Extracting relevant predictive variables for COVID-19 severity prognosis: An exhaustive comparison of feature selection techniques.

With the COVID-19 pandemic having caused unprecedented numbers of infections and deaths, large research efforts have been undertaken to increase our understanding of the disease and the factors which determine diverse clinical evolutions. Here we focused on a fully data-driven exploration regarding which factors (clinical or otherwise) were most informative for SARS-CoV-2 pneumonia severity prediction via machine learning (ML). In particular, feature selection techniques (FS), designed to reduce the dimensionality of data, allowed us to characterize which of our variables were the most useful for ML prognosis. We conducted a multi-centre clinical study, enrolling n = 1548 patients hospitalized due to SARS-CoV-2 pneumonia: where 792, 238, and 598 patients experienced low, medium and high-severity evolutions, respectively. Up to 106 patient-specific clinical variables were collected at admission, although 14 of them had to be discarded for containing ⩾60% missing values. Alongside 7 socioeconomic attributes and 32 exposures to air pollution (chronic and acute), these became d = 148 features after variable encoding. We addressed this ordinal classification problem both as a ML classification and regression task. Two imputation techniques for missing data were explored, along with a total of 166 unique FS algorithm configurations: 46 filters, 100 wrappers and 20 embeddeds. Of these, 21 setups achieved satisfactory bootstrap stability (⩾0.70) with reasonable computation times: 16 filters, 2 wrappers, and 3 embeddeds. The subsets of features selected by each technique showed modest Jaccard similarities across them. However, they consistently pointed out the importance of certain explanatory variables. Namely: patient's C-reactive protein (CRP), pneumonia severity index (PSI), respiratory rate (RR) and oxygen levels -saturation Sp O2, quotients Sp O2/RR and arterial Sat O2/Fi O2-, the neutrophil-to-lymphocyte ratio (NLR) -to certain extent, also neutrophil and lymphocyte counts separately-, lactate dehydrogenase (LDH), and procalcitonin (PCT) levels in blood. A remarkable agreement has been found a posteriori between our strategy and independent clinical research works investigating risk factors for COVID-19 severity. Hence, these findings stress the suitability of this type of fully data-driven approaches for knowledge extraction, as a complementary to clinical perspectives.

Bacteremic pneumococcal pneumonia: arrhythmogenic disease

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Bacteraemic pneumococcal pneumonia and SARS-CoV-2 pneumonia: differences and similarities.

OBJECTIVE: To analyse differences in clinical presentation and outcome between bacteraemic pneumococcal community-acquired pneumonia (B-PCAP) and sSvere Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) pneumonia. METHODS: This observational multi-centre study was conducted on patients hospitalized with B-PCAP between 2000 and 2020 and SARS-CoV-2 pneumonia in 2020. Thirty-day survival, predictors of mortality, and intensive care unit (ICU) admission were compared. RESULTS: In total, 663 patients with B-PCAP and 1561 patients with SARS-CoV-2 pneumonia were included in this study. Patients with B-PCAP had more severe disease, a higher ICU admission rate and more complications. Patients with SARS-CoV-2 pneumonia had higher in-hospital mortality (10.8% vs 6.8%; P=0.004). Among patients admitted to the ICU, the need for invasive mechanical ventilation (69.7% vs 36.2%; P<0.001) and mortality were higher in patients with SARS-CoV-2 pneumonia. In patients with B-PCAP, the predictive model found associations between mortality and systemic complications (hyponatraemia, septic shock and neurological complications), lower respiratory reserve and tachypnoea; chest pain and purulent sputum were protective factors in these patients. In patients with SARS-CoV-2 pneumonia, mortality was associated with previous liver and cardiac disease, advanced age, altered mental status, tachypnoea, hypoxaemia, bilateral involvement, pleural effusion, septic shock, neutrophilia and high blood urea nitrogen; in contrast, ≥7 days of symptoms was a protective factor in these patients. In-hospital mortality occurred earlier in patients with B-PCAP. CONCLUSIONS: Although B-PCAP was associated with more severe disease and a higher ICU admission rate, the mortality rate was higher for SARS-CoV-2 pneumonia and deaths occurred later. New prognostic scales and more effective treatments are needed for patients with SARS-CoV-2 pneumonia.

Alteración funcional pulmonar en el seguimiento precoz de pacientes con neumonía por COVID-19 / Pulmonary Function in Early Follow-up of patients with COVID-19 Pneumonia

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Are airways structural abnormalities more frequent in children with recurrent lower respiratory tract infections?

