Prognosis Of Severe Pneumonia Research Articles

Research progress of biomarkers in evaluating the severity and prognostic value of severe pneumonia in children.

Pneumonia is a serious and common infectious disease in children. If not treated in time, it may develop into severe pneumonia. Severe pneumonia in children is mainly characterized by hypoxia and acidosis, often accompanied by various complications such as sepsis and multiple organ dysfunction. Severe pneumonia has a rapid onset and progression, and a high mortality rate. Biomarkers assist clinicians in the early diagnosis and treatment of patients by quickly and accurately identifying their conditions and prognostic risks. In this study, common clinical and novel biomarkers of severe pneumonia in children were reviewed, and the application value of biomarkers related to the severity and prognosis of severe pneumonia in children was evaluated to provide help for early identification and precise intervention by clinicians.

The clinical value of mNGS of bronchoalveolar lavage fluid versus traditional microbiological tests for pathogen identification and prognosis of severe pneumonia (NT-BALF):study protocol for a prospective multi-center randomized clinical trial.

Early, rapid, and accurate pathogen diagnosis can help clinicians select targeted treatment options, thus improving prognosis and reducing mortality rates of severe pneumonia. Metagenomic next-generation sequencing (mNGS) has a higher sensitivity and broader pathogen spectrum than traditional microbiological tests. However, the effects of mNGS-based antimicrobial treatment procedures on clinical outcomes and cost-effectiveness in patients with severe pneumonia have not been evaluated. This is a regional, multi-center, open, prospective, randomized controlled trial to evaluate that whether the combination of mNGS and traditional testing methods could decrease 28-day call-cause mortality with moderate cost-effectiveness. A total of 192 patients with severe pneumonia will be recruited from four large tertiary hospitals in China. Bronchoalveolar lavage fluid will be obtained in all patients and randomly assigned to the study group (mNGS combined with traditional microbiological tests) or the control group (traditional microbiological tests only) in a 1:1 ratio. Individualized antimicrobial treatment and strategy will be selected according to the analysis results. The primary outcome is 28-day all-cause mortality. The secondary outcomes are ICU and hospital length of stay (LOS), ventilator-free days and ICU-free days, consistency between mNGS and traditional microbiological tests, detective rate of mNGS and traditional microbiological tests, turn-out time, time from group allocation to start of treatment, duration of vasopressor support, types and duration of anti-infective regimens, source of drug-resistant bacteria or fungi, and ICU cost. The clinical benefits of mNGS are potentially significant, but its limitations should also be considered. ChineseClinicalTrialRegistry.org, ChiCTR2300076853. Registered on 22 October 2023.

Diagnosis and Prognosis Evaluation of Severe Pneumonia by Lung Ultrasound Score Combined with Serum Inflammatory Markers.

To analyze the significance of lung ultrasound score (LUS) combined with serum inflammatory indexes in different severities of severe pneumonia and its clinical value on prognosis. 100 patients with severe pneumonia treated in the Gansu Provincial Hospital from June 2017 to June 2021 were selected as the research objects. According to the acute physiology and chronic health (APACHE II) score, they were divided into a low-risk group (28 cases), a medium-risk group (39 cases) and a high-risk group (33 cases). The general clinical data of the patients (age, gender, smoking history, and underlying diseases) were collected, the lung ultrasound score (LUS) of the patients was measured, and the serum inflammatory indicators (IL-6, IL-10, TNF-α, CRP and NLR) levels; Pearson correlation analysis to evaluate the correlation between LUS score, serum inflammatory index levels and disease severity; receiver operating characteristic (ROC) curve analysis to evaluate the prognostic value of the combined diagnosis of LUS score and serum inflammatory index for the severity of severe pneumonia. With the increase in the severity of severe pneumonia, the LUS score and the level of inflammation in the body continued to increase, and LUS combined with serum inflammatory indexes could distinguish the severity of low-risk, medium-risk and high-risk severe pneumonia and had high diagnostic value. In addition, the combined diagnosis of LUS and serum inflammatory markers is also closely related to the prognosis of patients with severe pneumonia, which can distinguish the prognosis. LUS combined with serum inflammatory indicators (IL-6, IL-10, TNF-α, CRP and NLR) can differentiate the severity and prognosis of severe pneumonia, which may be a new direction for diagnosing severe pneumonia and guide early clinical intervention.

