Risk Factors For Pneumonia Research Articles

Dietary zinc deficiency promotes Acinetobacter baumannii lung infection via IL-13 in mice.

Dietary zinc deficiency is a major risk factor for pneumonia. Acinetobacter baumannii is a leading cause of ventilator-associated pneumonia and a critical public health threat due to increasing rates of multidrug resistance. Patient populations at increased risk for A. baumannii pneumonia are also at increased risk of zinc deficiency. Here we established a mouse model of dietary zinc deficiency and acute A. baumannii pneumonia to test the hypothesis that host zinc deficiency contributes to A. baumannii pathogenesis. We showed that zinc-deficient mice have significantly increased A. baumannii burdens in the lungs, dissemination to the spleen and higher mortality. During infection, zinc-deficient mice produce more pro-inflammatory cytokines, including IL-13. Administration of IL-13 promotes A. baumannii dissemination in zinc-sufficient mice, while antibody neutralization of IL-13 protects zinc-deficient mice from A. baumannii dissemination and mortality during infection. These data highlight the therapeutic potential of anti-IL-13 antibody treatments, which are well tolerated in humans, for the treatment of pneumonia.

Risk factors for COVID-19 pneumonia in patients with hematological malignancies: a multi-center, prospective study in China

Risk factors for COVID-19 pneumonia in patients with hematological malignancies: a multi-center, prospective study in China

Pneumonia in patients with chronic lymphocytic leukemia treated with venetoclax‐based regimens: A real‐world analysis of Polish Adult Leukemia Group (PALG)

AbstractBackgroundPatients with chronic lymphocytic leukemia (CLL) are susceptible to infections that can affect their clinical outcomes.AimsTo assess: (1) the incidence of pneumonia in CLL patients treated with venetoclax‐based regimens in a real‐world setting, (2) the risk factors for event‐free survival (EFS), and (3) overall survival (OS).MethodsThis multicenter study included 322 patients from eight centers. Univariable and multivariable analyses (MVA) were performed, having the development of pneumonia during venetoclax‐based treatment and OS as outcomes.ResultsThe most common complication was neutropenia (59%). During treatment with venetoclax‐based regimens, 66 (20%) of patients developed pneumonia: 50 (23%) patients in the rituximab plus venetoclax (R‐VEN) group, 13 (16%) patients in the obinutuzumab plus venetoclax (O‐VEN) group (p = 0.15). Chronic obstructive pulmonary disease (COPD)/asthma, splenomegaly, elevated creatinine, and anemia <8 g/dL were the risk factors for EFS in MVA (hazard ratio [HR] = 2.08, 95% confidence interval [CI], 1.16–3.74, p = 0.014; HR 1.73, 95% CI, 1.08–2.78, p = 0.02; HR 2.13, 95% CI, 1.10–4.11, p = 0.03, HR 3.58, 95% CI, 2.18–5.89, p < 0.001, respectively). Relapsed/refractory (R/R) CLL patients treated with R‐VEN with pneumonia had worse OS than those without (p < 0.001). In patients treated with O‐VEN, median OS did not differ between patients with and without pneumonia (p = 0.45).ConclusionsOur real‐world study showed that pneumonia during venetoclax treatment occurs more frequently than reported in registration trials and has a negative impact on OS, especially in patients with R/R CLL treated with R‐VEN. Neutropenia is not a risk factor for pneumonia.

Medications to Modify Aspiration Risk: Those That Add to Risk and Those That May Reduce Risk.

Aspiration pneumonia results from the abnormal entry of fluids into the respiratory tract. We present a review of drugs known to affect the risk of aspiration. Drugs that increase the risk of aspiration pneumonia can be broadly divided into those that affect protective reflexes (like cough and swallowing) due to direct or indirect mechanisms, and drugs that facilitate gastric dysbiosis or affect esophageal and intestinal motility. Chief among the first group are benzodiazepines and antipsychotics, while proton pump inhibitors are the most well-studied in the latter group. Pill esophagitis may also exacerbate swallowing dysfunction. On the other hand, some research has also focused on pharmaceutical modulation of the risk of aspiration pneumonia. Angiotensin-converting enzyme inhibitors have been demonstrated to be associated with a decrease in the hazard of aspiration pneumonia in high-risk patients of Chinese or Japanese origin. Drugs like amantadine, nicergoline, or folic acid have shown some promising results in stroke patients, although the available evidence is thus far not enough to allow for any meaningful conclusions. Importantly, antimicrobial prophylaxis has been proven to be ineffective. Focusing on modifiable risk factors for aspiration pneumonia is relevant since this may help to reduce the incidence of this often severe problem. Among these, several commonly used drug classes have been shown to increase the risk of aspiration pneumonia. These drugs should be withheld in the high-risk population whenever possible, alongside general measures, such as the semirecumbent position during sleep and feeding.

