circulating strains during the study period. ICU admission was required for > 20%. Female sex, high Pneumonia Severity Index, ischemic heart disease, and immunosuppressed state were associated with increased mortality.

Increased plasma AACT level as an indicator of poor prognosis in patients hospitalised with community-acquired pneumonia: a multicentre prospective cohort study

Background and objectiveCommunity-acquired pneumonia (CAP) is a common respiratory disease that frequently requires hospitalisation, and is a significant cause of death worldwide. This study aimed to evaluate the usefulness of alpha-1-antichymotrypsin (AACT) as a diagnostic and prognostic biomarker of CAP.MethodsWe conducted a multicentre prospective cohort study in patients hospitalised with CAP. Plasma AACT levels were measured using a quantitative enzyme-linked immunosorbent assay. Receiver-operating characteristic (ROC) curves and Cox proportional hazards regression were used to assess the association between plasma AACT levels and CAP diagnosis and prognosis.ResultsA total of 274 patients with CAP were enrolled in the study. AACT levels were elevated in patients with CAP, especially those with severe CAP and non-survivors. The area under the curve (AUC) of AACT and CRP for diagnosing CAP was 0.755 and 0.843. Cox regression showed that CURB-65 and AACT levels were independent predictors of 30-day mortality. ROC curves showed that plasma AACT levels had the highest accuracy for predicting acute respiratory distress syndrome (ARDS), with an AUC of 0.862. Combining AACT with Pneumonia Severity Index and CURB-65 significantly improved their predictive accuracy for predicting 30-day mortality.ConclusionPlasma AACT levels are elevated in patients with CAP, but plasma AACT level is inferior to the C-reactive protein level for diagnosing CAP. The AACT level can reliably predict the occurrence of ARDS and 30-day mortality in patients with CAP.

Initial assessment and management of adults with suspected acute respiratory infection: a rapid evidence synthesis of reviews and cost-effectiveness studies.

This work was undertaken to inform a National Institute for Health and Care Excellence guideline on the initial assessment of adults with suspected acute respiratory infection. To undertake a rapid evidence synthesis of systematic reviews and cost-effectiveness studies of signs, symptoms and early warning scores for the initial assessment of adults with suspected acute respiratory infection. MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for systematic reviews and MEDLINE, EMBASE, EconLit and National Health Service Economic Evaluation Database were searched for cost-effectiveness studies in May 2023. References of relevant studies were checked. Clinical outcomes of interest included escalation of care, antibiotic/antiviral use, time to resolution of symptoms, mortality and health-related quality of life. Risk of bias was assessed using the Risk of Bias in Systematic Reviews tool or the National Institute for Health and Care Excellence economic evaluations checklist. Results were summarised using narrative synthesis. Nine systematic reviews and one cost-effectiveness study met eligibility criteria. Seven reviews assessed several early warning scores for patients with community- acquired pneumonia, one assessed early warning scores for nursing home-acquired pneumonia and one assessed individual signs/symptoms and the Centor score for patients with sore throat symptoms; all in face-to-face settings. Two good-quality reviews concluded that further research is needed to validate the CRB-65 in primary care/community settings. One also concluded that further research is needed on the Pneumonia Severity Index in community settings; however, the Pneumonia Severity Index requires data from tests not routinely conducted in community settings. One good-quality review concluded that National Early Warning Score appears to be useful in an emergency department/acute medical setting. One review (unclear quality) concluded that the Pneumonia Severity Index and CURB-65 appear useful in an emergency department setting. Two poor-quality reviews concluded that early warning scores can support clinical judgement and one poor-quality review found numerous problems with using early warning scores in a nursing home setting. A good-quality review concluded that individual signs and symptoms have a modest ability to diagnose streptococcal pharyngitis, and that the Centor score can enhance appropriate prescribing of antibiotics. The cost-effectiveness study assessed clinical scores and rapid antigen detection tests for sore throat, compared to delayed antibiotic prescribing. The study concluded that the clinical score is a cost-effective approach when compared to delayed prescribing and rapid antigen testing. Several early warning scores have been evaluated in adults with suspected acute respiratory infection, mainly the CRB-65, CURB-65 and Pneumonia Severity Index in patients with community-acquired pneumonia. The evidence was insufficient to determine what triage strategies avoid serious illness. Some early warning scores (CURB-65, Pneumonia Severity Index and National Early Warning Score) appear to be useful in an emergency department/acute medical setting; however, further research is required to validate the CRB-65 and Pneumonia Severity Index in primary care/community settings. The economic evidence indicated that clinical scores may be a cost-effective approach to triage patients compared with delayed prescribing. Only systematic reviews were eligible for inclusion in the synthesis of clinical evidence. There was a great deal of overlap in the primary studies included in the reviews, many of which had significant limitations. No studies were undertaken in remote settings (e.g. NHS 111). Only one cost-effectiveness study was identified, with limited applicability to the review question. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159945.

