Pneumonia Severity Index Research Articles

Soluble form of suppression of tumorigenicity-2 predicts clinical stability of inpatients with community-acquired pneumonia

The soluble form of the suppression of tumorigenicity-2 (sST2) is a biomarker for risk classification and prognosis of heart failure, and its production and secretion in the alveolar epithelium are significantly correlated with the inflammation-inducing in pulmonary diseases. However, the predictive value of sST2 in pulmonary disease had not been widely studied. This study investigated the potential value in prognosis and risk classification of sST2 in patients with community-acquired pneumonia. Clinical data of ninety-three CAP inpatients were retrieved and their sST2 and other clinical indices were studied. Cox regression models were constructed to probe the sST2's predictive value for patients' restoring clinical stability and its additive effect on pneumonia severity index and CURB-65 scores. Patients who did not reach clinical stability within the defined time (30 days from hospitalization) have had significantly higher levels of sST2 at admission (P < 0.05). In univariate and multivariate Cox regression analysis, a high sST2 level (≥72.8 ng/mL) was an independent reverse predictor of clinical stability (P < 0.05). The Cox regression model combined with sST2 and CURB-65 (AUC: 0.96) provided a more accurate risk classification than CURB-65 (AUC:0.89) alone (NRI: 1.18, IDI: 0.16, P < 0.05). The Cox regression model combined with sST2 and pneumonia severity index (AUC: 0.96) also provided a more accurate risk classification than pneumonia severity index (AUC:0.93) alone (NRI: 0.06; IDI: 0.06, P < 0.05). sST2 at admission can be used as an independent early prognostic indicator for CAP patients. Moreover, it can improve the predictive power of CURB-65 and pneumonia severity index score.

A multicenter prospective cohort study of Xuebijing injection in the treatment of severe coronavirus disease 2019

To evaluate the effect of Xuebijing injection on the improvement of pneumonia severity index (PSI) and prognosis in patients with severe coronavirus disease 2019 (COVID-19). A multicenter prospective cohort study was designed. Adult patients with COVID-19 admitted to the intensive care unit (ICU) of 28 designated COVID-19 hospitals in 15 provinces and cities of China from January to March 2020 were enrolled. All patients were treated according to the standard treatment plan of COVID-19 issued by the National Health Commission of the People's Republic of China. They were divided into Xuebijing group and standard treatment group according to whether they received Xuebijing injection or not. In the standard treatment group, routine medical care measures such as antiviral, respiratory support, circulatory support and symptomatic treatment were taken. In the Xuebijing group, on the basis of standard treatment, Xuebijing was used within 12 hours of admission to the ICU, 100 mL each time, twice daily. The minimum duration of Xuebijing administration was 1 day. The improvement rate of PSI risk rating on the 8th day and clinical outcome on the 28th day were recorded. A total of 276 COVID-19 patients were screened continuously, and the data of 144 severe patients who met PSI risk rating III-V were analyzed. Seventy-two cases were involved each in standard treatment group and Xuebijing group. The average age of the standard treatment group and Xuebijing group were (65.7±7.9) years old and (63.5±10.9) years old, and male accounted for 75.0% (54/72) and 70.8% (51/72), respectively. There were no significant differences in general conditions, comorbidities, PSI risk rating and score, sequential organ failure assessment (SOFA) score, oxygenation index (PaO2/FiO2), respiratory support mode and other baseline indicators between the two groups. Compared with the standard treatment group, the improvement rate of PSI risk rating in Xuebijing group on the 8th day after admission was significantly improved [56.9% (41/72) vs. 20.8% (15/72), between-group difference and 95% confidence interval (95%CI) was 36.1% (21.3% to 50.9%), P < 0.01], PSI score, SOFA score and PaO2/FiO2 were significantly improved [PSI score: 83.7±34.8 vs. 108.2±25.6, between-group difference (95%CI) was -24.5 (-34.9 to -14.1); SOFA score: 2.0 (1.0, 4.0) vs. 7.0 (4.0, 10.0), between-group difference (95%CI) was -3.5 (-5.0 to -2.0); PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 289.4±111.6 vs. 188.5±98.1, between-group difference (95%CI) was 100.9 (65.3 to 136.5); all P < 0.01]. The 28-day discharge rate of Xuebijing group was 44.5% higher than that of standard treatment group [66.7% (48/72) vs. 22.2% (16/72), P < 0.01], and the 28-day survival rate was 9.8% [91.7% (66/72) vs. 81.9% (59/72), P < 0.01]. There was no significant difference in the combination of antiviral drugs, antibiotics, anticoagulants and vasopressor drugs between the two groups. There was no significant difference in the incidence of adverse events between the Xuebijing group and standard treatment group [41.7% (30/72) vs. 43.1% (31/72), P > 0.05], and no serious adverse events and adverse reactions of Xuebijing were reported. Standard treatment combined with Xuebijing injection can significantly improve the PSI risk score and clinical prognosis of patients with severe COVID-19 without increasing drug safety risk.

