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Background: Community-acquired pneumonia (CAP) remains one of the leading causes of mortality and morbidity in children under 5 years of age. Early diagnosis and effective management remain the cornerstone to reduce complications and fatalities associated with CAP. Lately, C-reactive protein (CRP) and procalcitonin (PCT) have gained much attention as useful biomarkers in CAP. Recent data suggest that a very low PCT value has a high negative predictive value while identifying a population of children at low risk of typical bacterial infections. Hence, we propose to take up this study to assess the clinical utility of PCT in pediatric CAP. Aims and Objectives: The aim of this study was to study serum PCT level in children with the clinical diagnosis of CAP admitted at R.G Kar Medical College and Hospital, Kolkata, and its role in severity identification and contribution in the treatment of CAP. Materials and Methods: This cross-sectional hospital-based observational study was performed from January 2020 to June 2021 in the R.G Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 children were included within the age group of 2 months–5 years with CAP admitted in the Children’s ward and intensive care unit at our hospital. Clinical characteristics such as age, sex, symptoms such as history of fever, difficulty feeding or drinking, convulsion, lethargy, cyanosis, chest in-drawing, respiratory rates, auscultatory findings such as air entry of bilateral lungs, added sounds like-(inspiratory crept, bronchial breathing), and oxygen saturation were studied. Routine investigations such as complete blood count, serum CRP, blood culture, and chest radiograph sent along with serum PCT. Results: Out of 50 children diagnosed with CAP, 30 (60%) fell within the age range of 2–5 months of age. Among the study population, 70% of children displayed weakly positive and 20% strongly positive serum PCT values. A strong correlation (P < 0.001) was revealed between the severity of pneumonia and PCT, and also a positive correlation (P < 0.001) between clinical outcome and PCT. However, the role in contribution in early diagnosis could not be concluded. Conclusion: This study concluded that serum PCT may be used as a valuable indicator for assessing the severity and prognosis of CAP. All children with elevated PCT who were prescribed antibiotics did not experience further complications of CAP.
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Aspiration pneumonia is a common respiratory infection that can lead to complications, including lung abscess. While typical causative agents include P. aeruginosa, K. pneumoniae, and S. aureus, atypical agents must also be considered, especially in comorbid or elderly populations. This case report presents a rare instance of aspiration pneumonia caused by E. faecium that developed into a lung abscess in a patient with multiple comorbidities. The patient's medical history included left-sided hemiparesis, hypertension, and type-2 diabetes mellitus, as well as a thirty-year history of smoking and alcoholism. Radiological evaluation revealed a rounded opacity with an air-fluid level in the left lower zone, indicating a lung abscess. Microbiological evaluation confirmed the presence of Enterococcus spp. The case highlights the importance of considering atypical pathogens in aspiration pneumonia and the potential for severe complications in severely comorbid patients.
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Aim: This study aimed to investigate the patterns of etiological agents, predisposing factors, radiological presentations, and bacteriological etiologies of Community- Acquired Pneumonia (CAP). The primary objective was to study the prevalence of CAP, while the secondary objective was to explore its association with age, sex, comorbidities, risk factors and causative organisms. Study Design: Prospective observational study. Place and Duration of Study: The study was conducted at Ruby Hall Clinic, Pune, from December 1, 2022, to November 30, 2023. Background: Community-acquired pneumonia (CAP) Considered as one of the main causes of morbidity and mortality, particularly in the elderly. Diagnosis relies on clinical, radiological, and microbiological assessments. The study aims to provide insight into the clinical and microbiological profiles of CAP in a developing country setting. Methodology: 72 patients aged over 12 years, presenting with clinical and radiological evidence of CAP, were enrolled. Standard investigations included complete blood count, biochemistry, sputum Gram stain and culture, blood culture, BioFire FilmArray Pneumonia Panel, chest X-ray, and CT scan. The BioFire Panel was used selectively due to cost considerations. Data analysis employed statistical methods such as the Chi-Square test, Mean, Standard Deviation, Fischer Exact test, and Odds Ratio. Results: The mean age of the patients was 59.93 years, with a male predominance (61%). Fever, dyspnea, and cough were the predominant symptoms. Common comorbidities included hypertension, diabetes, and chronic lung diseases. Microbiological analysis revealed diverse pathogens, with gram-positive cocci in 17% and gram-negative bacilli in 11% of cases. Sputum culture and BioFire Panel identified various bacterial and viral pathogens. Prior antibiotic use significantly affected sputum culture results but not BioFire test outcomes. Conclusion: CAP in the studied cohort presented with diverse clinical and microbiological profiles. The BioFire Panel demonstrated higher sensitivity and a broader pathogen detection range compared to conventional methods. The findings emphasize the need for precise diagnostic tools and tailored treatment strategies to manage CAP effectively.
