Prognosis Of Pneumonia Research Articles

The relationship between the expression of serum IL-18 mRNA, CC16, and sTREM-1 and the severity and prognosis of ventilator-associated pneumonia in elderly patients.

This study aimed to explore the relationship between the severity and prognosis of elderly patients with ventilator-associated pneumonia (VAP) and the expression of serum interleukin-18 mRNA (IL-18 mRNA), Clara cell secretory protein 16 (CC16) and the soluble triggering receptor expressed on myeloid cells 1 (sTREM-1). The patients were divided into a VAP group (n=75) and a non-VAP group (n=110). According to the Acute Physiology and Chronic Health Evaluation II (APACHEII) score, the patients with VAP were divided into a low-risk group, an intermediate-risk group and a high-risk group. According to the 28-day outcome, the patients were divided into a survival group and a death group. Serum levels of IL-18, CC16 and sTREM-1 were detected, and their value in the prediction and prognosis of VAP was analyzed using a receiver operating characteristic (ROC) curve. Serum levels of IL-18 and sTREM-1 in the VAP group were higher than those in the non-VAP group, while CC16 levels were lower in the VAP group than those in the non-VAP group (P<0.05). Serum levels of IL-18 and sTREM-1 decreased in order from the high-risk group to the intermediate-risk group to the low-risk group, while CC16 levels increased in order (P<0.05). ROC curve analysis showed that the Youden index and AUC of combined diagnosis of VAP with serum IL-18 mRNA, CC16 and sTREM-1 were 0.710 and 0.930, which were higher than those of single diagnosis (P<0.05). Serum levels of IL-18 mRNA and sTREM-1 in the survival group were lower than those in the death group, and the CC16 level was higher than that in the death group (P<0.05). ROC curve analysis showed that the Youden index and AUC of combined diagnosis with serum IL-18 mRNA, CC16 and sTREM-1 were 0.506 and 0.731, which were higher than those of single diagnosis (P<0.05). The combination of these 3 factors is of high value in predicting the severity and prognosis of VAP and can provide reference for clinical treatment.

Implementing Lung Ultrasound in the Outpatient Management of COVID-19 Pneumonia: A Pilot Study to Update Local Guidelines.

Background: Lung ultrasound (LUS) has a good performance with a high sensitivity and specificity for the diagnosis of pneumonia compared with chest X-ray, and it has been extensively used to assess patients during the COVID-19 pandemic. This study aims to evaluate the potential advantages of the regular use of LUS for the assessment of the severity and prognosis of COVID-19 pneumonia and to propose an adapted protocol with its inclusion in current local validated and published guidelines.Methods: This is a single-center prospective study conducted during the first (April–May 2020) and second (October 2020–January 2021) waves of the SARS-CoV2 pandemic in Switzerland. All adult patients presenting to dedicated test centers with a suspicion of mild-to-moderate COVID-19 pneumonia and not requiring hospitalization at the time of diagnosis were included. Patients with confirmed COVID-19 pneumonia were referred to an ambulatory follow-up unit at our institution for reassessment, with the inclusion of the use of LUS in a random selection. Descriptive statistics were calculated for demographics using percentages, means, and standard deviations according to the distribution of variables.Results: Eighty-eight ambulatory patients with a confirmed COVID-19 pneumonia were included (men = 57 [59%]; mean age, 52.1 ± 13.5 years). Among these, 19 (21%) were hospitalized and none died. Twenty-five lung assessments by ultrasound were performed during the follow-up consultation. All were consistent with the clinical examination and confirmed the clinician's opinion.Conclusion: The use of a standardized pleuro-pulmonary ultrasound protocol for ambulatory patients with COVID-19 could help to reduce the use of chest X-rays and improve overall management at the time of referral and eventual follow-up. However, a specific study including LUS in a systematic approach should be performed to evaluate the outcome of patients according to findings.