The Association between Nutritional Parameters and the Prognosis of Community Acquired Pneumonia

Background: Community–acquired pneumonia (CAP) is the most common potentially fatal infectious disease in adults worldwide. Prognosis depends on many factors including nutritional status. (P.S this research began before COVID19 pandemic arrivals to our country). &#x0D; Objective: The present study aims to assess the association between markers of nutritional status and severity of CAP.&#x0D; Materials and Methods: This is observational descriptive study conducted in the Department of Pulmonology in Tishreen University Hospital –Lattakia- Syria from November 2019 to November 2020. Adult patients with the diagnosis of CAP were enrolled in the study.&#x0D; Results: A total of 70 patients were included, Median age was 65 years, 40 (57.10%) were male. Serum albumin and cholesterol levels were lower in patients older than 65 years; (3.07±0.4 vs 3.5±0.5, p:0.001) and (135.2±33.2 vs 154.8±31.7, p: 0.01), respectively. Levels of albumin and cholesterol were significantly higher in survivors group; (3.6±0.4 vs. 2.7±0.3, p:0.001) and (158.3±23.9 vs. 120.3±35.08, p: 0.0001).&#x0D; Pearson's correlation analysis revealed negative correlation between pneumonia severity index (PSI) and: serum albumin (r = -0.61, p:0.0001), cholesterol(r = -0.45, p:0.0001) and BMI (r = -0.16, p: 0.1). The CRP showed negative correlation with serum albumin (r = -0.55, p:0.0001), cholesterol (r = -0.51 ,p:0.0001) and BMI (r = -0.09, p: 0.4).&#x0D; Conclusion: Serum albumin and cholesterol values were found to be related to the severity of CAP and initial levels may be a useful biomarkers to predict the outcome of patients.

Accuracy Between CURB-65 Score and PSI in Determining The Prognosis of Community-Acquired Pneumonia Patients at H. Adam Malik General Hospital, Medan

Background: Community-Acquired Pneumonia (CAP) is an important problem associated with morbidity and mortality. An accurate initial assessment is required before starting management of a CAP patient to determine the prognosis of the patient as early as possible. The CURB-65 score and PSI (Pneumonia Severity Index) are initial assessment scores that can be used. This study aimed to compare the accuracy between the CURB-65 score and the PSI in determining the prognosis in CAP patients at H. Adam Malik General Hospital Medan. Method: A descriptive study was conducted on 76 patients diagnosed with CAP. Each patient was assessed for their CURB-65 score, PSI class and mortality within 30 days of admission. Data were collected through patient medical records diagnosed CAP in 2018 and performed statistical analysis using 2x2 tables. Results: The CURB-65 ≥3 score showed accuracy (71.0%), sensitivity (53.8%), and specificity (89,2%). The CURB-65 ≥ 2 score showed accuracy (75.0%), sensitivity (82.1%), and specificity (67.6%). Meanwhile, the Class IV-V PSI showed accuracy (77.6%), sensitivity (87.2%) and specificity (67.6%). Conclusion: The accuracy of the PSI is higher when compared to the CURB-65 score in determining the prognosis of CAP patients at H. Adam Malik General Hospital Medan. Although PSI is more accurate, CURB-65 is simpler, easier and less expensive to use

Usefulness of β-lactam and macrolide combination therapy for treating community-acquired pneumonia patients hospitalized in the intensive care unit: Propensity score analysis of a prospective cohort study