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Background: Pneumonia, the leading infectious cause of death in children worldwide, often requires a chest radiograph (CXR) for diagnosis, involving radiation exposure. Point-of-Care Ultrasound (POCUS) offers a radiation-free alternative and, specifically the pocket-size variant, enhances convenience at the patient's bedside. While evidence supports ultrasound's accuracy in detecting community-acquired pneumonia (CAP) in children comparable to CXR, few studies have explored its ability to distinguish pneumonia etiology, especially utilizing pocket-size POCUS devices. Methods: In this prospective diagnostic cohort study conducted over a year in a tertiary pediatric referral center, we aim to assess the diagnostic accuracy of a pocket-size POCUS device compared to CXR for determining the etiology of CAP in pediatric patients (aged >6 months and <18 years). At least 76 participants diagnosed with CAP will undergo independent POCUS examinations at various intervals, complemented by CXRs when necessary, independently classified by a third investigator. The General Electrics Vscan AirTM®, featuring Bluetooth connectivity to smartphone/tablet, will be employed for POCUS. Data collection will include systematized POCUS and CXR descriptions, alongside sociodemographic, clinical, and therapeutic variables. Statistical analysis using SPSS® version 28 will evaluate the diagnostic accuracy of the POCUS device. Conclusions: This trial's outcomes hold significant promise in unveiling unknown data about the diagnostic accuracy of pocket-size POCUS for pediatric CAP etiological diagnosis. Utilizing a device meeting technical recommendations, featuring a dual-headed probe and Bluetooth connectivity, this study has the potential to bring innovation to clinical practice, improving patient care and creating scientific value. Trial Registration Number: NCT06296693.
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Introduction: The escalation of community-acquired pneumonia cases amidst the COVID-19 pandemic has engendered a concerning phenomenon characterized by the unwarranted utilization of antimicrobial agents. Aims: To analyze the utilization trends of antimicrobial agents within the cohort of hospitalized individuals diagnosed with community-acquired pneumonia (CAP). Material and methods: A prospective observational study was conducted for 6 months within the Department of Medicine to investigate patients diagnosed with CAP. Detailed records of drug prescriptions were meticulously recorded, with subsequent computation of both the Daily Defined Dose (DDD) and Antibiotics Consumption Index (ACI). A dataset comprising information from 130 patients was meticulously examined and subsequent analysis conducted. Descriptive statistical analyses were undertaken to utilize both Microsoft Excel and SPSS software version 27. Results: The predominant empirical therapy for antibacterial agents was found to be amoxicillin-clavulanic acid, utilized by 73 (56.2%) patients, succeeded by levofloxacin, administered to 33 (25.4%) patients. Following culture and sensitivity testing, the most frequently employed antibacterial agents for definitive therapy included levofloxacin for 33 (25.4%) patients. Notably, the highest Antibiotics Consumption Index (ACI) value recorded was 14.4 for amoxicillin-clavulanic acid in empirical therapy, while in definitive therapy, levofloxacin exhibited an ACI of 14.8. A significant disparity in ACI values between empirical and definitive therapy was observed (p<0.05), signifying statistically meaningful differences. Conclusions: The findings of the current investigation accentuate a discernible trend in the administration of antibiotics for managing community-acquired pneumonia (CAP) within the Medicine Department amidst the COVID-19 pandemic.
