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Rationale Prognostic accuracy of the qSOFA and CRB-65 risk scores has not been widely evaluated in SARS-CoV-2 infected compared to SARS-CoV-2 non-infected community-acquired pneumonia (CAP). Objectives The aim was to validate the qSOFA(−65) and CRB-65 scores in a large cohort of SARS-CoV-2 infected and non-infected CAP patients. Methods We included all cases with CAP hospitalized in 2020 from the German nationwide mandatory quality assurance program and compared SARS-CoV-2 infected with non-infected cases. We excluded cases with unclear SARS-CoV-2 infection state, transferred to another hospital or on mechanical ventilation (MV) during admission. Predefined outcomes were hospital mortality and need of MV. Results Among 68 594 SARS-CoV-2 infected patients, hospital mortality (22.7%) and MV (14.9%) was significantly higher when compared to 167.880 SARS-CoV-2 negative patients (15.7% and 9.2%, respectively). All CRB-65 and qSOFA criteria were associated with both outcomes, and age dominated mortality prediction in SARS-CoV-2 (relative risk >9). Scores including the age-criterion had higher AUCs for mortality in SARS-CoV-2 positive (e.g. CRB-65 AUC 0.76) compared to SARS-CoV-2 negative (AUC 0.68) patients, and NPV was highest for qSOFA-65=0 (98.2%). Sensitivity for MV prediction was poor with all scores (AUCs 0.59–0.62), and NPVs were insufficient (qSOFA-65=0 missed 1490/10 198∼ 15% patients with MV). Results were similar when excluding frail and palliative patients. Conclusions Hospital mortality and MV rates were higher in SARS-CoV-2 positive compared to SARS-CoV-2 negative CAP. For SARS-CoV-2 positive CAP, the CRB-65 and qSOFA-65 scores showed adequate prediction of mortality, but not of MV.
ABSTRACT
INTRODUCTION: Despite improvements in medical science and public health, mortality of community-acquired pneumonia (CAP) has barely changed throughout the last 15 years. The current SARS-CoV-2 pandemic has once again highlighted the central importance of acute respiratory infections to human health. The "network of excellence on Community Acquired Pneumonia" (CAPNETZ) hosts the most comprehensive CAP database worldwide including more than 12,000 patients. CAPNETZ connects physicians, microbiologists, virologists, epidemiologists, and computer scientists throughout Europe. Our aim was to summarize the current situation in CAP research and identify the most pressing unmet needs in CAP research. METHODS: To identify areas of future CAP research, CAPNETZ followed a multiple-step procedure. First, research members of CAPNETZ were individually asked to identify unmet needs. Second, the top 100 experts in the field of CAP research were asked for their insights about the unmet needs in CAP (Delphi approach). Third, internal and external experts discussed unmet needs in CAP at a scientific retreat. RESULTS: Eleven topics for future CAP research were identified: detection of causative pathogens, next generation sequencing for antimicrobial treatment guidance, imaging diagnostics, biomarkers, risk stratification, antiviral and antibiotic treatment, adjunctive therapy, vaccines and prevention, systemic and local immune response, comorbidities, and long-term cardio-vascular complications. CONCLUSION: Pneumonia is a complex disease where the interplay between pathogens, immune system and comorbidities not only impose an immediate risk of mortality but also affect the patients' risk of developing comorbidities as well as mortality for up to a decade after pneumonia has resolved. Our review of unmet needs in CAP research has shown that there are still major shortcomings in our knowledge of CAP.
Subject(s)
COVID-19 , Community-Acquired Infections , Pneumonia , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/diagnosis , Community-Acquired Infections/epidemiology , Community-Acquired Infections/therapy , Europe/epidemiology , Humans , Pneumonia/diagnosis , Pneumonia/epidemiology , Pneumonia/therapy , SARS-CoV-2ABSTRACT
The key priority in patients with chronic lung diseases is currently immunization against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); all vaccines approved for this showed high effectiveness against severe infections. For patients with chronic pulmonary diseases the recommendations by the Standing Committee on Vaccination include not only the standard vaccinations in adulthood but also the so-called indication vaccinations. These include vaccinations against pneumococci and influenza. Advances include the recent development of new pneumococcal conjugate vaccines containing additional serotypes and the recommendation of a more effective high-dose vaccine against influenza for persons over 60 years old. With the next scheduled booster vaccination against tetanus and diphtheria a combination vaccine with pertussis antigen should be used. For patients with chronic lung disease the herpes zoster vaccine is recommended over the age of 50 years.
ABSTRACT
HLA molecules are key restrictive elements to present intracellular antigens at the crossroads of an effective T-cell response against SARS-CoV-2. To determine the impact of the HLA genotype on the severity of SARS-CoV-2 courses, we investigated data from 6,919 infected individuals. HLA-A, -B, and -DRB1 allotypes grouped into HLA supertypes by functional or predicted structural similarities of the peptide-binding grooves did not predict COVID-19 severity. Further, we did not observe a heterozygote advantage or a benefit from HLA diplotypes with more divergent physicochemical peptide-binding properties. Finally, numbers of in silico predicted viral T-cell epitopes did not correlate with the severity of SARS-CoV-2 infections. These findings suggest that the HLA genotype is no major factor determining COVID-19 severity. Moreover, our data suggest that the spike glycoprotein alone may allow for abundant T-cell epitopes to mount robust T-cell responses not limited by the HLA genotype.