Effect of antibiotic therapy on the prognosis of ventilator-associated pneumonia caused by Stenotrophomonas maltophilia

BackgroundVentilator-associated pneumonia (VAP) caused by Stenotrophomonas maltophilia is poorly described in the literature. However, it has been shown to be associated with increased morbidity and mortality. Probabilistic antibiotic therapy against S. maltophilia is often ineffective as this pathogen is resistant to many antibiotics. There is no consensus at present on the best therapeutic strategy to adopt (class of antibiotics, antibiotic combination, dosage, treatment duration). The aim of this study was to evaluate the effect of antibiotic therapy strategy on the prognosis of patients with VAP caused by S. maltophilia.ResultsThis retrospective study evaluated all consecutive patients who developed VAP caused by S. maltophilia between 2010 and 2018 while hospitalized in the intensive care unit (ICU) of a French university hospital in Reunion Island, in the Indian Ocean region. A total of 130 patients with a median Simplified Acute Physiology Score II of 58 [43–73] had VAP caused by S. maltophilia after a median duration of mechanical ventilation of 12 [5–18] days. Ventilator-associated pneumonia was polymicrobial in 44.6% of cases, and ICU mortality was 50.0%. After multivariate Cox regression analysis, the factors associated with increased ICU mortality were older age (hazard ratio (HR): 1.03; 95% CI 1.01–1.04, p = 0.001) and high Sequential Organ Failure Assessment score on the day of VAP onset (HR: 1.08; 95% CI 1.03–1.14, p = 0.002).Appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU mortality (HR: 0.42; 95% CI 0.24–0.74, p = 0.003) and decreased hospital mortality (HR: 0.47; 95% CI 0.28–0.79, p = 0.04).Time to start of appropriate antibiotic therapy, combination therapy, and duration of appropriate antibiotic therapy had no effect on ICU mortality (p > 0.5).ConclusionIn our study, appropriate antibiotic therapy, and in particular trimethoprim–sulfamethoxazole, was associated with decreased ICU and hospital mortality in patients with VAP caused by S. maltophilia.

The Impact of Risk Factors on Treatment Outcomes of Nosocomial Pneumonia Due to Gram-Negative Bacteria in the Intensive Care Unit.

IntroductionNosocomial pneumonia is a common infection associated with high mortality in hospitalized patients. Nosocomial pneumonia, caused by gram-negative bacteria, often occurs in the elderly and patients with co-morbid diseases.MethodsOriginal research using a prospective cross-sectional design was conducted on 281 patients in an intensive care unit setting with nosocomial pneumonia between July 2015 and July 2019. For each nosocomial pneumonia case, data regarding comorbidities, risk factors, patient characteristics, Charlson comorbidity index (CCI), Systemic Inflammatory Response Syndrome (SIRS), and quick Sepsis-Related Organ Failure Assessment (qSOFA) points and treatment outcomes were collected. Data were analyzed by SPSS 22.0.ResultsNosocomial pneumonia due to gram-negative bacteria occurred in patients with neurological disorders (34.87%), heart diseases (16.37%), chronic renal failure (7.12%), and post-surgery (10.68%). Worse outcomes attributed to nosocomial pneumonia were high at 75.8%. Mechanical ventilation, change of antibiotics, and CCI ≥ 3 and qSOFA ≥ 2 were significantly negative prognostic factors (p < 0.05) on outcomes of nosocomial pneumonia. There was no difference in treatment effects between gender, age, time of onset pneumonia, SIRS score (p > 0.05). The pathogens were significant factors that influence treatment effects, but they weren’t independent risk factors for poor outcomes (p = 0.823).ConclusionsPatients with nosocomial pneumonia hospitalized in intensive care units are usually associated with many underlying diseases, including neurological diseases. Mechanical ventilation, a change in antibiotics, CCI ≥ 3, and qSOFA ≥ 2 are also associated with a worse prognosis of nosocomial pneumonia. CCI and qSOFA might be used in predicting the outcome of nosocomial pneumonia.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00175-4.

Effect of Poor Nutritional Status and Comorbidities on the Occurrence and Outcome of Pneumonia in Elderly Adults.