Beneficial effect of sequential treatment with high-dose steroids and short-course oral glucocorticoids in patients with severe influenza virus-associated pneumonia

Accumulating evidence supports that glucocorticoid treatment for viral pneumonia (VPA) can shorten the disease course and improve survival. However, currently, the use of glucocorticoids in treating VPA remains controversial. Moreover, a unified standard for the dosage and duration of glucocorticoid therapy has not been presented in published articles. A retrospective analysis was conducted in patients who were hospitalized for severe influenza virus-associated pneumonia, and they received sequential treatment with high-dose glucocorticoids and short-course oral glucocorticoids. Patients were followed up for 3 months. A total of 11 patients were included in the study (average age 56 years). There was no gender difference, but age and underlying diseases could be risk factors for severe influenza virus-associated pneumonia. The types of viruses causing pneumonia included influenza A/B. The main clinical symptoms of patients were fever, cough, sputum production, and dyspnea. Chest computed tomography showed multiple ground-glass shadows in the lobes, and the presence of bacterial and fungal infections was accompanied by consolidation shadows. After glucocorticoid therapy, the symptoms improved. None of the patients underwent tracheal intubation, and all survived. After a 3-month follow-up, lung CT absorption in all patients had reached more than 80%, and lung imaging absorption in 20% patients was complete. No serious complications occurred in any of the patients. Sequential treatment with high-dose steroids and short-course oral glucocorticoids may be helpful for reducing the tracheal intubation rate and mortality rate in patients with severe influenza virus-associated pneumonia. Additionally, short-course oral glucocorticoids may reduce pulmonary fibrosis in patients with severe influenza virus-associated pneumonia without any serious complications.

Chinese expert consensus on diagnosis, treatment and prevention of pulmonary infection in patients with solid tumors (2024 edition)

Patients with solid tumors have an increased risk of developing pneumonia during the management of tumor. The prevention, diagnosis, and treatment of pneumonia in these patients have different characteristics compared to the general population, such as the correction of specific risk factors for pneumonia and the rational use of prophylactic antimicrobial drugs, the strategy of invasive sampling diagnostic techniques application, differential diagnosis from anti-tumor treatment associated pulmonary conditions, and consideration of pathogens and drug resistance in empirical antimicrobial treatment. In order to standardize the diagnosis, treatment, and prevention of pneumonia in patients with solid tumors, Oncology Respiratory Disease Committee initiated the "Chinese expert consensus on the diagnosis and treatment of pneumonia in patients with solid tumors". Based on a review of the latest evidence in this field, the consensus provides diagnostic and treatment pathways as well as recommendations. This consensus applies to oncologists, pulmonologists, infectious disease physicians, surgeons, emergency medicine physician, and general practice healthcare professionals involved in the management of solid tumors in adults.

Oropharyngeal dysphagia impact of pneumonia risk in neurological patients receiving enteral tube feeding: Insights from a gastroenterologist.

Oropharyngeal dysphagia is prevalent among neurological patients, often necessitating enteral tube feeding with a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). These patients are at significant risk of developing aspiration pneumonia. This study aimed to assess the impact of oropharyngeal dysphagia on pneumonia risk requiring hospitalization in neurological patients on long-term enteral tube feeding. This retrospective observational study was conducted between 2015 and 2022. It included neurological patients who underwent upper gastrointestinal endoscopy combined with a Modified Flexible Endoscopic Evaluation of Swallowing (mFEES) for suspect dysphagia, characterized by difficulty or discomfort in swallowing. Participants were either orally fed or had been on long-term enteral tube feeding via NGT or PEG. A 2-year follow-up was conducted to monitor pneumonia cases requiring hospitalization. Multivariate analyses were conducted to identify risk factors for pneumonia requiring hospitalization. A total of 226 orally fed and 152 enteral tube-fed patients were enrolled. Multivariate analyses showed a significantly increased risk of pneumonia in patients with a history of pneumonia and those receiving enteral tube feeding. Subgroup analysis indicated a significantly lower risk of pneumonia among enteral tube-fed patients with oropharyngeal dysphagia who PEG-fed patients compared to NGT-fed patients (adjusted HR: 0.21, 95% CI: 0.10-0.44, p < 0.001). The cumulative incidence of pneumonia requiring hospitalization was significantly lower in the PEG group than in the NGT group (p < 0.001). mFEES could be a screening tool for oropharyngeal dysphagia. PEG is preferred over NGT for long-term enteral feeding, as it significantly reduces the risk of pneumonia requiring hospitalization, especially in patients with oropharyngeal dysphagia.