Food-derived antioxidants intake association with serum oxidative stress markers and lung infection symptoms in COVID-19 infectious angina patients

PurposeResearch indicated that dietary antioxidants could improve immune system performance. This study aims to investigate the association of COVID-19 symptoms, total antioxidant capacity and serum inflammatory markers, with dietary antioxidants intake among angina patients.Design/methodology/approachA food frequency questionnaire was used in a cross-sectional study among 135 angina patients with COVID-19, to assess dietary antioxidants consumption. Serum levels of tumor necrosis factor, interleukin 1ß, malondialdehyde, high-sensitivity C-reactive protein and total antioxidant capacity were measured by enzyme-linked immunosorbent assay methods.FindingsAmong study angina patients, 76.67% followed unhealthy food patterns and 23.33% followed anti-inflammatory dietary patterns before hospitalization. The angina patients with anti-inflammatory food pattern had less fever (p = 0.021), cough (p = 0.018), dyspnea (p = 0.024), diarrhea (p = 0.014) and pneumonia severity index (p = 0.014) compared to patients with unhealthy food pattern. The serum levels of tumor necrosis factor, interleukin 1ß, high-sensitivity C-reactive protein and malondialdehyde, had a significantly negative association with dietary antioxidants intake (p < 0.05).Originality/valueThere are significant association between antioxidant intake with serum inflammation markers in COVID-19 patients. There is a need for more clinical trial studies for approval of these results.

Impact of Outdoor Air Pollutants Exposure on the Severity and Outcomes of Community-Acquired Pneumonia in Gabes Region, Tunisia.

Background Acute community-acquired pneumonia (CAP) is considered the leading cause of infectious death worldwide. Air pollution and prolonged exposure to airborne contaminants have been implicated in various respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD). However, the specific impact of air pollution on pneumonia, particularly CAP, remains underexplored. Given the rising levels of urban air pollution and its potential health ramifications, our study aimed to examine the association between exposure to outdoor air pollution and severity as well as the outcomes of pneumonia cases requiring hospitalization. Methodology A cohort analytical study with retrospective data collection was carried out in the pulmonology department of the Gabès University Hospital between January and October 2022. We compared levels of particulate matter less than or equal to 10µm in aerodynamic diameter (PM10),sulfur dioxide (SO2),ozone (O3), moisture and ambient temperature with severity and outcomes ofpneumonia requiring hospitalization. The choice of these specific pollutants and environmental factors was based on their established impact on respiratory health and their prevalence in the study region. Results Increased sulfur dioxide (SO2) levels were associated with increased use of non-invasive ventilation (NIV) (r = 0.400). Higher levels of particulate matter (PM10) were significantly associated with the development of lung abscesses. Similarly, increased humidity and ambient temperature were strongly correlated with the development of lung abscesses. Increased air SO2 levels were correlated with a higher CURB65 score (r = 0.299). High outdoor SO2 levels and increasing moisture content were associated with increased Pneumonia Severity Index (PSI) score (r = 0.303 and = 0.310, respectively). Higher levels of PM10 were associated with an increased risk of pleural effusion, a serious complication of pneumonia. Finally, higher ambient temperatures were correlated with more extensive opacities on chest X-rays (r = 0.706), suggesting the severity of pneumonia. Conclusion This study highlights the significant associations between environmental factors and various clinical parameters in pneumonia patients. The findings underscore the importance of considering environmental exposures, such as air quality and weather conditions, in understanding and managing the severity of pneumonia.