Background: Malnutrition and comorbidity are two common geriatric syndromes. The pathology of pneumonia is multifactorial, making its diagnosis and management a great challenge. Hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) are two main types of pneumonia. However, the effect of geriatric syndromes on pneumonia and its prognosis have not been clearly explored.Methods: We collected the relevant electronic data of inpatients aged over 65 years and diagnosed with pneumonia in the Geriatrics Department Building of the First Affiliated Hospital with Nanjing Medical University between December 2018 and December 2019, and further divided them into HAP group and CAP group. The correlations of age, age-adjusted Charlson Comorbidity Index (aCCI), basic diseases and nutritional indexes (i.e., albumin, electrolyte, hemoglobin) with pneumonia and prognosis were analyzed. We analyzed the associations between infection prognosis/infection level and age, nutritional status, aCCI and underlying diseases, using linear regression model. The box plot was applied to present infection outcome, and the nomogram was built for predicting infection outcomes. We utilized the heat map to show the associations between nutritional status and infection level/outcome in all infected patients, HAP, and CAP.Results: The final study comprised samples of 669 pneumonia patients divided into HAP group (n = 517) and CAP group (n = 152). In all patients, the infection outcome was negatively correlated with age (P = 0.013). The level of albumin was negatively correlated with infection prognosis in all patients (P = 0.03), and negatively correlated with neutrophil count and CRP (P = 0.008, P < 0.001). ACCI was positively correlated with CRP (P = 0.003). The prognosis was negatively associated with age and albumin level. In the patients with basic dementia/Alzheimer's disease and chronic obstructive pulmonary disease/asthma, the prognosis was worse.Conclusion: There was a correlation between poor nutritional status-related indexes and inflammatory indexes. A poor nutritional status might predict a high risk of pneumonia in elderly adults. Advanced age and comorbidities were risk factors for the occurrence and poor prognosis of pneumonia. Therefore, comorbidities should be well-treated in the elderly with pneumonia.

19 Impact of variation in pediatric body weight on course and prognosis of Pneumonia

19 Impact of variation in pediatric body weight on course and prognosis of Pneumonia

Особенности ведения больных негоспитальной пневмонией с сопутствующей патологией: обоснование целесообразности использования антигипоксантов на примере этилметилгидроксипиридина сукцината

Внебольничная пневмония относится к наиболее распространенным инфекционным заболеваниям ХХI века и остается важной медико-социальной проблемой из-за достаточно высоких показателей инвалидизации и смертности, а также значительных экономических потерь. Сопутствующие хронические заболевания и состояния, количество которых увеличивается с возрастом, способствуют усилению тяжести и неблагоприятному прогнозу пневмонии. Сочетание патологий, патогенез которых включает гипоксический компонент, у одного больного определяет исключительную важность и необходимость понимания механизмов гипоксии (в том числе на клеточном уровне), а также социальную значимость проблемы защиты организма от кислородной недостаточности и сопутствующего энергодефицита, в том числе с помощью антигипоксантов с антиоксидантным и мембраностабилизирующим действием. В многочисленных экспериментальных и клинических исследованиях получены данные о плейотропных эффектах сукцината и сукцинатсодержащих антигипоксантов у больных с заболеваниями и состояниями, которые сопровождаются гипоксическими расстройствами. Создана достаточная доказательная база клинических исследований, в которых установлена целесообразность использования этилметилгидроксипиридина сукцината в составе комплексной терапии у больных с острыми и хроническими нарушениями мозгового кровообращения, тревожными расстройствами, у пациентов со стабильной стенокардией, острым коронарным синдромом, сердечной недостаточностью, артериальной гипертензией. Раннее добавление препарата в состав комбинированной терапии на догоспитальном этапе лечения пневмонии будет способствовать уменьшению возникновения острых осложнений или декомпенсации течения сопутствующих хронических состояний, ускорению регресса проявлений постинфекционной астении, вегетативной лабильности, когнитивного дефицита.