UNLABELLED: We report bronchoscopic changes observed in children with recurrent lower airways infections (RLAI) and findings in control children undergoing bronchoscopy for causes other than RLAI. PATIENTS AND METHODS: Retrospective case-control cohorts study. The clinical records of children who had fiberoptic bronchoscopy (FB) for a history of RLAI without any known underlying disorder between 2007 and 2013 and of control children who required FB for other causes were reviewed. Clinical features, bronchospic findings and bronchoalveolar lavage (BAL) results were assessed. RESULTS: Cases were 62 (32 female) children aged 5 years (1-12) and controls 29 children aged 4.5 years (0.5-14). Airway malacia was observed in 32 (52%) vs. 4 (13%) (p = 0.001), profuse respiratory secretions in 34(55%) vs. 6 (20%) (p = 0.007). Endobronchial obstruction: 4 (6.4%) and tracheobronchomegaly were observed only in cases. In cases with profuse respiratory secretions there was a higher prevalence of airways malacia: 64.7% vs. 35.7% (p = 0.04) and of positive BAL cultures: 45.5% vs. 13.3% (p = 0.04). Isolated organisms in cases were non-typable Haemophilus influenzae and Streptococcus pneumoniae most frequently. Pneumocystiis jirovecii, Staphylococcus aureus, and Streptococcus mitis were isolated in controls. CONCLUSIONS: Half of the children with RLAI had tracheo and/or bronchomalacia, their frequency being in keeping with previous reports and far higher than that observed in controls. It was associated with profuse respiratory secretions and with a higher frequency of positive BAL cultures mostly for non typable H. influenzae and S. pneumoniae which were not isolated in controls.

Hereditary pulmonary alveolar proteinosis. Could it be triggered by Mycoplasma pneumoniae pneumonia?

We present a three-year-old girl with respiratory failure due to hereditary pulmonary alveolar proteinosis caused by abnormal alpha chain of the granulocyte-macrophage colony-stimulating factor receptor. Both the patient and an asymptomatic seven-year-old sister were homozygous for the same mutation in CSF2RA. We speculate that the Mycoplasma pneumoniae pneumonia might have triggered the clinical presentation. While a good response to serial partial lung lavage was noticed, the ultimate outcome is uncertain.

Comorbilidad infecciosa en la EPOC / Infectious comorbidity in COPD

La infección respiratoria es la comorbilidad infecciosa más frecuente y característica de los pacientes conenfermedad pulmonar obstructiva crónica (EPOC). Esta infección respiratoria origina 2 cuadros clínicos. Elprimero y más común se asociaría a una agudización, aunque no todas las agudizaciones son de causa infecciosa;su porcentaje estaría entre el 50 y el 70% de estos procesos. El segundo cuadro clínico corresponderíaa la presencia de una neumonía, ya que, como se sabe, la EPOC es la comorbilidad más frecuenteasociada al desarrollo de una neumonía.De los agentes infecciosos causantes de agudizaciones, el 50-60% de los casos corresponderían a bacterias,que son los microorganismos que más se han estudiado y cuyo papel con las últimas investigaciones cadadía es más notorio. Dentro de las bacterias habría que destacar el hecho que cada vez se están aislando enagudizaciones un número mayor de casos de Pseudomonas aeruginosa y microorganismos más agresivos.Un segundo grupo que causa agudizaciones infecciosas serían los virus, que parece que pueden tener unpapel relevante en estos procesos, aunque menos determinante que el de las bacterias. En muchos casospueden predisponer a una infección bacteriana posterior.La neumonía comunitaria (NAC) es una entidad muy común en pacientes con EPOC y es conocido que entreel 25 y el 50% de los pacientes que ingresan con una NAC tienen una EPOC. Pese a ello, la EPOC no se haconsiderado un factor de riesgo de mala evolución en los pacientes con NAC, como quedó demostrado en elPneumonia Severity Index, en el que la EPOC no estaba entre las comorbilidades asociadas a mortalidad alos 30 días. Aunque recientemente ha habido algunos estudios que sí la asociaban a una mayor mortalidad,este hecho todavía es cuestionable y esta posible mejor evolución podría deberse al empleo de corticoidessistémicos en la gran mayoría de estos cuadros(AU)

Respiratory infection is the most frequent and characteristic infectious comorbidity in patients withchronic obstructive pulmonary disease (COPD) and can lead to two clinical scenarios. The fi rst and mostcommon is exacerbation, although not all exacerbations are caused by infections, which account for 50-70% of these processes. The second scenario is pneumonia, since COPD is the most frequent comorbidityassociated with the development of pneumonia.Of the infectious agents causing exacerbations, 50-60% of cases correspond to bacteria, which are the mostwidely studied microorganisms and whose role is becoming increasingly notorious. Among bacteria, agreater number of Pseudomonas aeruginosa and more aggressive microorganisms are being isolated inexacerbations. A second cause of infectious exacerbations are viruses, which seem to play an importantrole in these processes, although less so than bacteria. Viral infections seem to predispose many patients toa subsequent bacterial infection.Community-acquired pneumonia (CAP) is highly common in patients with COPD and between 25 and 50%of patients hospitalized with this diagnosis have COPD. Nevertheless, COPD has not been considered as arisk factor for poor outcome in patients with CAP and the Pneumonia Severity Index (PSI) showed thatCOPD was not among the comorbidities associated with mortality at 30 days. Although some studies haverecently associated COPD with increased mortality, this association is questionable and the possibleimproved outcome could be due to the use of systemic corticosteroids in most patients with COPD(AU)

Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / No disponible

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Tratamiento antimicrobiano de la enfermedad pulmonar obstructiva crónica en el anciano / Antimicrobial therapy of chronic obstructive pulmonary disease in the elderly

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