IntroductionWhether β-lactam and macrolide combination therapy reduces mortality in severe community-acquired pneumonia (SCAP) patients hospitalized in the intensive care unit (ICU) is controversial. The aim of the present study was to evaluate the usefulness of β-lactam and macrolide combination therapy for SCAP patients hospitalized in the ICU. MethodsA prospective, observational, cohort study of hospitalized pneumonia patients was performed. Hospitalized SCAP patients admitted to the ICU within 24 h between October 2010 and October 2017 were included for analysis. The primary outcome was 30-day mortality, and secondary outcomes were 14-day mortality and ICU mortality. Inverse probability of treatment weighting (IPTW) analysis as a propensity score analysis was used to reduce biases, including six covariates: age, sex, C-reactive protein, albumin, Pneumonia Severity Index score, and APACHE II score. ResultsA total of 78 patients were included, with 48 patients in the non-macrolide-containing β-lactam therapy group and 30 patients in the macrolide combination therapy group. β-lactam and macrolide combination therapy significantly decreased 30-day mortality (16.7% vs. 43.8%; P = 0.015) and 14-day mortality (6.7% vs. 31.3%; P = 0.020), but not ICU mortality (10% vs 27.1%, P = 0.08) compared with non-macrolide-containing β-lactam therapy. After adjusting by IPTW, macrolide combination therapy also decreased 30-day mortality (odds ratio, 0.29; 95%CI, 0.09–0.96; P = 0.04) and 14-day mortality (odds ratio, 0.19; 95%CI, 0.04–0.92; P = 0.04), but not ICU mortality (odds ratio, 0.34; 95%CI, 0.08–1.36; P = 0.13). ConclusionsCombination therapy with β-lactam and macrolides significantly improved the prognosis of SCAP patients hospitalized in the ICU compared with a non-macrolide-containing β-lactam regimen.

The Role of Macrolides for the Management of Community-Acquired Pneumonia and Pneumonia by the Novel Coronavirus SARS-CoV-2 (COVID-19): A Position Paper by Four Medical Societies from Greece.

In light of the accumulating evidence for survival benefit coming from the use of macrolides for community-acquired pneumonia (CAP), a group of experts from the field of internal medicine and infectious diseases frame a position statement on the use of macrolides for the management of bacterial CAP and for infection by the novel coronavirus (COVID-19). The statement is framed taking into consideration existing publications and own research experience. The main content of this statement is that the combination of one β-lactam and a macrolide should be the first treatment of choice for patients with severe bacterial CAP. Severity is assessed as scoring 2 or more points on the CURB65 scoring system of severity or as pneumonia severity index III to V or C-reactive protein more than 150 mg/l; the suggested macrolide is either azithromycin or clarithromycin. The experts also suggest that in COVID-19 pneumonia, the combination of one β-lactam and a macrolide should be reserved only when there is strong suspicion of bacterial co-infection.

BioFire® FilmArray® Pneumonia Panel for Severe Lower Respiratory Tract Infections: Subgroup Analysis of a Randomized Clinical Trial.

IntroductionThe epidemiology of severe lower respiratory tract infections (LRTI) is constantly changing. We aimed to describe it using the BioFire® FilmArray® Pneumonia plus (PNplus) Panel.MethodsIn a sub-study of the PROGRESS trial, sputum samples of 90 patients with sepsis and LRTI were retrospectively studied. The primary endpoint was the comparative detection rate of pathogens between conventional microbiology and PNplus Panel; secondary endpoints were microbiology and the association with the inflammatory host response.ResultsFifty-six patients with community-acquired pneumonia without risk factors for multidrug-resistant (MDR) pathogens and another 34 patients with risk factors for MDR were studied; median pneumonia severity index (PSI) was 113 (88–135). PNplus detection rate was 72.2% compared to 10% by conventional microbiology (p < 0.001); Streptococcus pneumoniae was the most common pathogen. PSI and procalcitonin were greater among patients with bacterial pathogens than viral pathogens. Median procalcitonin was 0.49 ng/ml and 0.18 ng/ml among patients with ≥ 105 and < 105 copies/ml of detected bacteria, respectively (p = 0.004). Resistance reached 14.4%.ConclusionPNplus detects severe pneumonia pathogens at a greater rate than conventional microbiology. High levels of inflammation accompany bacterial detection.Trial RegistrationPROGRESS, ClinicalTrials.gov NCT03333304, 06/11/2017.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00459-x.