Significance of Acute Phase Reactants as Prognostic Biomarkers for Pneumonia in Children

Community acquired pneumonia (CAP) is a major contributing cause for the increased rate of childhood mortalities and morbidities in the developing countries. Thus, we aimed in this study to appraise the significance of acute phase reactant proteins in correlation with the modified pneumonia prognostic score to assess the disease severity and outcome in children.This study included 40 children with pneumonia ( age between 6 months 2 years ) and other 40 healthy controls ( age and sex matched). They were enrolled in the study and a detailedhistory’s obtained, full clinical examination and assessment of AGP, CRP and ferritin in serum in addition to CBC.AGP, CRP and ferritin showed significant higher levels in children with pneumonia than healthy controls. Also, their values were significantly higher in nonsuvivors than survivors.The present investigation provides a distinct evidence for the prominence of acute phase reactants (ferritin, CRP and AGP) in comparison with the clinical scores in predicting early high risk prognosis of pneumonia in children.

Characteristics and prognosis of Herpesviridae-related pneumonia in critically ill burn patients

BackgroundThe aim of this study was to describe the prevalence, characteristics and outcome of critically burn patients with pulmonary HSV reactivation. MethodsRetrospective, single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients with bronchoalveolar lavage performed for pneumoniae suspicion and screened for HSV from January 2013 and April 2017. We used logistic regression to identify factors associated with HSV reactivation and outcomes. Results94 patients were included, mean age was 51 (39−64) years; median total body surface area burned was 36 (25–54)% and ICU mortality 38%. Fifty-five patients (59%) had pulmonary HSV reactivation and 30 (55%) were treated with acyclovir. Patients with HSV reactivation were more severely ill with higher SOFA score at admission compared to patient without HSV reactivation (6 [3–8] vs. 2 [1–4], p < 0.0001 respectively). In multivariate analysis, sex, SOFA score at admission and smoke inhalation were significantly associated with HSV reactivation. Only septic shock was associated with 90-day mortality when HSV reactivation was not. ConclusionsPulmonary HSV reactivation is frequent among severely ill burn patients. Initial severity and smoke inhalation are risk factors. Antiviral treatment was not associated with outcome.

The Role of Red Blood Cell Distribution Width in the Severity and Prognosis of Community-Acquired Pneumonia.

Objectives The objective of this study is to unravel the correlation between RDW and the severity and prognosis of CAP, as well as exploring RDW with the inflammatory markers white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT). Methods According to the data characteristics, appropriate statistical methods were selected to analyze the relationship between RDW and the severity and prognosis of CAP patients and to determine whether RDW is associated with the inflammatory markers WBC, CRP, and PCT. Results The results show that with the increase of PSI and CURB-65 values, the proportion of patients with RDW ≥ 12.987% is significantly higher than that of RDW < 12.987% (P < 0.01). When RDW is combined with PSI or CURB-65 to predict the 90-day mortality of CAP patients, the area under the receiver operating characteristic (ROC) curve increased prominently, and if RDW, PSI, and CURB-65 are combined, the area under the ROC curve is maximized. Conclusions Our findings suggest that the higher RDW value is associated with short-term adverse outcomes in CAP patients. We also find that when RDW, PSI, and CURB-65 are combined, the best performance is achieved to predict CAP 90-day mortality risk.

Delayed positive COVID19 nasopharyngeal test, a case study with clinical and pathological correlation

BackgroundThere are various reasons for delayed positive nasopharyngeal PCR tests for coronavirus disease 2019 (COVID19) in not only asymptomatic but also severely diseased patients. The pathophysiological attributes are not known. We explore this possibility through a case report.Case presentationA 64-year-old male with history of pulmonary fungal infection, asthma and chronic pulmonary obstructive disease (COPD), diabetes, coronary artery disease presented with shortness of breath, fever and chest image of ground opacity, reticular interstitial thickening, highly suspicious for COVID19. However, nasopharyngeal swab tests were discordantly negative for four times in two weeks, and IgG antibody for COVID19 was also negative. However, serum IgE level was elevated. No other pathogens are identified. His symptoms deteriorated despite corticosteroid, antibiotics and bronchodilator treatment. Bronchoalveolar lavage (BAL) and open lung wedge biopsy were performed for etiology diagnosis. They demonstrated COVID19 viral RNA positive fibrosing organizing pneumonia with respiratory tract damage characterized by suspicious viral cytopathic effect, mixed neutrophilic, lymphoplasmacytic, histiocytic and eosinophilic inflammation and fibrosis besides expected asthma and COPD change. One week later, repeated COVID19 nasopharyngeal tests on day 40 and day 49 became positive.ConclusionOur case and literature review indicate that allergic asthma and associated high IgE level together with corticosteroid inhalation might contribute to the delayed positive nasopharyngeal swab in upper airway; COPD related chronic airways obstruction and the addition of fibrosis induced ventilator dependence and poor prognosis in COVID19 pneumonia, and should be therapeutically targeted besides antiviral therapy.