Changes and Clinical Value of Serum miR-24 and miR-223 Levels in Patients with Severe Pneumonia.

Severe pneumonia progresses rapidly, so early assessment of the severity and prognosis is crucial for reducing mortality rates. We explore the role of serum microRNA-24 (miR-24) and microRNA-223 (miR-223) in the prognosis of severe pneumonia. There were a total of 96 patients with general pneumonia, 94 patients with severe pneumonia, and 93 healthy people, who were enrolled in this study. The levels of serum miR-24 and miR-223 were detected by real-time fluorescent quantitative PCR in all groups. The serum miR-223 level in the severe group was higher than that in the common group and the control group, and the miR-24 level was lower than that in the common group and the control group (P<0.05). The serum miR-223 levels and APACHEII scores in the death group were higher than those in the survival group on the first, third, and seventh day after admission, while the miR-24 levels were lower than those in the survival group (P<0.05). The proportion of patients with mechanical ventilation in the death group was higher than that in the survival group (P<0.05). The level of serum miR-24 was negatively correlated with APACHEII score and mechanical ventilation in patients who died of severe pneumonia (P<0.05), and miR-223 was positively correlated with APACHEII score and mechanical ventilation (P<0.05). The AUC predicted by serum miR-24, miR-223, and APACHEII scores alone and jointly were 0.867, 0.839, 0.791, and 0.952, respectively. MiR-24 and miR-223 are protective and independent risk factors for mortality in severe pneumonia patients, respectively (P<0.05). MiR-24 was a protective factor affecting the death of patients with severe pneumonia, and miR-223 was an independent risk factor affecting the death of patients with severe pneumonia (P<0.05). The combination of serum miR-24 and miR-223 levels on the first day after admission and APACHEII score can effectively predict prognosis.

Diagnostic and Prognostic Value of Dysregulated miR-10a-3p in Patients with Severe Pneumonia.

Previous studies have shown that microRNA is involved in regulating a variety of human inflammatory diseases. The purpose of this study was to investigate the expression of miR-10a-3p in the blood of patients with severe pneumonia and evaluate its value in the diagnosis and prognosis of severe pneumonia. Seventy patients with severe pneumonia and 75 healthy individuals were included in this study. Venous blood of all subjects was obtained for RT-qPCR analysis to obtain the relative expression level of miR-10a-5p. The diagnostic accuracy of miR-10a-5p for severe pneumonia was assessed by ROC curve. After standardized treatment, the prognosis of patients with severe pneumonia was analyzed by a 28-day follow-up method. Kaplan-Meier curve and multivariate Cox regression analysis were used to determine the basic factors influencing the prognosis of patients. Compared with healthy control, serum miR-10a-3p expression in patients with severe pneumonia was distinctly upregulated (P < 0.001). Besides, ROC analysis showed that miR-10a-3p had high diagnostic accuracy for severe pneumonia, with an AUC of 0.881, sensitivity and specificity of 75.7% and 84.0%, respectively. Kaplan-Meier curve exhibited that high miR-10a-3p expression group had a higher probability of death than those with low miR-10a-3p expression. Multivariate Cox regression analysis demonstrated that miR-10a-3p and CRP were independent risk factors affecting the prognosis of patients. The expression of miR-10a-3p was increased in patients with severe pneumonia, and abnormally expressed miR-10a-3p has the potential to be used as a diagnostic and prognostic marker for severe pneumonia, which provides a new biological direction for the early detection and risk assessment of severe pneumonia.

Study on the Changes and Significance of Immune State and Cycokines in Children with Adenovirus Pneumonia.