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The treatment of pediatric community-acquired pneumonia (CAP) with antibiotics is important due to its substantial global health impact. To support clinical practice and antibiotic stewardship, this narrative review investigates the effects of the length of antibiotic therapy on the outcomes of childhood CAP. A thorough search of PubMed, Scopus, and Google Scholar produced English articles published in the last ten years (2019�24) and looked at the connection between the length of antibiotic therapy and the outcomes of community-associated pneumonia in children. There is increasing evidence to support the similarity of shorter and longer antibiotic regimens for treating juvenile community-acquired pneumonia. Research continuously shows that shorter periods of antibiotic therapy梪sually five days梡roduce similar clinical results as lengthier regimens that last seven to 10 days. Furthermore, emphasis is placed on tailored treatment plans that take into account the child's age, the severity of the symptoms, and regional trends of antibiotic resistance. The included studies, albeit observational and retrospective, provide important insights into the safety, effectiveness, and consequences of various antibiotic regimens in the therapy of pediatric CAP. This review emphasizes the significance of evidence-based strategies to maximize antibiotic treatment for pediatric CAP, while also noting research limitations. More research is required to enhance treatment methods and results for kids with CAP. This includes carefully planned randomized controlled trials and integrated diagnostic tools.
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Background: The prevalence of acute kidney injury (AKI) progressively increases with age. A higher rate of dialysis dependency and mortality is observed in elderly with AKI. Here we have studied the comparison of clinical features, outcomes of AKI between elderly (age � years) and non-elderly AKI patients and their risk factors for mortality. Methods: This prospective observational study enrolled 100 patients with AKI, with elderly and non-elderly in a 1:1 ratio for comparison, from September 2021 to January 2023 at AIIMS Rishikesh in India. Detailed history, clinical examination, relevant laboratory and radiological investigations were done to evaluate for the cause of AKI. Etiological causes, complications of AKI, and in-hospital outcomes were observed. They were given standard treatment and dialysis as per standard indications. We analysed the mortality risk of these groups using the Cox proportional hazards model. Results: The in-hospital mortality rates among these two groups were non-significant (p=0.29). A significantly higher number of patients with non-elderly AKI were HD-dependent at discharge (p=0.027). Elderly patients had significantly lesser complications like uremic encephalopathy and fluid overload compared to non-elderly. There was a significant association between mortality and female gender, intensive care unit (ICU) admissions, hospital-acquired AKI, pre-renal/renal causes, chronic obstructive pulmonary disease (COPD) as comorbidity, multiple organ dysfunction syndrome (MODS), mechanical ventilation requirement, vasopressor support requirement, need for hemodialysis and prolonged ICU stay. Conclusions: Elderly patients with AKI do not experience worse mortality outcomes than non-elderly patients with AKI. Therefore, elderly patients should not be denied timely treatment, solely based on their age.
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Background: The lower respiratory tract infections (LRTIs), including pneumonia, are the fourth most common cause of mortality globally and the second most frequent reason for years of life lost. India is home to one-quarter of the world’s pneumonia cases. Aims and Objectives: The present study was aimed to evaluate the clinical, bacteriological and radiological profile of CAP, HAP and VAP patients from a tertiary care teaching hospital. Material & Methods: This cross-sectional, observational study was conducted at the Department of Pulmonary Medicine, Bharati Vidyapeeth (DTU) Medical College and Hospital, Pune, India. The study included 100 clinically diagnosed patients of community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP). Patients were evaluated for clinical symptoms, microbiological investigations, radiological assessment, treatment given, and final outcome. Severity indices were calculated for CAP, HAP, and VAP patients to predict the severity and rate of mortality. Results: The most common symptoms are cough, fever, and shortness of breath. The most common organisms isolated in sputum cultures of patients with pneumonia are Streptococcus, Pseudomonas, and Acinetobacter. The most common site of consolidation on chest X-ray is bilateral. Mortality rates are highest in patients with ventilator-associated pneumonia (VAP), followed by hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP). Conclusion: The most common symptoms of pneumonia are cough, fever, crepitation, and expectoration. Mortality rates are highest in patients with VAP, followed by HAP and CAP.