Improvement of pneumococcal pneumonia diagnosis using quantitative real-time PCR targeting lytA in adult patients: a prospective cohort study

ObjectivesThe aim of the study was to assess the performance of real-time PCR targeting the lytA gene (rtPCR-lytA) in plasma, urine and nasopharyngeal (NP) samples for the diagnosis of pneumococcal community-acquired pneumonia (P-CAP). MethodsProspective observational study including all consecutive adults with CAP from November 2015 to May 2017. P-CAP was defined if pneumococcus was identified using conventional methods (CM) and/or a positive rtPCR-lytA was detected in blood, urine or NP samples (NP cut-off ≥8000 copies/mL). Diagnostic performance of each test was calculated. ResultsA total of 133 individuals with CAP were included. Of these, P-CAP was diagnosed in 62 (46.6%). The proportion of P-CAP diagnosed by rtPCR-lytA methods was significantly higher than that diagnosed by CM (87.1% versus 59.7%, p 0.005). The rtPCR-lytA identified Streptococcus pneumoniae in 25 patients (40.3% of all individuals with P-CAP) whose diagnosis would have been missed by CM. NP-rtPCR-lytA allowed diagnosis of 62.3% of P-CAP. A nasopharyngeal colonization density ≥2351 copies/mL predicted P-CAP diagnosis (area under the curve = 0.82, sensitivity 83.3%, specificity 80.9%). There was a positive correlation between increasing bacterial load in blood and CURB-65 score (Spearman correlation coefficient r = 0.4, p 0.001), pneumonia severity index (r = 0.3, p 0.02) and time to clinical stability (r = 0.33, p 0.01). Median bacterial load in blood was higher in P-CAP patients with bacteraemia (0.65 × 103 versus 0 × 103 copies/mL, p 0.002), intensive care unit admission (0.68 × 103 versus 0 × 103 copies/mL, p 0.04) or mechanical ventilation (7.45 × 103 versus 0 × 103 copies/mL, p 0.04). ConclusionsThe use of rtPCR-lytA methods significantly increased the diagnosis of P-CAP compared with CM. Nasopharyngeal swabs rtPCR-lytA detection, with an accurate cut-off value, was the most promising among molecular methods for the diagnosis of P-CAP.

Clinically Significant Monocyte Biomarker for Differential Diagnosis of COVID-19 Pneumonia in the Emergency Department

To determine basic patient characteristics and biomarkers to help in the early diagnosis of Coronavirus disease 2019 (COVID-19) pneumonia in patients with pneumonia who visited the emergency department (ED). This retrospective study evaluated patients diagnosed with community-acquired pneumonia (CAP) or COVID-19 pneumonia in the ED at four tertiary medical centers between February 1 and March 31, 2020. Parameters related to the differential diagnosis between CAP and COVID-19 were investigated. Clinical characteristics and laboratory results of biomarkers were analyzed. In total, 81 patients presented to the ED with COVID-19 pneumonia. Multivariate logistic regression analysis showed that monocyte count [odds ratio (OR): 0.996; 95% confidence interval (CI): 0.994–0.999] and pneumonia severity index (PSI) [OR: 1.025; 95% CI: 1.002–1.049] were associated with diagnosis of COVID-19 pneumonia. The area under the curve comprising the combination of monocyte and PSI was 0.789. Differential diagnosis of COVID-19 pneumonia from pneumonia patients who visited the ED can be made by monocyte count and PSI score. Keywords: COVID-19, Emergencies, Monocytes, Pneumonia

145-LB: Glycemic Control Is Not an Independent Predictor of Mortality or Length of Stay for Patients Hospitalized with Coronavirus 2019 (COVID-19)