Risk factor analysis and prediction model construction for severe adenovirus pneumonia in children

BackgroundSevere adenovirus pneumonia in children has a high mortality rate, but research on risk prediction models is lacking. Such models are essential as they allow individualized predictions and assess whether children will likely progress to severe disease.MethodsA retrospective analysis was performed on children with adenovirus pneumonia who were hospitalized at the Children’s Hospital of Nanjing Medical University from January 2017 to March 2024. The patients were grouped according to clinical factors, and the groups were compared using Ridge regression and multiple logistic regression to identify risk factors associated with severe adenovirus pneumonia. A prediction model was constructed, and its value in clinical application was evaluated.Results699 patients were included in the study, with 284 in the severe group and 415 in the general group. Through the screening of 44 variables, the final risk factors for severe adenovirus pneumonia in children as the levels of neutrophils (OR = 1.086, 95% CI: 1.054‒1.119, P < 0.001), D-dimer (OR = 1.005, 95% CI: 1.003‒1.007, P < 0.001), fibrinogen degradation products (OR = 1.341, 95% CI: 1.034‒1.738, P = 0.027), B cells (OR = 1.076, 95%CI: 1.046‒1.107, P < 0.001), and lactate dehydrogenase (OR = 1.008, 95% CI: 1.005‒1.011, P < 0.001). The value of the area under the receiver operating characteristic curve was 0.974, the 95% CI was 0.963–0.985, and the P-value of the Hosmer-Lemeshow test was 0.547 (P > 0.05), indicating that the model had strong predictive power.ConclusionIn this study, the clinical variables of children with adenovirus pneumonia were retrospectively analyzed to identify risk factors for severe disease. A prediction model for severe disease was constructed and evaluated, showing good application value.

Risk factors of severe Chlamydia trachomatis pneumonia in children: a retrospective case-control study.

This study explored the clinical characteristics of Chlamydia trachomatis (C. trachomatis) pneumonia in children and the risk factors for severe C. trachomatis pneumonia. This retrospective case-control study included children with C. trachomatis pneumonia who were admitted to the Department of Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University (Xiamen, China) between January 2018 and December 2021. Among 117 children, 33 (28.2%) had severe C. trachomatis pneumonia and 84 children had mild-to-moderate C. trachomatis pneumonia. According to the results of the binary logistic regression analysis, congenital heart disease [odds ratio (OR) = 0.09, 95% confidence interval (CI): 0.01-0.74, P-value = .024], mixed infection (OR = 0.17, 95%CI: 0.05-0.51, P-value = .002), white blood cell count greater than 15 000 cells/dl (OR = 1.20, 95%CI: 1.03-1.40, P-value = .022), and partial pressure of carbon dioxide (PaCO2) (OR = 1.14, 95%CI: 1.02-1.26, P-value = .016) were found as independent predictive factors for severe C. trachomatis pneumonia in children. This study explored key risk factors for severe C. trachomatis pneumonia, a condition underreported in tropical regions where pediatric respiratory infections are a leading cause of morbidity and mortality. By identifying risk factors, such as congenital heart disease, mixed infections, and elevated PaCO2, this research may guide early intervention strategies in resource-limited settings, potentially reducing pediatric pneumonia deaths.