Clinical characteristics of recurrent pneumonia in children with or without underlying diseases

Recurrent pneumonia is uncommon in children and few studies investigate the clinical impact of underlying diseases on this issue. This study aimed to explore the difference in clinical manifestations, pathogens, and prognosis of recurrent pneumonia in children with or without underlying diseases. We conducted a retrospective study of pediatric recurrent pneumonia from 2007 to 2019 in National Taiwan University Hospital. Patients under the age of 18 who had two or more episodes of pneumonia in a year were included, and the minimum interval of two pneumonia episodes was more than one month. Aspiration pneumonia was excluded. Demographic and clinical characteristics of patients were collected and compared. Among 8508 children with pneumonia, 802 (9.4%) of them had recurrent pneumonia. Among these 802 patients, 655 (81.7%) had underlying diseases including neurological disorders (N=252, 38.5%), allergy (N=211, 32.2%), and cardiovascular diseases (N=193, 29.5%). Children without underlying diseases had more viral bronchopneumonia (p < 0.001). Children with underlying diseases were more likely to acquire Staphylococcus aureus (p = 0.001), and gram-negative bacteriae, more pneumonia episodes (3 vs 2, p < 0.001), a longer hospital stay (median: 7 vs. 4 days, p < 0.001), a higher ICU rate (28.8% vs 3.59%, p < 0.001), and a higher case-fatality rate (5.19% vs 0%, p < 0.001) than those without underlying diseases. Children with underlying diseases, prone to have recurrent pneumonia and more susceptible to resistant microorganisms, had more severe diseases and poorer clinical outcomes. Therefore, more attention may be paid on clinical severity and the therapeutic plan.

Cough monitoring and pneumonia diagnosis algorithm through analysis of respiratory system-based vibro-acoustic signals and AI technology

In case of pneumonia often accompanied by serious complications, sometimes lead to death, early diagnosis and continuous monitoring can greatly reduce the dangerousness. Moreover, the COVID-19 pandemic has demonstrated the need for new diagnostic tools that can minimize medical personnel engagement while avoiding equipment being exposed to afflicted patients. In this study, we developed cough monitoring algorithm by detecting the vibrations of human body. The acceleration response at each part of body was measured to determine propagation characteristics of vibration when cough occurs. And it was confirmed that the monitoring accuracy was improved when use the vibration signal compared to the case of using only acoustic signal. After that, we analyzed the perceived cough in terms of psych-acoustical and sound-energy aspects. For the characteristic features derived by quantifying the results of analysis, the data augmentation process was applied, and finally AI-based pneumonia diagnosis algorithm was constructed. To estimate the performance of algorithm, the accuracy of pneumonia determination in new cough cases was verified. It showed the higher value than the accuracy of pulmonologists with only cough sounds. Therefore, developed algorithm that perform continuous cough monitoring and reliable pneumonia diagnosis can be used as an effective supplementary tool for early diagnosis and prognosis of pneumonia.