Objective To observe the difference between peripheral blood T lymphocytes subsets and cycokines in children with severe adenovirus pneumonia and nonsevere adenovirus pneumonia, and to investigate their clinical value in the prognosis of severe pneumonia. Methods 215 children with adenovirus pneumonia and 30 healthy volunteers (which was set as the control group) in our hospital from January 2017 to May 2019 were enrolled in the study. There were 47 children with severe pneumonia in the severe group and 168 nonsevere pneumonia children in the nonsevere group. The flow cytometry and ELISA methods were used to detect the serum levels of CD3+, CD4+, CD8+ T cells and interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α), interferon-γ (IFN-γ). Results (1) The levels of CD3 (%) T cells, CD4 (%) T cells, and CD4/CD8 ratio values of children with adenovirus pneumonia were lower than these of normal children (P < 0.05). And the levels of CD3 (%) T cells, CD4 (%) T cells, and CD4/CD8 ratio values of children in the severe group were lower than these of children in the nonsevere group (P < 0.05). (2) The levels of IL-2, IL-6, IL-10, TNF-α, and IFN-γ values of children with adenovirus pneumonia were lower than these of normal children (P < 0.05). And the levels of IL-2, IL-6, IL-10, TNF-α, and IFN-γ of children in the severe group were higher than these of children in the nonsevere group (P < 0.05). (3) Among the 47 children with severe adenoviral pneumonia, 39 received systematic treatment in our hospital. According to the treatment effect, 39 children were divided into the effective group (n = 25) and the ineffective group (n = 14). (4) The CD3 (%), CD4 (%), and CD4/CD8 ratios of the children in the effective group were higher than those in the ineffective group (P < 0.05). (5) The levels of IL-2, IL-6, IL-10, TNF-α, and IFN-γ in the effective group were lower than those in the ineffective group (P < 0.05). Conclusion The immunophenotype of peripheral blood T lymphocytes and cycokines could be helpful to judge the severity of adenovirus pneumonia, which could be used as the objective indexes to evaluate the prognosis of children with severe adenovirus pneumonia.

Can diaphragm excursion predict prognosis in patients with severe pneumonia?

Although thorax ultrasound has been used to diagnose pneumonia in recent years, the role of ultrasonic diaphragm evaluation in the prognosis of pneumonia is unknown. This study aimed to assess the impact of diaphragmatic excursion (Dex) measured by ultrasound on the prognosis of severe pneumonia in critical care patients. We prospectively recruited patients with severe pneumonia who were admitted to the intensive care unit (ICU) between January 2019 and July 2021. Patients' Dex values, vital signs, clinical features, laboratory parameters, APACHE-II scores on the first admission day of ICU, mortality and respiratory support status at follow-up were recorded. There were 39 patients enrolled in the study. Mean Dex of the study patients was 30.66 ± 12.17 mm. Mean Dex was significantly lower in deceased patients than survivors (18.37 ± 8.12 vs 34.90 ± 10.36 p< 0.001). Dex was lower in patients who required invasive mechanical ventilation than those not (24.90 ± 10.93 vs 34.26 ± 11.70, p= 0.017). The cut-off value of Dex was found 19.0 mm for significantly predicted (p≤ 0.001) survival with the sensitivity of 96.6% and specificity of 70%. Among the study group, diaphragm excursion was negatively correlated with APACHE-II score (r= -0.688, p≤ 0.001) and respiratory rate (r= -0.531, p= 0.001). Dex measured on the day of ICU admission can be used to evaluate the prognosis of patients with severe pneumonia.

The value of early changes in platelet counts in assessing the prognosis of aged patients with severe pneumonia

Objective To explore the predictive value of early changes in platelet counts in the prognosis of severe pneumonia in aged patients. Methods This retrospective study included elderly patients with severe pneumonia, who were ≥65 years old and whose length of ICU stay ≥72 hours, admitted to the intensive care unit(ICU)of NO.2 People's Hospital of Changzhou from January 2014 to January 2017.They were divided into a survival group and a death group according to the 28-day outcome.General information and serum platelet levels at 0, 24, 36, and 72 hours after admission were collected.Receiver operating characteristic curve(ROC)was plotted according to platelet counts, changes in platelet counts and rates of change in platelet counts to evaluate their predictive value for 28-day prognosis.Kaplan-Meier survival curve was used to analyze the 28-day cumulative survival rate between different groups of patients, who were further divided according to platelet counts at 0 and 72 hours after admission to ICU, changes in platelet counts and rates of change in platelet counts at 72 hours after admission. Results (1)One hundred elderly patients with severe pneumonia were enrolled, among whom 41 cases were in the death group, thus with a mortality of 41.0%.The acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), sequential organ failure assessment(SOFA), C-reactive protein(CRP), and procalcitonin(PCT)in the death group were significantly higher than those in the survival group.2)Serum platelet levels showed a downward trend in both the death group and the survival group.The level of serum platelets at 72 hours after admission to ICU in the death group was significantly lower than that in the survival group(80.00×109/L vs.171.00×109/L, Z=5.786, P<0.05); changes in platelet counts and rates of change in platelet counts in the death group were significantly higher than those in the survival group, especially at 72 hours after admission to ICU(△PLT72: -79.00×109/L vs.-38.00×109/L, Z=4.938, P<0.05; △PLT 72%: -43.6% vs.-17.7%, Z=6.816, P<0.05). (3)ROC curve analysis showed that platelet levels, changes in platelet counts, and rates of change in platelet counts could predict 28-day mortality in aged patients with severe pneumonia.The largest area under ROC curve was 0.902 when plotted with the rate of platelet counts at 72 hours after admission to ICU.Using the cut-off value of -36.14% in the rate of change at 72 hours after admission to evaluate the predictive value in 28-day mortality, the sensitivity and specificity were 89.8% and 75.6%, respectively.(4)Kaplan-Meier survival analysis showed that the 28-day survival rate was significantly higher and the length of survival was significantly greater when platelet counts at 0 and 72 hours after admission to ICU were higher than the cut-off value, and this also occurred in changes in platelet count and rates of change at 72 hours after admission to ICU. Conclusions Continuous decline in serum platelet levels indicates poor prognosis.When combined with platelet counts, changes in platelet counts and rates of change in platelet counts at 72 hours after admission to ICU, it may play an important role in assessing the prognosis of aged patients with severe pneumonia. Key words: Blood platelets; Pneumonia; Prognosis