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Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news
Objetivo: desarrollar un puntaje predictivo de mortalidad para pacientes con covid-19. Materiales y méto-dos: estudio retrospectivo, analítico, observacional y transversal, realizado en dos fases. Se revisaron 620 historias clínicas con una cohorte de derivación de 320 pacientes y una de validación de 300 pacientes. Las variables se analizaron con test de Anova, chi cuadrado de Pearson y análisis multivariante con regresión binaria, que determinaron sensibilidad, especificidad y valor predictivo negativo y positivo. Los puntajes se compararon mediante curvas cor con los scoresnews y hews. Resultados: los dos puntajes obtenidos incluyeron valores de edad, conteo de linfocitos, SatO2/FiO2, leucocitos, plaquetas, ausencia de síntomas, hipertensión arterial, epid y dhl. El área bajo la curva (abc) fue de 0.838 para el puntaje con dhl, con una mortalidad del 100 % para 7.75 puntos o más, y un abc de 0.826 para el primer puntaje. En la cohorte de validación, el abc para el primer puntaje fue de 0.831 y para el score con dhl fue 0.855. El puntaje hewsobtuvo un abc de 0.451, y el news, un abc de 0.396. Conclusiones: se desarrollaron dos herramientas para predecir mortalidad en pacientes con covid-19, con alto poder de discriminación, superior a los puntajes británicos hews y news
Objetivo: desenvolver um escore preditivo de mortalidade para pacientes com covid-19. Materiais e Métodos: estudo retrospectivo, analítico, observacional e transversal, realizado em duas fases. Foram revisados 620 prontuários, com uma coorte de derivação de 320 pacientes e uma coorte de validação de 300 pacientes. As variáveis foram analisadas com teste anova, qui-quadrado de Pearson e análise multivariada com regressão binária, determinando sensibilidade, especificidade, valor preditivo nega-tivo e positivo. As pontuações foram comparadas por meio de curvas cor com as pontuações news e hews. Resultados: os dois escores obtidos incluíram valores de: idade, contagem de linfócitos, SatO2/FiO2, leucócitos, plaquetas, ausência de sintomas, hipertensão arterial, epid e dhl. A área sob a curva (abc) foi de 0,838 para o escore dhl, com 100 % de mortalidade para 7,75 pontos ou mais, e uma abc de 0,826 para o primeiro escore. Na coorte de validação, a abc para o primeiro escore foi de 0,831 e para o escore com dhl foi de 0,855. A pontuação hews obteve abc de 0,451 e o news uma abc de 0,396. Conclusões: foram desenvolvidas duas ferramentas para prever mortalidade em pacientes com covid-19, com alto poder de discriminação, superior aos escores britânicos hews e news
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Humans , Frail Elderly , Self-Injurious BehaviorABSTRACT
ObjectiveTo investigate the clinical application value of a predictive model for the efficacy of third-generation cephalosporin in the treatment of community-acquired spontaneous bacterial peritonitis （CASBP）. MethodsThis prospective study was conducted among 50 patients with liver cirrhosis and CASBP who were admitted to The Ninth Hospital of Nanchang from January 2021 to June 2022， and the patients were randomly divided into optimized treatment group and traditional treatment group， with 25 patients in each group. The patients in the optimized treatment group received ceftazidime or imipenem for initial treatment based on the above predictive model， and those in the traditional treatment group received ceftazidime for initial treatment， with the subsequent use of antibiotics adjusted based on the efficacy of initial treatment. The two groups were compared in terms of the response rate of initial treatment， cure rate on day 5， and 30-day mortality rate. The independent-samples t test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups. ResultsAll patients completed the study. The optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.0% vs 60.0%， χ2=5.094， P=0.024）， while there was no significant difference in the cure rate on day 5 between the two groups （80.0% vs 56.6%， χ2=3.309， P=0.069）. As for the patients who received ceftazidime for initial treatment， the optimized treatment group had a significantly higher response rate of initial treatment than the traditional treatment group （88.9% vs 60.0%， χ2=4.341， P=0.037）， while there was no significant difference in the cure rate on day 5 between the two groups （83.3% vs 56.0%， χ2=2.425， P=0.119）. There was no significant difference in 30-day mortality rate between the two groups （8.0% vs 20.0%， χ2=0.664， P=0.415）. For all patients， there was a significant association between response of initial treatment and cure on day 5 （odds ratio ［OR］=9.643， 95% confidence interval ［CI］： 2.292 — 40.564） and between cure on day 5 and 30-day mortality （OR=0.138， 95%CI： 0.023 — 0.813）. ConclusionThis predictive model for efficacy helps clinicians to identify the patients who can benefit from third-generation cephalosporin treatment and improve the efficacy of third-generation cephalosporin in the initial empirical treatment of CASBP.