Diabetes mellitus (DM) is an important prognostic factor for coronavirus 2019 (COVID-19). However, studies of hospital glycemic control and outcomes controlled for factors that affect morbidity and mortality in pneumonia (PNA) are limited. We conducted a multicenter retrospective cohort study of patients ≥ 18 years (N=108) admitted to either the ICU or noncritical units January 1, 2020 to September 29, 2020 with a clinical diagnosis or radiographic evidence of PNA, laboratory confirmation of COVID-19, and DM or newly diagnosed hyperglycemia, defined as admission plasma glucose &amp;gt; 126 mg/dL or one or more random plasma glucose measurements &amp;gt; 200 mg/dL. Co-primary endpoints were mortality, ICU length of stay (LOS), and total hospital LOS stratified by mean capillary blood glucose (CBG) for hospitalization. Endpoints were compared by logistic, linear, or Poisson regressions controlling for demographic variables, prehospital HbA1c, residence, pneumonia severity index score, Sequential Organ Failure Assessment score (ICU patients), pulmonary consultation, infectious diseases consultation, and study site. Patients treated with dexamethasone (N=42) were evaluated separately from untreated patients. There was no difference in mortality for patients with mean hospital CBG &amp;lt; 180 mg/dL (30.1%) or ≥ 180 mg/dL (20.0%, P=0.24). Median total hospital LOS was 8 (5-15) and 8 (6-16) days for patients with mean CBG &amp;lt; 180 mg/dL or ≥ 180 mg/dL, respectively (P=0.35), and there was no difference in ICU LOS by glycemic status (P=0.19). No measures of glycemic control were independent predictors of mortality or LOS in multivariable regression analyses, and results were unaffected by dexamethasone treatment status. In this study controlling for multiple validated PNA prognostic factors, hospital glycemic control did not have a significant effect on mortality or LOS for patients with DM or newly diagnosed hyperglycemia hospitalized with COVID-19. Disclosure M. G. Jakoby: None. V. Williams: None. S. Ward: None. S. K. Lee: None. M. Buhnerkempe: None. K. Izuora: None.

Risk factors associated with methicillin-resistant Staphylococcus aureus isolation from serially collected sputum samples of patients hospitalized with pneumonia

IntroductionRisk factors associated with the new detection of methicillin-resistant Staphylococcus aureus (MRSA) during hospitalization remain unclear. This study aimed to identify risk factors associated with MRSA isolation from the sputum of patients admitted with pneumonia, during their hospitalization. MethodsPatients were prospectively enrolled from 2003 to 2012. Sputum samples were collected for bacterial cultures on days 1, 4, 7, 11, and 14 of hospitalization and thereafter. Cases of MRSA first isolated from sputum obtained before day 4 were defined as “carriage on admission.” Cases of MRSA first isolated on day 4 and thereafter, were defined as “new detection after admission.” Statistical analysis was used to investigate the risk factors associated with MRSA isolation. ResultsMRSA was isolated from 167 of 1,008 patients (carriage: 47; new detection: 120). Multivariate analysis revealed that the risk factors for MRSA carriage were activities of daily living (ADL) disability prior to admission (odds ratio [OR], 2.92; 95% confidence interval [CI], 1.37–6.22) and hospitalization within the previous 90 days (OR, 3.75; 95% CI, 1.90–7.41). ADL disability prior to admission (risk ratio [RR], 1.82; 95% CI, 1.17–2.84) and a high pneumonia severity index score upon admission (RR, 2.20; 95% CI, 1.37–3.65) were risk factors for new detection of MRSA. ConclusionsSeveral risk factors were found to be associated with MRSA carriage and/or its new detection, based on the sputum samples from patients admitted with pneumonia. These factors may be indicators for selective surveillance and the early implementation of infection control measures.

Monocyte-to-lymphocyte ratio as a predictor of stroke-associated pneumonia: A retrospective study-based investigation.