B-141 Analysis of risk factors and construction of prediction model for pneumonia in patients with pneumoconiosis based on the clinical laboratory indexes

Abstract Background Pneumoconiosis has been the leading industrial disease in China. Pneumonia is one of the common comorbidities for patients with pneumoconiosis, which may lead to the worse condition and poor prognosis. Timely and accurate diagnosis is necessary to retard the pneumonia progression in pneumoconiosis patients. Due to the similarity of clinical features between pneumoconiosis and pneumonia, clinical laboratory tests are needed for assessing the hazard of pneumonia occurrence in patients with pneumoconiosis. Therefore, we aim to explore the risk factors of pneumonia from laboratory test indexes for patients with pneumoconiosis, construct prediction model, and evaluate its feasibility. Methods A total of 243 patients with pneumoconiosis from the General Hospital of Xuzhou Mining Group from September 2021 to August 2023 were selected as the modeling set, which was further separated as the non-pneumonia group and the pneumonia group. Nineteen laboratory test indexes related to inflammation, tumor markers, renal function, and blood routine examination were compared between the two groups. The univariate and multivariate Logistic analysis was used to screen out risk factors and construct the prediction model. Two hundred and twenty-eight patients with pneumoconiosis from General Hospital of Xuzhou Mining Group (Yi'an Branch) were enrolled as the validation set. The predictive efficiency of the model on pneumonia for patients with pneumoconiosis was evaluated through Hosmer-Lemeshow(H-L)test and receiver operating characteristic (ROC) curve. Results C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), β2 microglobulin, creatinine, urea, neutrophil percentage, lymphocyte percentage, and lymphocyte count in pneumonia group were significant different from those in non-pneumonia group (&amp;lt;0.05). Logistic regression analysis suggested that CRP (OR=3.883, &amp;lt;0.001), IL-6 (OR=1.217, =0.003), IL-8 (OR=1.215, =0.002) and β2-microglobulin (OR=2.838, =0.002) were independent risk factors for pneumonia in patients with pneumoconiosis. The prediction model was constructed as Logit (P) =1.357×CRP+0.196×IL-6+0.195×IL-8+1.043×β2-microglobulin-9.772. The H-L test demonstrated that there was no significantly difference between predicted values and the true values. The areas under ROC curves of the model in the modeling set and the validation set were 0.909 and 0.848. The sensitivity was 86.8% and 75.6%, and accuracy 82.1% and 79.7%, respectively. Conclusions CRP, IL-6, IL-8, and β2-microglobulin were independent risk factors of pneumonia for pneumoconiosis patients. The risk model constructed by laboratory test indexes showed a good predictive performance, which might provide laboratory evidence for the pneumonia diagnosis in patients with pneumoconiosis.

The U-shaped association between hemoglobin concentrations and all-cause death risk in patients with community-acquired pneumonia.

The prevalence of anemia in patients with community-acquired pneumonia (CAP) has been well described. However, few studies have explored its association with short-term and long-term mortality risk in CAP patients. We aimed to investigate the associations between hemoglobin concentrations at baseline and 14-day and 1-year mortality risk in a CAP population with a large sample size. Our data originated from the Dryad database, including a dataset from the study "Incidence rate of community-acquired pneumonia in adults: a population-based prospective active surveillance study in 3 cities in South America." A total of 1463 study samples with follow-up data from the dataset were enrolled for our analysis. During the follow-up period of 3 years, the 14-day risk and 1-year mortality risk were 206 (14.08%) and 401 (27.41%), respectively, among these CAP patients. Curve analysis indicated a strong U-shaped relationship between blood hemoglobin concentrations and 14-day mortality (r = -0.191, P < .001) and 1-year mortality (r = -0.220, P < .001). The blood hemoglobin level with the lowest point of mortality risk was 14.5g/dL, suggesting that an increased hemoglobin concentration contributed to reduced 14-day and 1-year mortality risk in CAP patients when hemoglobin does not exceed 14.5g/dL even if it is within the normal clinical range. In addition, we also observed significant associations of hemoglobin with 14-day mortality risk (odds ratio [OR] = 0.817; 95% CI, 0.742-0.899 P < .001) and 1-year mortality risk (OR = 0.834; 95% CI, 0.773-0.900; P < .001), but only in participants without risk factors for health care-associated pneumonia (HCAP) rather than in participants with risk factors for HCAP. The greatest discovery is that our findings indicated a significant U-shaped relationship between hemoglobin levels and 14-day and 1-year mortality risk in CAP patients. However, a significant relationship was only discovered in subjects without risk factors for HCAP. More evidence is needed to support this finding.