Advances in the roles of biomarkers in evaluating the severity and prognosis of severe pneumonia in children

Pneumonia is the primary cause of death in children under five-years old.About 2 million children younger than 5 years die of pneumonia each year worldwide, accounting for 19%of the total number of deaths.According to the survey in 2008, 7% to 13% of the children with pneumonia were severe pneumonia.Currently, the early diagnosis and treatment of severe pneumonia is often difficult.In order to improve the early diagnosis an prognosis cognition level of severe pneumonia, here is to make a review on the recent literatures on the biomarkers like brain natriuretic peptide, D-Dimer, C-reactive protein, lactate, zinc, procalcitoin, prealbumin, platelet count, endothelin-1 and high mobility group box 1 in children with severe pneumonia.

The relationship between IL-10, IL-18 and severe pneumonia

Pneumonia is the primary cause of death in children under five years of age.About 2 million children younger than 5 years die of pneumonia each year worldwide,accounting for 19％ of the total number of deaths.According to the survey in 2008,7％ ～ 13％ of the children with pneumonia are severe pneumonia.Severe pneumonia is a life-threatening disease which needs for intensive care.Cytokine IL-10 is a anti-inflammatory cytokine,and IL-18 is a proinflammatory cytokine,both of them are released by the inflammatory response,and can be involved in severe pneumonia immune-mediated.They are closely related to the occurrence,development and prognosis of severe pneumonia. Key words: Severe pneumonia; Interleukin-10; Interleukin-18

The effect of low molecular heparin on the prognosis of severe pneumonia in elderly patients

To investigate the effect of low molecular heparin on degree of severity and prognosis of severe pneumonia in elderly patients. A prospective randomized control study was conducted. During October 2009 to July 2013, 63 patients over 65 years old and suffering from severe pneumonia were enrolled. Patients were grouped into control or treatment group randomly. The control group (n=36) received routine treatment, while low molecular heparin 4 kU once a day was added in treatment group (n=39) for 7 days. Acute physiology and chronic health evaluationII(APACHEII) score, coagulation function indexes, blood gas analysis, arterial lactic acid at 1, 3, 7 days after treatment, and length of mechanical ventilation, days of stay in ICU, and 7-day mortality were compared between both groups. The basic data and APACHEII score had no difference between two groups (all P>0.05). Bleeding events occurred on day 1, 3, 7 in 1, 1, 2 patients in control group, respectively, and 0, 1, 3 cases in treatment group. There was no difference in APACHEII score on day 1 and day 3 between control group and treatment group (1 day: 19.33 ± 5.90 vs. 20.31 ± 4.97, t=0.775, P=0.441; 3 days: 18.69 ± 4.88 vs. 17.41 ± 3.83, t=1.272, P=0.207). APACHEII score on day 7 in treatment group was significantly lower than that in control group (13.92 ± 3.61 vs. 16.20 ± 4.23, t=2.480, P=0.016). There was no significant difference in coagulation function indexes during observation period between two groups (all P>0.05). The blood gas analysis showed that only arterial partial pressure of oxygen (PaO2) 7 days after treatment in treatment group was significantly higher than that in control group (110.52 ± 28.57 mm Hg vs. 95.47 ± 24.17 mm Hg, t=-2.354, P=0.022). There was no significant difference in 7-day mortality between two groups. The mechanical ventilation time in treatment group was slightly shorter than that in control group (147.45 ± 111.45 hours vs. 192.20 ± 115.57 hours, t=1.704, P=0.093). The length of stay in ICU in treatment group was significantly shorter than that in control group (13.77 ± 5.77 days vs. 17.22 ± 6.21 days, t=2.497, P=0.015). In elderly patients suffering from severe pneumonia, low molecular heparin may reduce APACHEII score, shorten mechanical ventilation time and length of ICU stay, and the prognosis may be improved.