Performance of various pneumonia severity models for predicting adverse outcomes in elderly inpatients with community-acquired pneumonia

ObjectiveWe aimed to assess the performance of common pneumonia severity scores, such as pneumonia severity index (PSI), CURB-65, CRB-65, A-DROP, and SMART-COP, in predicting adverse outcomes in elderly community-acquired pneumonia cohort and to determine the optimal scoring system for specific outcomes of interest. MethodsA total of 822 elderly inpatients were included in the retrospective cohort study. Clinical and laboratory results on admission were used to calculate the above scores. The primary outcome was 30-day mortality. Secondary outcomes were in-hospital mortality, need for mechanical ventilation (MV) and ICU admission. Model discrimination was evaluated by the area under receiver operating characteristic curves (AUCs). ResultsThe 30-day and in-hospital mortality rates were 6.8% (56/822) and 8.6% (71/822), respectively. One hundred and ninety-eight (24.0%) received MV and 111 (13.5%) were admitted to the ICU. All five scoring systems showed the same trend of increasing rates of each adverse outcome with increasing risk groups (all p < 0.001). PSI had the highest AUC, sensitivity, and negative predictive value (NPV) in predicting 30-day mortality and in-hospital mortality. SMART-COP had the highest AUC for predicting the need for MV and ICU admission, but PSI had the highest sensitivity and NPV for these two outcomes. DiscussionPSI performed well in identifying elderly patients at risk for 30-day mortality and its high NPV is helpful in excluding patients who are not at risk. Considering their effectiveness and simplicity, SMART-COP and CURB-65 are easier to perform in clinical practice than PSI.

How to assess survival prognosis in patients hospitalized for community-acquired pneumonia in 2024?

Community-acquired pneumonia (CAP) is increasingly recognized as a complex, multisystemic disease with the potential to cause both acute and long-term sequelae, significantly impacting patient mortality rates. In this manuscript, the authors review the current methodologies for assessing mortality risk among CAP patients. The most common prediction scores for ICU care and short-term mortality include Pneumonia Severity Index (PSI), CURB-65, SMART COP, SCAP, and ATS/IDSA criteria. These models have clinical utility in the prediction of short-term mortality, but they have significant limitations in addressing long-term mortality. For patients who are discharged alive from the hospital, we do not have scores to predict long term mortality. The development of an optimal prognostic tool for postacute sequelae of CAP is imperative. Such a tool should identify specific populations at increased risk. Moreover, accurately identifying at-risk populations is essential for their inclusion in clinical trials that evaluate potential therapies designed to improve short and long-term clinical outcomes in patients with CAP.

Analysis of Survival Modification by Furosemide Use in a Cohort of Hospitalized COVID-19 Patients with Severe or Critical Disease in Mexico: Due to Its Chemical Structure, Furosemide Is More than Just a Diuretic.

In the ongoing fight against Coronavirus Disease 2019 (COVID-19), researchers are exploring potential treatments to improve outcomes, especially in severe cases. This includes investigating the repurposing of existing medications, such as furosemide, which is widely available. This study aimed to evaluate the impact of furosemide on mortality rates among COVID-19 patients with severe or critical illness. We assessed a cohort of 515 hospitalized adults who experienced a high mortality rate of 43.9%. Using a multivariate analysis with adjusted risk ratios (AdRRs), factors like smoking (AdRR 2.48, 95% CI 1.53-4.01, p < 0.001), a high Pneumonia Severity Index (PSI) score (AdRR 7.89, 95% CI 5.82-10.70, p < 0.001), mechanical ventilation (AdRR 23.12, 95% CI 17.28-30.92, p < 0.001), neutrophilia (AdRR 2.12, 95% CI 1.52-2.95, p < 0.001), and an elevated neutrophil-to-lymphocyte ratio (NLR) (AdRR 2.39, 95% CI 1.72-3.32, p < 0.001) were found to increase mortality risk. In contrast, vaccination and furosemide use were associated with reduced mortality risk (AdRR 0.58, p = 0.001 and 0.60, p = 0.008; respectively). Furosemide showed a pronounced survival benefit in patients with less severe disease (PSI < 120) and those not on hemodialysis, with mortality rates significantly lower in furosemide users (3.7% vs. 25.7%). A Kaplan-Meier analysis confirmed longer survival and better oxygenation levels in patients treated with furosemide. Furthermore, a Structure-Activity Relationship analysis revealed that furosemide's sulfonamide groups may interact with cytokine sites such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6), potentially explaining its beneficial effects in COVID-19 management. These findings suggest that furosemide could be a beneficial treatment option in certain COVID-19 patient groups, enhancing survival and improving oxygenation.