Risk Factors for Postoperative Pneumonia in Esophageal Cancer Patients

Purpose Patients undergoing surgery for esophageal cancer (EC) frequently experience postoperative pneumonia (POP). POP promotes poor prognosis as well as increased medical costs and longer hospital stays. Therefore, it is desirable to prevent and strictly control high-risk cases to reduce the incidence of pneumonia. The present study aimed to determine the risk factors for POP in EC. Patients and Methods The subjects of this retrospective study were 151 patients with EC who underwent subtotal esophagectomy in our department between January 2012 and December 2021. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of POP and clinical factors. Results Among 151 patients, 33 cases (21.8%) developed POP. Multivariate analysis identified preoperative C-reactive protein-to-albumin ratio (CAR) ≥0.03 [odds ratio (OR), 2.69; P = 0.0352], chronic obstructive lung disease (COPD) (OR, 7.32; P = 0.0001), and diabetes mellitus (DM) (OR, 3.35; P = 0.0252) as independent risk factors for POP. In accordance with the number of risk factors, the incidence rate of POP drastically increased, and its rate in patients with 3 risk factors was 80%. Conclusion High CAR, COPD, and DM are independent risk factors for the development of POP in patients undergoing subtotal esophagectomy for EC. Clinicians should be aware of the risk factors for POP and consider more intensive preventive measures and postoperative management in patients with EC.

Chest CT features and risk factors for patients with Omicron variant pneumonia: a multicenter retrospective clinical study.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron variant infection has become widespread in China as a result of the alterations in epidemic control and prevention policies. We identified the clinical characteristics and lung computed tomography (CT) imaging characteristics of patients infected during the early stage of the Omicron BA.5 wave in Shanghai to provide a guide to the diagnosis, treatment, and prognosis of infection. Clinical information and lung CT imaging characteristics of patients with Omicron variant infection admitted to three designated hospitals in Shanghai from March to June 2022 were analyzed retrospectively. A total of 958 patients were included in the analysis. Among the patients, 169 (17.64%) had pneumonia confirmed by CT, of whom 70.41% (119/169) had lesions in < 10% of the lung area. Older age, unvaccinated status, and comorbid chronic lung disease, cerebrovascular disease, kidney disease, or Alzheimer`s disease were associated with poor prognosis. In patients with coronavirus disease 2019 (COVID-19) pneumonia, a large lesion size was associated with a poor prognosis. Age ≥ 65 years, unvaccinated status, fever > 5 days, and lymphocyte count < 0.5×109/L were risk factors for pneumonia. Age ≥ 65 years, unvaccinated status, fever > 5 days, and lymphocyte count < 0.5×109/L can be used to identify high-risk individuals who warrant a CT scan to screen for COVID-19 pneumonia, especially during the period of Omicron variant predominance. Concurrently, the importance of immunization should be emphasized to help people withstand the effects of Omicron variant infection.

Analysis of pathogenic bacteria and risk factors of neonatal ventilator-associated pneumonia

Analysis of pathogenic bacteria and risk factors of neonatal ventilator-associated pneumonia

Effect of Perioperative Inhaled Tiotropium for patients with chronic Obstructive Pulmonary disease in Esophageal cancer surgery (EPITOPE): an open-label, randomized, parallel-group pilot study.

Chronic obstructive pulmonary disease (COPD) is a risk factor for pneumonia following esophagectomy. This study aimed to investigate the efficacy of perioperative inhaled tiotropium in patients with COPD undergoing esophagectomy. This open-label, randomized controlled trial randomly assigned 32 patients with COPD undergoing esophagectomy to conventional management or addition of tiotropium inhalation. The intervention group received tiotropium from two weeks before esophagectomy until the final evaluation one month after esophagectomy. The primary outcome was the incidence of pneumonia within 30 postoperative days. We also assessed the changes and the percentages from baseline in pulmonary function and walking distance of the incremental shuttle walking test to just before esophagectomy and final evaluation. Enrolled patients were randomly assigned to the control group (n = 18) and the intervention group (n = 14). Pneumonia was recorded in 4 (28.6%) and 5 (27.8%) patients in the intervention and control groups, respectively (risk difference: 0.8%, 95% confidence interval: - 30.6 to 32.2). The intervention group demonstrated a significant improvement in pulmonary function and walking distance preoperatively. Further, the pulmonary function test was significantly better preoperatively in the intervention group than in the control group. Postoperatively, pulmonary function deterioration was more significant in the control group than in the intervention group. Preoperative tiotropium inhalation significantly improved pulmonary function and exercise tolerance in patients with COPD undergoing esophagectomy. The perioperative tiotropium did not reduce pneumonia after esophagectomy, but it may contribute to patient recovery by reducing postoperative pulmonary function deterioration.