Background and purposeEarly prediction of stroke‐associated pneumonia (SAP) is significant in clinical practice, as it is frequently challenging due to delays in typical clinical manifestations and radiological changes. The monocyte‐to‐lymphocyte ratio (MLR) has been proposed as an indicator of systemic inflammation and infection. However, none of these studies have focused on the predictive value of the MLR for SAP. We investigated the predictive value of MLR for SAP and investigated its relationship with disease severity.MethodsIn this retrospective study, we assessed 399 consecutive patients with acute stroke. SAP was defined according to the modified Centers for Disease Control and Prevention criteria. The severity of pneumonia was rated using the pneumonia severity index (PSI). MLR was calculated by dividing absolute monocyte counts by absolute lymphocyte counts.ResultsAmong all the patients, SAP occurred in 116 patients (29.1%). White blood cell (WBC), neutrophil, monocyte, and MLR levels in the SAP group were higher than those in the non‐SAP group, while lymphocyte levels were lower (p < .05). Multivariable regression analysis revealed that the MLR (OR = 7.177; 95% CI = 1.190–43.292, p = .032) remained significant after adjusting for confounders. The ROC curve showed that the AUC value of MLR for SAP was 0.779, the optimal cutoff value of MLR for SAP was 0.388, with a specificity of 64.7% and sensitivity of 81.3%. The MLR levels were significantly higher in the severe pneumonia group when assessed by PSI (p = .024) than in the mild group. The AUC value of MLR was 0.622 (95% CI = 0.520–0.724, p = .024) in the severe pneumonia group. The optimal cutoff value of MLR was 0.750, with a specificity of 91.0% and a sensitivity of 33.0%.ConclusionsOur study shows that a high MLR is an independent risk factor for SAP and has a predictive value for severe pneumonia in patients with SAP.

Comparison of the clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease (CCVD) and non-CCVD patients.

Cardio-cerebrovascular disease (CCVD) is a major comorbidity of Coronavirus disease 2019 (COVID-19). However, the clinical characteristics and outcomes remain unclear. In this study, 102 cases of COVID-19 from January 22, 2020 to March 26, 2020 in Xixi Hospital of Hangzhou were included. Twenty cases had pre-existing CCVD. Results showed that compared with non-CCVD patients, those with CCVD are more likely to develop severe disease (15% versus 1%), and the proportion of pneumonia severity index grade IV was significantly higher (25% versus 3.6%). Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group (90% versus 63.4%). Compared with non-CCVD group, the levels of C-reactive protein, fibrinogen, D-dimer, and serum amyloid-A were higher, whereas the total protein and arterial partial PaO2 were lower in the CCVD group. Although no statistical difference was observed in the outcomes between groups, CCVD patients received more intensive comprehensive treatment to improve COVID-19 symptoms compared with non-CCVD patients. Integrated Chinese and Western medicine treatments have certain advantages in controlling the severe conversion rate and mortality of COVID-19. In addition, given that COVID-19 patients are usually related to coagulation disorders and thrombosis risk, the application of Chinese medicine in promoting blood circulation and removing stasis should be strengthened.

Renal Replacement Therapy in Patients with Influenza Pneumonia Related Acute Respiratory Distress Syndrome.

Acute kidney injury (AKI) requiring renal replacement therapy (RRT) increases the mortality of acute respiratory distress syndrome (ARDS) patients. The aim of this study was to investigate the outcomes and predictors of RRT in patients with influenza pneumonia-related ARDS. This retrospective cohort study includes patients from eight tertiary referral centers in Taiwan between January and March 2016, and all 282 patients with influenza pneumonia-related ARDS were enrolled. Thirty-four patients suffered from AKI requiring RRT, while 16 patients had underlying end stage renal disease (ESRD). The 30- and 60-day mortality rates were significantly higher in patients with AKI requiring RRT compared with those not requiring RRT (50.0% vs. 19.8%, p value < 0.001; 58.8% vs. 27.2%, p value = 0.001, respectively), but the patients with ESRD had no significant difference in mortality (12.5% vs. 19.8%, p value = 0.744; 31.3% vs. 27.2%, p value = 0.773, respectively). The predictors for AKI requiring RRT included underlying chronic liver disease and C-reactive protein. The mortality predictors for patients with AKI requiring RRT included the pneumonia severity index, tidal volume, and continuous renal replacement therapy. In this study, patients with influenza pneumonia-related ARDS with AKI requiring RRT had significantly higher mortality compared with other patients.

Clinical relevance of emphysema in patients hospitalized with community-acquired pneumonia: Clinical features and prognosis.