Survival at 3, 6 and 12 months in patients diagnosed with community-acquired pneumonia in Colombia: a retrospective cohort study

BackgroundThe primary aim of this study is to assess the survival rates of individuals diagnosed with Community-Acquired Pneumonia (CAP) post-hospitalization in Colombia. Additionally, explore potential risk factors associated with decreased long-term survival. MethodsA retrospective cohort study was conducted in a hospital in Colombia, evaluating survival at 3, 6 and 12 months in CAP patients, using the Kaplan–Meier method. Stratifications were made by age, sex, comorbidity, and severity. The comparison of survival curves was performed using the Log-Rank test, a multivariate analysis with Cox regression was performed to study possible risk factors that affected 12-month survival in patients with CAP. Results3688 subjects were admitted, with a mortality of 16.3 % per year. Survival at three, six, and twelve months was 92.9 % (95 % CI 92–93 %), 88.8 % (95 % CI 87–90 %), and 84.2 % (95 % CI 82–85 %), respectively. Analysis stratified by pneumonia severity index, 12-month survival was 98.7 % in Class I, 95.6 % in Class II, 87.41 % in Class III, 77.1 % in Class IV, and 65.8 % in class-V (p < 0.001). Cox-regression showed that being male (HR = 1.44; 95 % CI 1.22‒1.70; p < 0.001), an elevated pneumonia severity index (HR = 4.22; 95 % CI 1.89‒9.43; p < 0.001), a high comorbidity index (HR = 2.29; 95 % CI 1.89‒2.84; p < 0.001) and vasopressor requirement (HR = 2.22; 95 % CI < 0.001) were associated with a lower survival at twelve months of follow-up. ConclusionSurvival in patients with CAP who require hospitalization decreases at 3, 6, and 12 months of follow-up, being lower in patients older than 65 years, men, high comorbidity, and in subjects with severe presentation of the disease.

Development of a new prognostic model to predict pneumonia outcome using artificial intelligence-based chest radiograph results

This study aimed to develop a new simple and effective prognostic model using artificial intelligence (AI)-based chest radiograph (CXR) results to predict the outcomes of pneumonia. Patients aged > 18 years, admitted the treatment of pneumonia between March 2020 and August 2021 were included. We developed prognostic models, including an AI-based consolidation score in addition to the conventional CURB-65 (confusion, urea, respiratory rate, blood pressure, and age ≥ 65) and pneumonia severity index (PSI) for predicting pneumonia outcomes, defined as 30-day mortality during admission. A total of 489 patients, including 310 and 179 patients in training and test sets, were included. In the training set, the AI-based consolidation score on CXR was a significant variable for predicting the outcome (hazard ratio 1.016, 95% confidence interval [CI] 1.001–1.031). The model that combined CURB-65, initial O2 requirement, intubation, and the AI-based consolidation score showed a significantly high C-index of 0.692 (95% CI 0.628–0.757) compared to other models. In the test set, this model also demonstrated a significantly high C-index of 0.726 (95% CI 0.644–0.809) compared to the conventional CURB-65 and PSI (p < 0.001 and 0.017, respectively). Therefore, a new prognostic model incorporating AI-based CXR results along with traditional pneumonia severity score could be a simple and useful tool for predicting pneumonia outcomes in clinical practice.

Comparative analysis of prognostic scoring systems in predicting severity and outcomes of Omicron variant COVID-19 pneumonia.