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Community acquired pneumonia (CAP) is one of the common infectious diseases in clinic, with a high mortality. With the aging population, continuous variation of pathogens, and increasingly severe antibiotic resistance, the treatment difficulty of CAP continues to increase. This disease belongs to the categories of traditional Chinese medicine diseases such as " wind warm lung heat disease" and " cough". Traditional Chinese medicine treatment can effectively improve symptoms of CAP, control disease progression, shorten hospital stay, and also have certain advantages in prevention. This article mainly provides an overview of the diagnosis, etiology and pathogenesis, syndrome differentiation and treatment, and prevention of CAP, providing reference for the clinical diagnosis, treatment, and prevention of CAP in traditional Chinese medicine.
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Objective:To understand the pathogen distributions of community-acquired pneumonia (CAP) in children, and to provide evidence for clinical diagnosis and treatment.Methods:The hospitalized children with CAP in Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine from January to December 2022 were selected as the research subjects. They were divided into infant group (28 d to less than one year), toddler group (one year to less than three years), preschool age group (three years to less than six years), and school age group (not less than six years) by age. According to the onset season, they were divided into spring group (February to April), summer group (May to July), autumn group (August to October), and winter group (January, November to December). Deep airway sputum samples were collected from all patients for bacterial culture identification. Respiratory viruses (influenza A virus (IVA), influenza B virus (IVB), respiratory syncytial virus (RSV), adenovirus, parainfluenza virus type 1 (PIV1), parainfluenza virus type 2 (PIV2), parainfluenza virus type 3 (PIV3)) were detected using direct immunofluorescence assay. Mycoplasma pneumoniae (MP) DNA was detected using fluorescent quantitative polymerase chain reaction, and particle agglutination was used to detect serum MP antibodies. Statistical analysis was performed using the chi-square test. Results:Among the 397 cases of CAP in children, pathogens were detected in 269 cases, with a positivity rate of 67.8%. A total of 309 pathogens were identified, including 204 strains of MP (66.0%), 60 strains of bacteria (19.4%), 42 strains of viruses (13.6%), and three strains of fungi (1.0%). Staphylococcus aureus (19 strains), Haemophilus influenzae (15 strains) and Streptococcus pneumoniae (five strains) were the predominant bacteria, while RSV (19 strains) and PIV3 (nine strains) were the main viruses. The distribution rates of MP, bacteria, and viruses showed statistically significant differences among different age groups ( χ2=99.82, 24.71 and 17.40, respectively, all P<0.05). MP infection was mainly observed in the preschool age group and school age group, and bacterial infection predominantly occurred in the infant group, and viral infection was most common in the toddler group. Among virus infected patients, RSV was detected in the toddler group and the preschool age group, while three cases of PIV3 cases were found in children over five years old. The distribution differences of MP, bacterial and viral infections between different seasons were statistically significant ( χ2=141.65, 20.44 and 31.87, respectively, all P<0.001), with a higher prevalence in winter. RSV infections demonstrated a clear seasonal trend, with 16 cases of RSV infections occurring in winter and spring. Conclusions:MP is the most frequently detected pathogen in children with CAP. Bacterial infection is the most common pathogen in infants with CAP. RSV is the most common viral pathogen, with infections concentrated in the toddler group and the preschool age group, and prevalence in winter and spring. Attention should be paid to PIV3 pneumonia in children over five years old. Rational drug use should be based on the pathogen spectrum characteristics of different seasons and age groups before selecting empirical treatment combinations.
