scholarly journals Repeated Pneumonia Severity Index Measurement After Admission Increases its Predictive Value for Mortality in Severe Community-acquired Pneumonia

2009 ◽  
Vol 108 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Chiung-Zuei Chen ◽  
Po-Sheng Fan ◽  
Chien-Chung Lin ◽  
Cheng-Hung Lee ◽  
Tzuen-Ren Hsiue
Keyword(s):  
Predictive Value ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Index Measurement ◽  
Severe Community Acquired Pneumonia

Soluble form of suppression of tumorigenicity-2 predicts clinical stability of inpatients with community-acquired pneumonia

2021 ◽  
pp. 153537022110271
Author(s):  
Yifeng Zeng ◽  
Mingshan Xue ◽  
Teng Zhang ◽  
Shixue Sun ◽  
Runpei Lin ◽  
...  
Keyword(s):  
Regression Model ◽  
Predictive Value ◽  
Cox Regression ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Risk Classification ◽  
Soluble Form ◽  
Pneumonia Severity ◽  
Clinical Stability

The soluble form of the suppression of tumorigenicity-2 (sST2) is a biomarker for risk classification and prognosis of heart failure, and its production and secretion in the alveolar epithelium are significantly correlated with the inflammation-inducing in pulmonary diseases. However, the predictive value of sST2 in pulmonary disease had not been widely studied. This study investigated the potential value in prognosis and risk classification of sST2 in patients with community-acquired pneumonia. Clinical data of ninety-three CAP inpatients were retrieved and their sST2 and other clinical indices were studied. Cox regression models were constructed to probe the sST2’s predictive value for patients’ restoring clinical stability and its additive effect on pneumonia severity index and CURB-65 scores. Patients who did not reach clinical stability within the defined time (30 days from hospitalization) have had significantly higher levels of sST2 at admission ( P <  0.05). In univariate and multivariate Cox regression analysis, a high sST2 level (≥72.8 ng/mL) was an independent reverse predictor of clinical stability ( P < 0.05). The Cox regression model combined with sST2 and CURB-65 (AUC: 0.96) provided a more accurate risk classification than CURB-65 (AUC:0.89) alone (NRI: 1.18, IDI: 0.16, P < 0.05). The Cox regression model combined with sST2 and pneumonia severity index (AUC: 0.96) also provided a more accurate risk classification than pneumonia severity index (AUC:0.93) alone (NRI: 0.06; IDI: 0.06, P < 0.05). sST2 at admission can be used as an independent early prognostic indicator for CAP patients. Moreover, it can improve the predictive power of CURB-65 and pneumonia severity index score.

scholarly journals Azithromycin combination therapy for community-acquired pneumonia: propensity score analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Akihiro Ito ◽  
Tadashi Ishida ◽  
Hiromasa Tachibana ◽  
Hironobu Tokumasu ◽  
Akio Yamazaki ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Propensity Score Analysis ◽  
Pneumonia Severity Index ◽  
Severe Pneumonia ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Combination Group ◽  
Pneumonia Severity ◽  
Score Analysis ◽  
Severe Community Acquired Pneumonia

AbstractWhether macrolide combination therapy reduces the mortality of patients with severe community-acquired pneumonia (CAP) hospitalized in the non-intensive care unit (ICU) remains unclear. Therefore, we investigated the efficacy of adding azithromycin to β-lactam antibiotics for such patients. This prospective cohort study enrolled consecutive patients with CAP hospitalized in the non-ICU between October 2010 and November 2016. The 30-day mortality between β-lactam and azithromycin combination therapy and β-lactam monotherapy was compared in patients classified as mild to moderate and severe according to the CURB-65, Pneumonia Severity Index (PSI), and Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) criteria. Inverse probability of treatment weighting (IPTW) analysis was used to reduce biases. Based on the CURB-65 and PSI, combination therapy did not significantly reduce the 30-day mortality in either group (179 patients in the combination group, 952 in the monotherapy group). However, based on the IDSA/ATS criteria, combination therapy significantly reduced the 30-day mortality in patients with severe (odds ratio [OR] 0.12, 95% confidence interval [CI] 0.007–0.57), but not non-severe pneumonia (OR 1.85, 95% CI 0.51–5.40); these results were similar after IPTW analysis. Azithromycin combination therapy significantly reduced the mortality of patients with severe CAP who met the IDSA/ATS criteria.

scholarly journals Impact of Blood Cultures on the Changes of Treatment in Hospitalized Patients with Community-Acquired Pneumonia