The global spread of Coronavirus Disease 2019 (COVID-19) underscores the urgent need for reliable methods to forecast the disease's severity and outcome, thereby facilitating timely interventions and reducing mortality rates. This study focuses on evaluating the clinical and laboratory profiles of patients with Omicron variant-induced COVID-19 pneumonia and assessing the efficacy of various scoring systems in prognosticating disease severity and mortality. In this retrospective analysis, we examined the clinical records of 409 individuals diagnosed with Omicron variant COVID-19 pneumonia. We documented the Pneumonia Severity Index, CURB-65, and MuLBSTA scores within the first 24 h and analyzed the sensitivity, specificity, positive predictive value, negative predictive value, and the area under the receiver operating characteristic curve for each scoring system to ascertain their predictive accuracy for disease severity and fatality risk. The cohort's median age was 78 years, predominantly presenting with fever, cough, expectoration, fatigue, and gastrointestinal symptoms. Factors such as expectoration, fatigue, Glasgow Coma Scale score, lactate dehydrogenase levels, procalcitonin, creatinine levels, and co-occurrence of acute respiratory distress syndrome were identified as independent predictors of disease severity. Furthermore, age, oxygenation index, glucose levels, lactate dehydrogenase, and septic shock were independently associated with mortality. For severe disease prediction, the CURB-65, PSI, and MuLBSTA scores demonstrated sensitivities of 65.9%, 63.8%, and 79.7%, respectively, with specificities of 63.8%, 76.8%, and 60.9%, and AUROCs of 0.707, 0.750, and 0.728. To predict mortality risk, these scores at cutoffs of 1.5, 102.5, and 12.5 exhibited sensitivities of 83.3%, 96.3%, and 70.4%, specificities of 59.4%, 60.8%, and 65.4%, and AUROCs of 0.787, 0.850, and 0.736, respectively. The study cohort predominantly comprised elderly individuals with pre-existing health conditions. Elevated lactate dehydrogenase emerged as a significant marker for both disease severity and prognosis, sputum production, gastrointestinal symptoms, GCS score, creatinine, PCT, and ARDS as independent predictors of disease severity, and age, oxygenation index, glucose levels, and septic shock as independent mortality predictors in COVID-19 pneumonia patients. Among the scoring systems evaluated, Pneumonia Severity Index demonstrated superior predictive capability for both disease severity and mortality, suggesting its utility in forecasting the clinical outcomes of Omicron variant COVID-19 pneumonia.

A comparative study between curb-65 and psi/port score as predictors for ICU admission and mortality in community acquired pneumonia patients presenting to a tertiary care hospital

Despite recent advances in clinical medicine, mortality due to CAP has remained relatively the same. Therefore, early recognition for ICU admission plays a pivotal role in management of CAP. PSI/PORT (Pneumonia Severity Index/ Pneumonia Patient Outcome Research Team) score and CURB-65 (Confusion, Uremia, Respiratory rate, BP, Age &amp;#62; 65 years) are the two severity assessment scores that have extensively been used by the clinicians to distinguish between high risk and low risk patients. This study aims at comparing the predictive value of these two scores for ICU admission and mortality. The information required for calculating CURB-65 and PSI was extracted with careful history taking, patient assessment and necessary investigations. Patients with &amp;#62;18 years of age, diagnosed clinically and radiologically with CAP were included in the study.CURB-65 and PSI scores were determined in a total of 131 patients on admission. Based on careful clinical assessment and judgment of treating physician 60 patients were admitted in ICU whereas 71 patients were admitted in medical ward. Out of 60 patients admitted in ICU 23 died. The ability to predict ICU admission was almost similar for PSI/PORT score (AUC 0.9605; 95% CI 0.9277-0.9933) and CURB-65 (AUC 0.9694; 95% CI 0.9368-1.9714). The ability to predict mortality was almost similar for PSI/PORT score (AUC 0.9196; 95% CI 0.8670-0.9722) and CURB-65 (AUC 0.9214 95% CI 0.8696-0.9732). CURB-65 score was found almost similar in predicting ICU admission amongst patients coming with CAP to our hospital when compared to PSI/PORT score and when predicting mortality in patients with community-acquired pneumonia, CURB-65 and PSI/PORT score appear to have comparable specificity and sensitivity. Considering the simplicity, CURB-65 score could be preferred over PSI/PORT score. However, larger studies are required to know the exact Indian scenario. Despite of recent advances in the field of medical science the mortality due to CAP has remained relatively the same. Therefore, early diagnosis and admission to ICU with standard treatment play a pivot role in management of patients with CAP. Two scoring system, PSI/PORT score and CURB-65 score, are widely being used to differentiate between low risk and high risk patients. We undertook this study for comparing the predictive value of these two scores for ICU admission and mortality.

Pneumonia in Geriatric Patients and Prediction of Mortality Based on the Pneumonia Severity Index (PSI), CURB-65, Frailty Index (FI), and FI-Lab21 Scores.