Few studies have investigated the influence of emphysema on clinical features of patients presenting with community-acquired pneumonia (CAP). The aim of this study was to examine the clinical and microbiological features of patients with both CAP and emphysema. This retrospective study included patients with CAP who underwent computed tomography (CT) scan at the time of presentation. Patients were allocated into emphysema and control groups, and clinical variables were compared between the two groups. The emphysema group was further divided into three subgroups (mild, moderate, and severe) according to the extent of emphysema on CT scan. The clinical variables of each subgroup were compared with the control group. Of 1676 patients, 431 patients (25.7%) were classified into the emphysema group. CAP patients with emphysema were more likely to have a high CURB-65 score and pneumonia severity index and a lower incidence of complicated parapneumonic effusion or empyema. The emphysema group exhibited longer hospital stay. In addition, 30-day mortality in the severe emphysema group was significantly higher compared with the control group. As etiological agents, Streptococcus pneumoniae, Pseudomonas aeruginosa, Enterobacteriaceae, and multidrug-resistant pathogens were significantly more common in the emphysema group compared with the control group. The presence of emphysema in CAP patients was associated with a more severe form of CAP, a longer hospital stay, and a lower incidence of complicated parapneumonic effusion or empyema. Moreover, CAP patients with severe emphysema exhibited higher 30-day mortality than those without emphysema.

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.

Community-acquired pneumonia severity assessment tools in patients hospitalized with COVID-19: a validation and clinical applicability study

ObjectiveTo externally validate community-acquired pneumonia (CAP) tools on patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia from two distinct countries, and compare their performance with recently developed COVID-19 mortality risk stratification tools. MethodsWe evaluated 11 risk stratification scores in a binational retrospective cohort of patients hospitalized with COVID-19 pneumonia in São Paulo and Barcelona: Pneumonia Severity Index (PSI), CURB, CURB-65, qSOFA, Infectious Disease Society of America and American Thoracic Society Minor Criteria, REA-ICU, SCAP, SMART-COP, CALL, COVID GRAM and 4C. The primary and secondary outcomes were 30-day in-hospital mortality and 7-day intensive care unit (ICU) admission, respectively. We compared their predictive performance using the area under the receiver operating characteristics curve (AUC), sensitivity, specificity, likelihood ratios, calibration plots and decision curve analysis. ResultsOf 1363 patients, the mean (SD) age was 61 (16) years. The 30-day in-hospital mortality rate was 24.6% (228/925) in São Paulo and 21.0% (92/438) in Barcelona. For in-hospital mortality, we found higher AUCs for PSI (0.79, 95% CI 0.77–0.82), 4C (0.78, 95% CI 0.75–0.81), COVID GRAM (0.77, 95% CI 0.75–0.80) and CURB-65 (0.74, 95% CI 0.72–0.77). Results were similar for both countries. For the 1%–20% threshold range in decision curve analysis, PSI would avoid a higher number of unnecessary interventions, followed by the 4C score. All scores had poor performance (AUC <0.65) for 7-day ICU admission. ConclusionsRecent clinical COVID-19 assessment scores had comparable performance to standard pneumonia prognostic tools. Because it is expected that new scores outperform older ones during development, external validation studies are needed before recommending their use.

A COMPARATIVE STUDY OF CLINICAL AND BIOCHEMICAL PROFILE AMONG SURVIVORS AND NON SURVIVORS OF PATIENTS WITH COVID-19 INFECTION - A RETROSPECTIVE STUDY.

BACKGROUND: The pandemic caused by SARS-Corona Virus-2 (COVID-19) is far from over. There has been ongoing new infections across the globe. The clinical course of the disease is varied among different individuals. The prediction of severity and mortality is very difcult but quite essential for timely escalation of the treatment. This is a comparative study of clinical, biochemical parameters among the survivors and non survivors of COVID-19 infection. METHODOLOGY: This is a retrospective study conducted in a tertiary care hospital in South India. This study was an audit of 39 survivors and 39 non survivors of COVID-19 infection. These patients were matched with age and gender. The clinical prole, Biochemical parameters and the clinical course among the two groups were compared and analyzed. RESULTS: 39 survivors and 39 non survivors were included in the study. The two groups were age and gender matched. The symptoms were fever, cough, breathlessness, fatigue, myalgia, body ache, diarrhea. Breathlessness was more common among patients who did not survive. Pneumonia severity index was class 1 and class 2 among patients who survived. PSI was class 4 and class 5 among the patients who did not survive. This difference was statistically signicant. It was seen that there were signicant number of comorbidities and inammatory markers like CRP, D DIMER, LDH, S. Ferritin seen among non survivors compared to the survivors. The study CONCLUSION: shows that presence of comorbidities has an adverse impact on the outcome of the patients with COVID-19 infection. The elevated inammatory markers like CRP, D Dimer and LDH predicted poor outcome. Pneumonia severity index was a useful marker to predict the outcome among patients of COVID.