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Objective To analyze the seasonal and epidemiological characteristics of community-acquired pneumonia (CAP) in Chuzhou from 2010 to 2022. Methods The epidemiological data of CAP in Chuzhou from 2010 to 2022 were obtained from the center for diseases control and prevention of Chuzhou City, Anhui Province. After inclusion and exclusion, a total of 1 053 cases were enrolled. General data were collected. Then the characteristics of CAP patients in terms of gender, age, regional and seasonal distribution and pathogenic bacteria distribution were analyzed. Results A total of 316 patients with CAP, with a prevalence rate of 30.01%, including 152 males (48.10%) and 164 females (51.90%). Regarding age, 86 cases (27.22%) at 19-40 years, 106 cases (33.54%) at 41-60 years, and 124 cases (39.24%) at >60 years, suggesting a statistical difference in the CAP detection rate among different genders and ages (P<0.05). Seasonally, 118 cases (37.34%) were detected in spring, 13 cases (4.11%) in summer, 49 cases (15.51%) in autumn, and 136 cases (43.04%) in winter, with the highest CAP detection rate in winter, followed by spring. Pathogenic bacteria were positive in 198 of 316 patients, with a detection rate of 62.66%. A total of 125 strains of pathogenic bacteria were detected in sputum culture, of which 138 cases were Gram-negative, mainly Escherichia coli (24.24%, 48/198), and 60 cases were Gram-positive, mainly Streptococcus pneumoniae (14.14%, 28/198). Among 198 patients positive for pathogen detection, 41 cases were detected in spring, 37 cases in summer, 56 cases in autumn and 64 cases in winter. The drug sensitivity results showed that Escherichia coli had the highest resistance rate to ampicillin and cefazolin, and was sensitive to imipenem and other antibiotics; Streptococcus pneumoniae has the highest resistance rate to penicillin and erythromycin, and is sensitive to vancomycin. Conclusion CAP is quite common in elderly population in Chuzhou from 2010 to 2022, with a high prevalence rate in spring and winter, and the prevention work of high-risk groups should be strengthened.
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Airway mucus hypersecretion is one of the pathological changes in children with community acquired pneumonia（CAP），and affects the severity，progression and prognosis of CAP.Diagnosis of airway mucus hypersecretion currently relies on fiberoptic bronchoscopy. To predict the risk of airway mucus hypersecretion and to take early action to avoid serious consequences such as plastic bronchitis and hypoxia and respiratory failure，the article summarizes the relationship between age，clinical characteristics and laboratory indices and the formation of airway mucus hypersecretion in children with CAP. Among them，age，pathogenic species，fever peak and fever range，neutrophil ratio，C-reactive protein，lactate dehydrogenase，D-dimer，serum 25（OH）D，and some interleukins，interferons，and acquired immune indicators have an early warning effect on the development of airway mucus hypersecretion in children with CAP.
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Community acquired pneumonia（CAP）is the leading cause of death in children，and as molecular diagnostic techniques continue to improve，more CAP is found to be caused by viral infections. At present，many factors are known to affect the severity of viral pneumonia，including viral subtypes，viral virulence，host factors，environmental factors，etc. Some studies have found that viral load is related to the severity of viral pneumonia，and different viral load levels have different effects on the severity of viral pneumonia. The correlation with virus type，subtype，site of virus specimen collection，age，sex and co-infection may be also different. This article will review the relationship between viral load and disease severity in pneumonia caused by common respiratory viral infections.