Background Elderly individuals have higher rates of morbidity, death, and financial burden due to community-acquired pneumonia (CAP). Objectives The study aimed to assess the outcomes of geriatric pneumonia patients and the prediction of mortality based on the pneumonia severity index (PSI), CURB-65 (confusion, urea, respiratory rate, blood pressure, and 65-year-old score), frailty index (frailty index), and FI-Lab21 (21-item frailty index based on laboratory) scores. Methods A prospective observational study was conducted on 100 elderly patients (≥ 65 years) with CAP. PSI, CURB-65, FI, and FI-Lab21 scores were determined. The outcome measures were 30-day mortality and the risk factors of mortality. The mortality predictive value of scores were compared. Results The mean age of the study subjects was 72.14 ± 6.1 years. Specifically, 76 (76%) were male, and 24 (24%) were females.During the follow-up, there was a 30-day mortality rate of 57%. On performing multivariate regression, the PSI score and severely frail were significant independent risk factors of mortality, with an odds ratio of 1.046 and 52.213, respectively. Area under the ROC curve (AUC) showed that the performance of the PSI score (AUC: 0.952; 95% CI: 0.910-0.994), CURB-65 score (AUC: 0.936; 95% CI: 0.893-0.978), and severely frail (AUC: 0.907; 95% CI: 0.851-0.962) was outstanding, while FI-Lab21 (AUC: 0.515; 95% CI: 0.400-0.631) was non-significant. Among all the parameters, the PSI score was the best predictor of mortality at the cutoff points of >121 with a diagnostic accuracy of 92%. Conclusion CAP in the elderly carries a high mortality rate. Out of PSI, CURB-65, FI, and FI-Lab21 scores, the PSI holds the best predicting ability for mortality.

Prospective observational study of Trichomonas tenax infection in patients with pneumonia

Trichomonas tenax, an oral commensal parasite commonly found in the human mouth, is associated with periodontitis and poor oral hygiene. However, it has also been identified in the bronchoalveolar lavage fluid (BALF) of individuals with lung diseases. Notably, significant quantities of T. tenax have been isolated following bronchoscopy in cases of empyema and acute respiratory distress syndrome (ARDS). Furthermore, research has demonstrated its ability to induce inflammation in pulmonary epithelial cells. To comprehend the potential role of T. tenax in pneumonia, it is crucial to elucidate the relationship between the parasite and the disease. We investigated the clinical factors associated with T. tenax infection in patients with pneumonia. Employing nested polymerase chain reactions, we amplified nucleic acids from BALF and analyzed the relationships between T. tenax and various clinical factors. Our data revealed a significant association between T. tenax and bacterial infections, high pneumonia severity index (PSI) scores, nasogastric tube feeding, and pulmonary complications. Logistic regression analyses also showed strong associations between T. tenax and these clinical factors in pneumonia patients. These findings suggest that T. tenax infection in pneumonia is accompanied by bacterial infection and severe clinical manifestations.

Prognostic utility of paraspinal muscle index in elderly patients with community-acquired pneumonia.

This study investigated the associations between paraspinal muscle measurements on chest computed tomography and clinical outcomes of elderly patients with community-acquired pneumonia (CAP). This single-center, retrospective, observational study analyzed elderly patients (≥65 years) with CAP hospitalized through an emergency department between March 2020 and December 2022. We collected their baseline characteristics and laboratory data at the time of admission. The paraspinal muscle index and attenuation were calculated at the level of the 12th thoracic vertebra using chest computed tomography taken within 48 hours before or after admission. Univariable and multivariable logistic regression analyses were conducted to evaluate the association between paraspinal muscle measurements and 28-day mortality. Receiver operating characteristic (ROC) curve and area under the curve (AUC) analyses were used to evaluate the prognostic predictive power. Of the 338 enrolled patients, 60 (17.8%) died within 28 days after admission. A high paraspinal muscle index was associated with low 28-day mortality in elderly patients with CAP (adjusted odds ratio, 0.994; 95% confidence interval, 0.992-0.997). The area under the ROC curve for the muscle index was 0.75, which outperformed the pneumonia severity index and the CURB-65 (confusion, urea, respiratory rate, blood pressure, age ≥65 years) metric, both of which showed an AUC of 0.64 in predicting mortality. A high paraspinal muscle index was associated with low 28-day mortality in patients aged 65 years or older with CAP.