2013 ◽  
Vol 7 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Genta Ishikawa ◽  
Naoki Nishimura ◽  
Atsushi Kitamura ◽  
Yasuhiko Yamano ◽  
Yutaka Tomishima ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Blood Cultures ◽  
Contributing Factors ◽  
Pneumonia Severity ◽  
Alternative Diagnosis ◽  
Severe Community Acquired Pneumonia ◽  
Initial Blood

Background: Initial blood cultures (BCs) with severe community-acquired pneumonia (CAP) are warranted. However, other than severity, the specific contributing factors that affect the decision to change antimicrobial agents have not been evaluated previously. Methods: Consecutive adults with CAP hospitalized between January 2008 and December 2010 were assessed retrospectively. We enrolled those who were over 18 years old with typical symptoms of pneumonia and with an infiltrate consistent with pneumonia, from which 2 sets of BCs were obtained. Those who had been immunocompromised, hospitalized, or prescribed antibiotics in the past 30 days were excluded. We retrospectively assessed the factors contributing to the change in antimicrobial agents as well as the frequency of these changes in the enrolled patients based on the initial BC results. Results: In total, 793 patients with initial diagnosis of CAP were admitted; 399 met the inclusion criteria. Among them, 386 were made definitive diagnosis of CAP after admission (the remaining 13 were made alternative diagnosis [non-pneumonia illnesses]). BC results were positive in 17 (4.4%) out of 386 CAP patients, among whom antimicrobial therapy was changed based on the BC results in 8 (2.1%) (Pneumonia Severity Index [PSI] grade IV; 2, PSI grade V; 6). Alternative diagnosis after admission was contributing factors for changing antimicrobial agents based on the positive blood culture results. Conclusions: The use of BCs should be limited to patients with very severe cases. It would be helpful to find alternative diagnosis and modify treatment.

scholarly journals Characterizing and Developing Strategies for the Treatment of Community-Acquired Pneumonia at a Community Hospital

2002 ◽  
Vol 9 (4) ◽  
pp. 247-252 ◽  
Author(s):  
Mark C Fok ◽  
Zahra Kanji ◽  
Rajesh Mainra ◽  
Michael Boldt
Keyword(s):  
Peer Group ◽  
Pneumonia Severity Index ◽  
Retrospective Chart Review ◽  
Severity Index ◽  
Early Discharge ◽  
Primary Diagnosis ◽  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Pneumonia Severity Index Score ◽  
Step Down

BACKGROUND: Patients admitted to Lions Gate Hospital, North Vancouver, British Columbia, with a primary diagnosis of community-acquired pneumonia (CAP) have a mean length of stay (LOS) of 9.1 days compared with 7.9 days for peer group hospitals. This difference of 1.2 days results in an annual potential savings of 406 bed days and warranted an investigation into the management of CAP.OBJECTIVE: To characterize and provide recommendations for the management of CAP.METHODS: A retrospective chart review of patients admitted with a primary diagnosis of CAP between May 1, 2000 and August 31, 2000.RESULTS: Fifty-one patients were included in the study, with a mean LOS of 9.9 days and a median LOS of five days. Based on pneumonia severity index scores calculated for each patient, eight patients (16%) were admitted inappropriately. Initial empirical antibiotic choices were consistent with the Canadian CAP guidelines in 27 patients (53%), with inconsistencies arising mainly because cephalosporin or azithromycin monotherapy regimens were prescribed. Step-down from intravenous to oral antibiotics occurred in approximately 20 patients (39%). An additional 12 patients (24%) could have undergone step-down, and step-down was not applicable in 19 patients (37%). The potential annual cost avoidance from implementing admission criteria based on a pneumonia severity index score, applying step-down criteria and promoting early discharge criteria was estimated to be $220,000.CONCLUSIONS: Considerable variability exists in the treatment of CAP. A CAP preprinted order sheet was developed to address the issues identified in the present study and provide consistency in the management of CAP at Lions Gate Hospital.

CURB-65 PNEUMONIA SEVERITY INDEX AND APACHE II SCORES TO ASSESS MORTALITY RISK IN COMMUNITY-ACQUIRED PNEUMONIA PATIENTS FROM PROWESS

CHEST Journal ◽  
2007 ◽  
Vol 132 (4) ◽  
pp. 559A ◽  
Author(s):  
Guy Richards ◽  
Howard Levy ◽  
Pierre-Francois Laterre ◽  
Charles Feldman ◽  
Becky M. Bates ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Pneumonia Severity Index ◽  
Severity Index ◽  
Community Acquired Pneumonia ◽  
Apache Ii ◽  
Pneumonia Severity
Sign in / Sign up

Export Citation Format

Share Document