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Objective To explore the development and validation of a prediction model for severe communi-ty-acquired pneumonia in adults based on peripheral blood inflammatory indicators.Methods Venous blood samples of 204 community-acquired pneumonia in adults patients admitted to 7 hospitals in Chongqing area from April 2021 to August 2022 were collected to detect C-reactive protein(CRP),peripheral white blood cell count(WBC),neutrophil to lymphocyte ratio(NLR),cytokines,lymphocyte subgroups and neutrophil CD64 index.All of patients were divided into a training group and a validation group according to the time of admis-sion.Univariate and multivariate Logistic regression were used to analyze the data of the training group,the characteristic factors of severe progression for pneumonia were selected to construct the nomogram model,and the data of the validation group was used to verify the model.The receiver operating characteristic(ROC)curve,calibration curve and decision curve analysis(DCA)were used to evaluate the prediction ability of the model for severe community-acquired pneumonia in adults.Results Logistic regression analysis showed that age,CRP,WBC,interleukin(IL)-4/interferon gamma ratio and IL-6/IL-10 ratio were independent risk factors for severe community-acquired pneumonia in adults.The area under the ROC curve of the nomogram model in the training group and the validation group was 0.893 and 0.880,respectively.The calibration curve and DCA results shown that the model had a good prediction effect for severe community-acquired pneumonia in adults.Conclusion The inflammatory indicators included in this model are simple and easy to obtain clinically.This model with good differentiation and accuracy,it can be used as a practical tool to predict severe community-ac-quired pneumonia in adults,and has certain clinical application value.
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Objective To explore the clinical characteristics and risk factors of death during hospitalization in patients with community-acquired pneumonia(CAP)complicated with diabetes mellitus(DM).Methods A retrospective analysis was performed on 566 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022.The patients were divided into simple CAP group(n=478)and CAP combined with diabetes(CAP+DM)group(n=88)according to whether they had diabetes,and then CAP+DM group(n=88)was divided into survival group(n=69)and death group(n =19)according to whether the patients died during hospitalization.The clinical data and laboratory test indicators of patients in different groups were compared.Cox regression analysis was used to screen the risk factors of death during hospitalization in the CAP+DM group.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of independent risk factors on hospitalization death.Results Compared with the simple CAP group,the CAP+DM group had significant differences in age,concomitant hypertension,coronary heart disease,CURB-65 score,neutrophil to lymphocyte ratio(NLR),C-reactive protein(CRP),procalcitonin(PCT),albumin(ALB),prealbumin(PA),glucose(GLU),serum potassium(K),calcium(Ca),phosphorus(P),magnesium(Mg),lactic acid(Lac),non-invasive ventilation time,ICU occupancy rate and mortality rate(P<0.05);Compared with the survival group,there were statistically significant differences in CURB-65 score,NLR,CRP,PCT,GIU,ALB,PA,serum iron(Fe),Ca,non-invasive ventilation time,and ICU admission rate among the death group patients(P<0.05).Cox regression analysis showed that the increase of NLR level and the decrease in PA level were the risk factors for in-hospital death in patients with CAP complicated with diabetes(P<0.05).When the PA cutoff value was 91 mg/L,the AUC,sensitivity,and specificity for predicting in-hospital death of CAP patients with diabetes were 0.849,84.2%and 81.2%,respectively.Conclusion Patients with CAP combined with diabetes are more serious and have worse prognosis than those with CAP alone.PA has a good predictive value for the prognosis of these patients.Early detection and active intervention should be carried out to reduce the in-hospital mortality of patients.