Oxidant and Antioxidant Balance in Children with Community-Acquired Pneumonia

Abstract Objective The balance between oxidant and antioxidant defense mechanisms is crucial. In this article, we aimed to evaluate the role of this balance in community-acquired pneumonia (CAP) in children. Methods We analyzed serum oxidant and antioxidant stress parameters according to the clinical and demographic data of children with CAP and compared them with healthy controls. Serum total antioxidant status (TAS) and total oxidant status (TOS) were evaluated and compared between the groups, along with levels of ischemia-modified albumin (IMA), antioxidant enzymes, nonenzymatic antioxidant factors, and plasma thiol. Results Of 160 children evaluated, 106 had CAP (54 outpatients and 52 inpatients), and the other 54 were healthy (control group). Total thiol and native thiol levels were significantly lower in the inpatient group compared with the outpatient group (p = 0.004 and p = 0.005, respectively). Serum IMA differed significantly among the groups (p = 0.001), with inpatients showing the highest level. A positive correlation was found between serum IMA and C-reactive protein levels in patients with pneumonia (r = 0.351; p = 0.001). Conclusion Parameters that provide information about antioxidant capacity may be useful in the diagnosis and prognosis of pneumonia. Our results suggest that plasma thiol levels and IMA may be good candidate biomarkers to predict hospitalization for CAP in children.

A two-stage amplified PZT sensor for monitoring lung and heart sounds in discharged pneumonia patients

Assessment of lung and heart states is of critical importance for patients with pneumonia. In this study, we present a small-sized and ultrasensitive accelerometer for continuous monitoring of lung and heart sounds to evaluate the lung and heart states of patients. Based on two-stage amplification, which consists of an asymmetric gapped cantilever and a charge amplifier, our accelerometer exhibited an extremely high ratio of sensitivity to noise compared with conventional structures. Our sensor achieves a high sensitivity of 9.2 V/g at frequencies less than 1000 Hz, making it suitable to use to monitor weak physiological signals, including heart and lung sounds. For the first time, lung injury, heart injury, and both lung and heart injuries in discharged pneumonia patients were revealed by our sensor device. Our sound sensor also successfully tracked the recovery course of the discharged pneumonia patients. Over time, the lung and heart states of the patients gradually improved after discharge. Our observations were in good agreement with clinical reports. Compared with conventional medical instruments, our sensor device provides rapid and highly sensitive detection of lung and heart sounds, which greatly helps in the evaluation of lung and heart states of pneumonia patients. This sensor provides a cost-effective alternative approach to the diagnosis and prognosis of pneumonia and has the potential for clinical and home-use health monitoring.

Neutrophil extracellular traps (NETs) in complicated course of respiratory disorders in newborns

Introduction. The pathology of the respiratory tract during the neonatal period remains one of the leading causes of morbidity in children. Respiratory disorders lead to severe consequences for the subsequent quality of life of the child. Therefore, early diagnosis of complicated course is critical for optimizing the prognosis in respiratory distress syndrome and congenital pneumonia. The aim of the work was to assess the severity of the formation of neutrophil extracellular traps in the peripheral blood in pneumonia and respiratory distress syndrome in newborns. Material and methods. We observed 2 groups of newborns: 35 newborns with neonatal pneumonia and respiratory distress syndrome, and the control group consisted of 15 "almost healthy" newborns without respiratory tract pathology. Results. It was found that pneumonia and respiratory distress syndrome occur against the background of increased formation of neutrophil extracellular traps (NET) in the peripheral blood, the number of which was significantly greater than in the control group (1.2 [0.8; 2.1] and 0.6 [ 0.3; 1.4], respectively (p=0.02)). The percentage of NETs in the blood was also higher in the group of children with respiratory disorders (p=0.0005). A correlation was found between the severity of pneumonia and increased netosis by the 3-5th day of life in premature infants. The percentage of neutrophil extracellular traps of more than 23% in blood on the third -fifth day of life can be used as an additional diagnostic criterion for a complicated and unfavorable course of pneumonia and RDS in newborns. Conclusion. Determination of the percentage of neutrophil extracellular traps in the peripheral blood makes it possible to determine the possibility of developing complications in respiratory disorders in newborns and to initiate adequate therapeutic and preventive measures in a timely manner.

Application of fiberoptic bronchoscopy assisted local injection of budesonide in improving the prognosis of severe pneumonia.

Application of fiberoptic bronchoscopy assisted local injection of budesonide in improving the prognosis of severe pneumonia.