Role of biomarkers in community-acquired pneumonia management

Community-acquired pneumonia (CAP) poses a significant global health threat, particularly affecting vulnerable populations. Biomarkers and scoring systems play a crucial role in diagnosing, assessing severity, and guiding treatment decisions for CAP patients. Biomarkers like C reactive protein, procalcitonin, and the neutrophil-to-lymphocyte ratio aid in diagnosis and severity assessment, while scoring systems such as CURB-65 and Pneumonia Severity Index classify patients into risk categories. Emerging biomarkers (uremia, elevated respiratory rate, hypotension, and age ≥ 65) like serum amyloid A and S100 proteins show promise in predicting disease severity and prognosis. However, further research is needed to determine their precise roles and clinical utility in CAP management.

Comparison of NEWS2 and PSI as mortality predictors in patients with community acquired pneumonia

In the West, National Early Warning Score 2 (NEWS2) is commonly applied to predict the severity of illness using only bedside variables unlike the extensive Pneumonia Severity Index (PSI). The objective of this study was to compare these scores as mortality predictors in patients admitted with community acquired pneumonia (CAP). This cross-sectional study was conducted in Jinnah Postgraduate Medical Centre, Karachi, Pakistan, for six months in 2020 on 116 patients presenting with CAP. Cases of aspiration pneumonia, hospital acquired pneumonia, pulmonary tuberculosis, pulmonary embolism, and pulmonary oedema were excluded. In-hospital mortality was taken as the outcome of this study. The mean age of the participants was 46.9±20.5 years. The in-hospital mortalities were 45(38.8%). NEWS2 was 97.8% sensitive but only 15.5% specific in predicting the outcome, whereas PSI was less sensitive (68.9%) but more specific (50.7%), which showed that in comparison with PSI, ---Continue

#2271 Cardiovascular event prediction in kidney transplant recipients: a new risk score derivation and internal validation

Abstract Background and Aims Kidney transplant recipients (KTRs) have a cardiovascular (CV) risk 3 to 5-fold higher than that of the general population.CV disease represents the main cause of death in KTRs, both due to the presence of traditional risk factors and factors strictly related to transplant. The main CV risk calculators proved to be poorly predictive in the KTR population. We, therefore, aimed to compare the performance of CV risk scores already in use and to develop and validate a CV risk score in our KTRs population. Method Our analysis included 371 adult KTRs in follow-up at the outpatient clinic from 1 January 2015 to 31 December 2016. The composite outcome was the occurrence of MACE. We compared the performance of three main CV risk calculators (Framingham Risk Score-FRS-, INDANA score and PORT score). Thereafter, we built a predictive model selecting study variables by backward stepwise Cox regression. The risk score for each variable was weighted according to the HR of the final multivariable model. Internal and external validation of the prediction score and its discriminative capacity was assessed via area under the curve (AUC) curve, and the calibration via the Hosmer–Lemeshow test. Results After a mean follow-up of 68 months, CV events occurred in 71 (19%) KTRs. FRS, INDANA and PORT were demonstrated to have low predictive power in our population (Fig. 1). The accuracy did not improve after adjustment for immunological and transplant-related variables. Therefore, we derived a model including significative variables at multivariate analysis: age, dialysis vintage, systolic blood pressure, eGFR and 24-hour proteinuria (Akaike information criteria 713). The model discrimination was good (Harrel's c: 0.73). According to the hazard ratio, 3 points have been attributed to age higher than 60 years and 24 h proteinuria higher than 1 g/d, 2 points to dialysis vintage longer than 5 years, systolic blood pressure higher than 140 mmHg and eGFR less than 30 ml/min/1.73 m2. The new score demonstrated good discrimination (AUC 0.70, Fig. 2) and calibration (Hosmer-Lemeshow test 11.34, P = 0.12). The new score was internally validated by 10-fold cross-validation (mean AUC 0.70, 95% CI 0.60-0.77). For each point of the new score, the risk of the event increased by 40% and a score higher than three was associated with a 4-fold increased risk of composite endpoint. Conclusion We confirmed the poor predictive power of the known CV risk assessment tools in our real-world KTRs population. Moreover, their discriminatory power was not improved by adjustment for the occurrence of biopsy-proven rejection, HLA compatibility and donor-specific antibody. A new score for CV event prediction including traditional risk factors, such as age and systolic blood pressure, and variables related to renal function and the effects of previous chronic kidney disease, was developed and internally validated.