Risk factors of acute stroke associated pneumonia and predictive value of serum amyloid A combined with neutrophil-to-lymphocyte ratio

Objectives: This study aimed to explore the risk factors for stroke-associated pneumonia (SAP) and assess the predictive value of Serum Amyloid A (SAA) combined with neutrophil-to-lymphocyte ratio (NLR) on SAP. Methods: The study included acute ischemic stroke (AIS) patients from January 2021 to June 2022 in our hospital. The patients’ history of chronic diseases, the clinical characteristics, and the laboratory testing data were recorded. SPSS 22 was used for statistical analysis. Receiver operating characteristics (ROC) curves and logistic regression analysis were used to identify independent predictors. Results: We studied 356 patients with AIS, of which 19.4% (n = 69) developed SAP. In the SAP group, the patients with higher the proportion of hypertension, coronary heart disease and higher the NIHSS score were older, the blood glucose, neutrophil count, NLR and SAA of the SAP group were significantly higher than the Non-SAP group. Multiple logistic regression analysis for SAP showed that age , NIHSS,SAA and NLR were independent risk factors for SAP. For SAA alone, the area under the curve (AUC) in the ROC curve was 0.765, For NLR alone, the AUC was 0.840. When SAA combined with NLR, the AUC increased to 0.853. we created a 4-item prediction model, the AUC increased to 0.881. Conclusion: Age, NIHSS, SAA and NLR were independent risk factors for SAP. When SAA combined with NLR, its predictive value for SAP was higher than its alone, the value of prediction for SAP appeared to be much stronger when SAA and NLR incorporated in a prediction model including age, and NIHSS.

Application value of P-selectin and Clara cell secretory protein 16 expression in children with severe adenovirus pneumonia.

This study investigated the roles of P-selectin and Clara cell secretory protein 16 (CC16) levels in the pathogenesis of severe adenovirus (ADV) pneumonia in children and evaluated their ability to predict disease. Fifty-one children (age, 1-5 years) with ADV pneumonia who were admitted to Xiamen Children's Hospital were included in this study and divided into the mild group (24 patients) and severe group (27 patients). A control group comprising healthy children of the same age who underwent routine physical examinations during the same period (30 patients) was also included. The univariate analysis demonstrated that the levels of the white blood cell count and C-reactive protein, procalcitonin, d-dimer, and P-selectin were increased in a severe group compared with a mild group, while CC16 levels were significantly decreased (p < 0.05). The logistic regression analysis revealed that P-selectin and CC16 levels were independent risk factors for severe ADV pneumonia in children. The areas under the ROC curves suggested that P-selectin and CC16 exhibited high predictive value for severe ADV pneumonia. P-selectin values more than 898.58 pg/mL and CC16 values less than 11.355 ng/mL predicted severe ADV pneumonia. P-selectin and CC16 levels are correlated with the severity of ADV pneumonia in children.

250. CHANGES IN AND CLINICAL UTILITY OF MAXIMUM PHONATION TIME AND REPETITIVE SALIVA SWALLOWING TEST SCORES AFTER ESOPHAGECTOMY

Abstract Background Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, intervention by speech-language pathologists (STs) has reported to be important for the prevention of postoperative pneumonia. In this study, we report on the perioperative swallowing rehabilitation led by STs at our hospital. In addition, we focused maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. Methods ST intervention was started at the induction of preoperative chemotherapy, and pre-surgical swallowing rehabilitation including oral care, incentive spirometry, abdominal breathing, and breath-hold swallowing was started and continued after surgery. MPT is the longest speech duration after maximal inspiration, and RSST is the number of empty swallowing that can be repeated in 30 seconds. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between 2020 and 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. Results The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4 s, respectively; postoperative MPTs were significantly lower than preoperative MPT. Meanwhile, there were no significant changes in perioperative RSST scores. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (OR: 12.6, 95%CI: 1.29–123, P = 0.03) in the multivariate analysis. Regarding the onset of postoperative pneumonia, the MPT on POD6 was significantly associated with late-onset pneumonia, but not with early pneumonia (P = 0.02 and P = 0.25, respectively). Conclusion The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia. Early resumption of oral intake after esophagectomy might be a risk factor of aspiration pneumonia since expectoration function is not restored, especially in patients with a low MPT on POD 6.