Patient hematology during hospitalization for viral pneumonia caused by SARS-CoV-2 and non-SARS-CoV-2 agents: a retrospective study

BackgroundHematological comparison of coronavirus disease (COVID-19) and other viral pneumonias can provide insights into COVID-19 treatment.MethodsIn this retrospective case–control single-center study, we compared the data of 126 patients with viral pneumonia during different outbreaks [severe acute respiratory syndrome (SARS) in 2003, influenza A (H1N1) in 2009, human adenovirus type 7 in 2018, and COVID-19 in 2020].ResultsOne of the COVID-19 characteristics was a continuous decline in the hemoglobin level. The neutrophil count was related to the aggravation of COVID-19 and SARS. Thrombocytopenia occurred in patients with SARS and severe COVID-19 even at the recovery stage. Lymphocytes were related to the entire course of adenovirus infection, recovery of COVID-19, and disease development of SARS.ConclusionsDynamic changes in hematological counts could provide a reference for the pathogenesis and prognosis of pneumonia caused by respiratory viruses in clinics.

Admission lysophosphatidylethanolamine acyltransferase level predicts the severity and prognosis of community-acquired pneumonia.

Early diagnosis and prognosis of patients with community-acquired pneumonia (CAP) are still difficult clinical challenges. This study aimed to investigate the role of lysophosphatidylethanolamine acyltransferase (LPEAT) in CAP and to evaluate the effectiveness of this enzyme as an indicator of disease severity and risk of death in CAP. This retrospective, multi-center study was conducted in 2017. A total of 267 patients with CAP were included. Of these 267 patients, 175 patients had non-severe CAP (non-SCAP) and 92 patients had severe CAP (SCAP). In addition, we recruited 15 healthy volunteers and 42 hospitalized disease controls in our study. The demographic and clinical characteristics were recorded for all participants. Admission levels of LPEAT were determined by quantitative enzyme-linked immunosorbent assay. Admission levels of LPEAT in patients with SCAP were significantly higher, particularly in non-survivors and were not affected by the causative etiology. Furthermore, when the patients were stratified according to PSI and CURB-65 scores, the patients with high severity scores had higher LPEAT levels upon admission than patients with low severity scores. LPEAT also performed well in predicting SCAP in patients with CAP. Moreover, LPEAT could predict the 30-day mortality rate of patients with CAP, and combining LPEAT with the clinical severity score further improved the accuracy of mortality prediction. Elevated LPEAT levels can reliably predict the severity of illness in patients with CAP at the time of admission. Adding LPEAT to clinical scoring methods could improve prognostic accuracy. Trial registration ClinicalTrials.gov, NCT03093220. Registered on March 28th, 2017.

Lung ultrasound presentation of COVID-19 patients: phenotypes and correlations

Bedside lung ultrasound (LUS) can play a role in the setting of the SarsCoV2 pneumonia pandemic. To evaluate the clinical and LUS features of COVID-19 in the ED and their potential prognostic role, a cohort of laboratory-confirmed COVID-19 patients underwent LUS upon admission in the ED. LUS score was derived from 12 fields. A prevalent LUS pattern was assigned depending on the presence of interstitial syndrome only (Interstitial Pattern), or evidence of subpleural consolidations in at least two fields (Consolidation Pattern). The endpoint was 30-day mortality. The relationship between hemogasanalysis parameters and LUS score was also evaluated. Out of 312 patients, only 36 (11.5%) did not present lung involvment, as defined by LUS score < 1. The majority of patients were admitted either in a general ward (53.8%) or in intensive care unit (9.6%), whereas 106 patients (33.9%) were discharged from the ED. In-hospital mortality was 25.3%, and 30-day survival was 67.6%. A LUS score > 13 had a 77.2% sensitivity and a 71.5% specificity (AUC 0.814; p < 0.001) in predicting mortality. LUS alterations were more frequent (64%) in the posterior lower fields. LUS score was related with P/F (R2 0.68; p < 0.0001) and P/F at FiO2 = 21% (R2 0.59; p < 0.0001). The correlation between LUS score and P/F was not influenced by the prevalent ultrasound pattern. LUS represents an effective tool in both defining diagnosis and stratifying prognosis of COVID-19 pneumonia. The correlation between LUS and hemogasanalysis parameters underscores its role in evaluating lung structure and function.