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Objective:To investigate the dynamic trend of platelet（PLT）count and mean platelet volume（MPV）in children with severe community-acquired pneumonia（SCAP）in PICU and their correlation with prognosis.Methods:A retrospective study was conducted in 215 SCAP children who were admitted to the PICU of Beijing Children's Hospital Affiliated to Capital Medical University from January 2016 to December 2019.According to the disease outcome，the patients were divided into improvement group ( n=184) and unrecovered group ( n=31).The changes of PLT count and MPV at admission，on the 2nd，3rd，and 7th days of hospitalization and before discharge were observed，and the relationship between changes in PLT parameters and poor prognosis was analyzed. Meanwhile，the correlation between thrombocytopenia on admission and on the 7th day of hospitalization and prognosis was further explored. Results:The PLT count of improvement group at admission，on the 2nd，3rd，and 7th days of hospitalization and at discharge[(328±159, 329±137, 362±159, 439±168, 510±171)×10 9/L] were significantly higher than those of unrecovered group [(210±142, 207±152, 267±143, 260±162, 343±159)×10 9/L]（ P＜0.05）.Although the MPV of improvement group [(10.9±1.9)fL] on admission was significantly lower than that of the unrecovered group[(12.7±2.5) fL]（ P＜0.05），there was no significant difference in MPV between two groups on the 2nd，3rd，7th days of hospitalization and discharge（ P＞0.05）.In addition，compared with the admission，children in improvement group had significantly higher PLT count on the 7th day of hospitalization and before discharge（ P＜0.05），but there was no significant change in unrecovered group（ P＞0.05）.Compared with SCAP patients with thrombocytopenia at admission (PLT＜100×10 9/L)( n=22),those with thrombocytopenia on 7th day of hospitalization had a significant higher rate of non recovery( P＜0.05). Conclusion:The occurrence of thrombocytopenia on admission and after 7 days of hospitalization in children with SCAP is associated with poor prognosis.No significant increase or decrease in PLT count after 7 days of hospitalization is often indicative of poor prognosis.Dynamic monitoring of PLT parameter changes may help to better judge the prognosis of severe pneumonia.
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Severe community-acquired pneumonia(SCAP) is one of the leading causes of death in children.Early identification of risk factors in children with SCAP,accurate assessment of disease conditions and reduction of mortality in children with SCAP are important tasks at present.The death risk factors of SCAP in children are affected by many factors,which are different among countries,regions and families.At present,the relevant prospective studies and retrospective studies are not comprehensive.This review summarized the literatures on the risk factors of SCAP death in children at home and abroad in recent years,to provide the basis for the diagnosis of childhood SCAP.
ABSTRACT
Objective:To investigate the relationship between the age-adjusted Charlson comorbidity index(aCCI)and the risk of in-hospital death for people aged ≥ 90 years with community-acquired pneumonia(CAP), and to construct a novel scoring model for predicting in-hospital mortality.Methods:Basic personal and medical data about sex, age, hospitalization days, hospitalization expenses, in-hospital outcomes and discharge/admitting diagnosis of CAP patients aged ≥ 90 years hospitalized in Peking University Third Hospital between 2010 and 2019 were collected retrospectively.Multivariate Logistic regression analysis was conducted to examine the association between aCCI or other complications and in-hospital death.The receiver operating characteristic curve(ROC)was used to assess the value of aCCI and a new scoring model in predicting in-hospital death of CAP in people aged ≥ 90 years.Results:A total of 274 CAP patients aged ≥ 90 years were included in this study, of whom 85 died in hospital.Multivariate Logistic regression analysis showed that malnutrition( OR=2.21, 95% CI: 1.05-4.67, P<0.05), respiratory failure( OR=18.91, 95% CI: 9.34-38.25, P<0.001)and aCCI( OR=1.51, 95% CI: 1.23-1.85, P<0.001)were prognostic factors for in-hospital death in CAP patients aged ≥ 90 years.Based on the above results, a novel scoring model, MRC(malnutrition, respiratory failure, aCCI)was established.The area under the ROC curve of the aCCI score for predicting the risk of in-hospital death in CAP patients aged ≥ 90 years was 0.743(95% CI: 0.684-0.802). The area under the ROC curve of the MRC score was 0.891(95% CI: 0.848-0.933), indicating a higher predictive value than that of the aCCI score alone( Z=6.337, P<0.001). Conclusions:The MRC score model can be used to evaluate and predict the risk of in-hospital death in long-living CAP patients.