Prevalence and risk factors for ventilator-associated pneumonia after cardiac surgery: a systematic review and meta-analysis.

There is currently significant variation in the reported incidence of ventilator-associated pneumonia (VAP) among postoperative cardiac patients. Moreover, the risk factors for VAP in postoperative cardiac patients remain controversial. This study aims to assess the incidence and risk factors of VAP in postoperative cardiac patients to provide a basis for further prevention and treatment of VAP. We systematically reviewed PubMed, EMBASE, and Cochrane Library databases to select studies that met the inclusion criteria until November 2023. Fifteen studies involving 10,478 patients who underwent cardiac surgery were selected for meta-analysis. The incidence of VAP in postoperative cardiac patients was 10%. The preoperative risk factors for VAP after cardiac surgery included age >70 years, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, renal disease, and severe pulmonary hypertension. Furthermore, the perioperative risk factors for VAP after cardiac surgery included emergency surgery, redo surgery, airway instrumentation, gastric aspiration, reintubation, mechanical ventilation duration >3 days, intra-aortic balloon, New York Heart Association >3, American Society of Anesthesiologists >3, need for transfusion during surgery, and ascending aortic surgery. The incidence of VAP after cardiac surgery was found to be 10%, and the comprehensive risk factors for VAP were identified, emphasizing the critical need for targeted interventions, including optimization of preoperative health and refined surgical protocols, to effectively reduce the occurrence of VAP in postoperative cardiac patients.

451. PREDICTIVE FACTORS FOR PNEUMONIA AND ANASTOMOTIC LEAK AFTER TRANSTHORACIC ESOPHAGECTOMY FOR CANCER AND FAILURE TO RESCUE ANALYSIS ON 1355 PATIENTS

Abstract Background Pneumonia (PN) and anastomotic leak (AL) represent the most feared complications after transthoracic esophagectomy for cancer, the former more commonly observed after open and the latter after minimally-invasive (MI) procedures. Studies comparing these two complications with focus on predictive risk factors and procedure-related failure-to-rescue (FTR) are sparse. Aim of the study was to explore such aspects with a large multicentric dataset. Methods All patients who underwent an Ivor Lewis transthoracic esophagectomy for cancer between 2008 and 2022 in four tertiary centers were queried. Predictive risk factors for pneumonia, anastomotic leak and in-hospital mortality were analyzed with univariable models. FTR was defined as in-hospital death following a major complication. Patients were then classified and compared according to the type of operation [open, hybrid-laparoscopic, hybrid-robotic, standard minimally-invasive (MIE) or robotic minimally-invasive (RAMIE)]. Pneumonia and anastomotic leak associated FTR was calculated and compared across the groups. Machine-learning models (neuronal nets, support vector machines and random forests classifier) were applied to predict complications and FTR. Results In total, 1,355 patients were included. Significant (p&amp;lt;0.05) predictors for PN (n=211, 15.6%) were ASA=4, preexisting cardiac and pulmonary conditions, conversion (thoracotomy), neoadjuvant therapy and age. Those for AL (n=160, 11.8%) were preexisting cardiac condition, conversion (thoracotomy) and operation time. Overall FTR-rate was 3.6%. Age&amp;gt;65y, preexisting cardiac and pulmonary condition, AL, PN, postoperative bleeding, sepsis, pulmonary embolism, myocardial infarction, arrhythmia and need for blood transfusion were the risk factors significantly associated with in-hospital mortality. PN- and AL- associated FTR rates did not significantly differ among the different operation types (Figure 1). Machine-learning models were unable to predict complications or FTR properly. Conclusions Our study showed that there is a greater number of factors associated with pneumonia rather than anastomotic leak, probably making the prevention of this complication more challenging to achieve. However, pneumonia- and leak-associated FTR-rates did not significantly differ among the groups, demonstrating that the implementation of minimally-invasive procedures can be safely carried out, if experience is provided.