Clinical Features of the 60 Years and Older Patients Infected with 2019 Novel Coronavirus: Can We Predict Mortality Earlier?

Introduction: The novel coronavirus (COVID-19), which has affected over 100 countries in a short while, progresses more mortally in elderly patients with comorbidities. In this study, we examined the epidemiological, clinical, and laboratory characteristics of the patients aged 60 and over who had been infected with COVID-19. Methods: The data of the patients admitted to the hospital within 1 month from May 8, 2020 onwards and hospitalized for COVID-19 pneumonia were obtained from the hospital medical records, and the epidemiological, clinical, and laboratory parameters of the patients during the admission to the emergency department were examined. Patients were divided into 2 groups regarding the criteria of having in-hospital mortality (mortality group) and being discharged with full recovery (survivor group). The factors, which could have an impact on the mortality, were investigated using a univariate and multivariate logistic regression analysis. Results: This retrospective study included 113 patients aged 60 years and older, with a confirmed diagnosis of COVID-19 pneumonia. The mean age of the patients was 70.7 ± 7.9, and 64.6% (n = 73) of them were male. The mortality rate was 19.4% (n = 22). Among the comorbid illnesses, only renal failure was significant in the mortality group (p = 0.04). A CURB-65score ≥3 or pneumonia severity index (PSI) class ≥4 manifested a remarkable discrimination ability to predict 30-day mortality (p < 0.001). When the laboratory parameters were considered, the value of neutrophil to lymphocyte ratio (NLR) was significant in predicting mortality in univariate and multivariate analysis (odds ratio [OR] = 1.11; 95% confidence interval [95% CI], 1.03–1.21; p = 0.006, and OR = 1.51; 95% CI, 1.11–2.39; p = 0.044, respectively). Conclusion: In our study, NLR was determined to be an independent marker to predict in-hospital mortality among patients with COVID-19. PSI and CURB-65 revealed a considerably precise prognostic accuracy for the patients with COVID-19 in our study as well. Moreover, thanks to that NLR results in a very short time, it can enable the clinician to predict mortality before the scoring systems are calculated and hasten the management of the patients in the chaotic environment of the emergency room.

Capillary Lactate Level in Non-Severe and Severe CommunityAcquired Pneumonia Patients

Background: Community-acquired pneumonia is an inflammatory disease of the lung caused bymicroorganisms acquired from a non-hospital environment. The pneumonia severity index and ATS/IDSAseverity criteria are widely used to predict the severity of CAP. Lactate is a biomarker that can be measuredby point-of-care devices that provide results in a short of time. This study aimed to determine the differencein capillary lactate level between non-severe and severe pneumonia to provide an additional method toquickly stratify pneumonia severity and treat it accordingly.Methods: This cross-sectional study was performed in the emergency room of a regional research hospital.The pneumonia diagnosis was determined by the symptoms, physical examination and radiological findings.Capillary lactate level was measured with Accutrend Plus lactate point-of care device. Severity stratificationwas done according to ATS/IDSA criteria. The mean of lactate level in all subjects was 3.40±1.52, in nonsevere pneumonia subgroup was 2.25±0.94, and 4.56±1.01 in severe pneumonia subgroup. Lactate issignificantly higher in severe pneumonia subgroup. The cut-off point of lactate level for severity group was3.2 mmol/L (95.5% sensitivity, 86.4% specificity).Conclusion: The early prediction of CAP severity is essential to determine the need for admission in theintensive care unit and close follow up. The lactate level can be used for immediate severity stratification inemergency departments.