Distinguishing Malaria from Severe Pneumonia among Hospitalized Children who Fulfilled Integrated Management of Childhood Illness Criteria for Both Diseases: A Hospital-Based Study in Mozambique

Malaria and severe pneumonia in hospitalized young children may show striking clinical similarities, making differential diagnosis challenging. We investigated ways to increase diagnostic accuracy in patients hospitalized with clinical symptoms compatible with malaria and severe pneumonia, in an area with high a prevalence of infection with human immunodeficiency virus. A total of 646 children admitted at the Manhiça District Hospital in Manhiça, Mozambique who met the World Health Organization clinical criteria for severe pneumonia and malaria were recruited for 12 months and thoroughly investigated to ascertain an accurate diagnosis. Although symptom overlap between malaria and severe pneumonia was frequent among hospitalized children, true disease overlap was uncommon. Clinical presentation and laboratory determinations were ineffective in reliably distinguishing between the two diseases. Infection with human immunodeficiency virus differentially influenced the epidemiology and clinical presentation of these two infectious diseases, further challenging their discrimination on clinical grounds, and having a greater impact on the current burden and prognosis of severe pneumonia.

Correlation between soluble E-selectin and interleukin-8 levels and the development of severe pneumonia.

Objective This study was designed to evaluate the correlations between soluble E-selectin (sE-selectin) and intedeukin-8 (IL-8) levels and the condition and prognosis of severe pneumonia. Methods A total of 67 patients with pneumonia were identified at the intensive care unit and the Respiratory Department of Zibo Central Hospital between April 2007 and March 2008. The patients were divided into two groups according to the severity of pneumonia: severe (Group A, n = 35) and non-severe (Group B, n = 32). Group A was also subdivided into two groups of patiems: patients with Multiple Organ Dysfunction Syndrorae(MODS) (Group A_1, n = 13) and pa-tients with severe pneumonia alone (Croup A_2, n= 22). Thirty healthy people whose age and sex matched with the patients were enrolled as a control group (Group C). Patients with cancer, who had undergone surgery within the past 1 month, connective tissue disease or acute conplications of diabetes, for example, were excluded from the study. The serum levels of s-Eselectin and IL-8 were measured by EI.ISA, and correlations with Acute physiol-ogy and chronic Health Evaluation Ⅱ (APACHE-Ⅱ)score, Oxygenation index(PaO_2/FiO_2), percentage of poly-morphonuclear leukocyte (PMN)and high sensitive C-reactive protein (hs-CRP)levels were determined. The data were analyzed using t tests, one-way ANOVA, X~2 tests and linear correlation analysis using SAS 8.2 software. Results The sermn levels of sE-selectin and IL-8 in Croup A and Group B were significant higher than Group C (P < 0.05), and the levels in Group A were higher than those in Group B (P < 0.05). Furthermore, the levels of sE-selectin and IL-8 were higher in Group A_1 than in Group A_2(P < 0.001). The correlation analysis showed a positive correlation between the levels of sE-selectin and IL-8 in patients with pneumonia (r = 0.781,P < 0.01) ; and both were positively correhted with APACHE-Ⅱ score, PMN% and hs-CRP (P < 0.01), and nega-tively correlated with PaO_2/FiO_2 (P < 0.01).Conclusions sE-selectin and IL-8 levels are important indices for the assessment of the severity of pneumonia in tetras of the condition and prognosis. Key words: E-selectin; Interleukin-8; Severe pneumonia