scholarly journals Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Jin-liang Liu ◽  
Feng Xu ◽  
Hui Zhou ◽  
Xue-jie Wu ◽  
Ling-xian Shi ◽  
...  
Keyword(s):  
Severity Score ◽  
Community Acquired Pneumonia ◽  
Score System ◽  
Pneumonia Severity ◽  
Increased Risk ◽  
Severity Scores ◽  
Low Blood Pressure ◽  
Health Care Associated Pneumonia ◽  
Score Systems ◽  
Better Than

Abstract Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia (CAP) patients. A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy. Using age ≥ 65 years, LDH > 230 u/L, albumin < 3.5 g/dL, platelet count < 100 × 109/L, confusion, urea > 7 mmol/L, respiratory rate ≥ 30/min, low blood pressure, we assembled a new severity score named as expanded-CURB-65. The 30-day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of 30-day mortality in the main cohort were 0.826 (95% CI, 0.807–0.844), 0.801 (95% CI, 0.781–0.820), 0.756 (95% CI, 0.735–0.777), 0.793 (95% CI, 0.773–0.813) and 0.759 (95% CI, 0.737–0.779) for the expanded-CURB-65, PSI, CURB-65, SMART-COP and A-DROP, respectively. The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia (HCAP). The expanded CURB-65 is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems.

scholarly journals Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review

2019 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Author(s):  
Nicolò Maria Vanoni ◽  
Manuela Carugati ◽  
Noemi Borsa ◽  
Giovanni Sotgiu ◽  
Laura Saderi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Community Acquired Pneumonia ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Increased Risk ◽  
Severity Scores ◽  
Ventilatory Management

Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles—of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.

scholarly journals Role of Plasma Presepsin, Procalcitonin and C-reactive Protein Levels in Determining the Severity and Mortality of Community-Acquired Pneumonia in the Emergency Department

2020 ◽  
Keyword(s):  
Emergency Department ◽  
Community Acquired Pneumonia ◽  
C Reactive Protein ◽  
Pneumonia Severity ◽  
Protein Levels ◽  
Reactive Protein ◽  
Imaging Results ◽  
Severity Scores ◽  
Significant Difference

Objective: In this study, we aimed to explore the role of the plasma presepsin level in patients with community-acquired pneumonia during admission to the emergency department in assessing the diagnosis, severity, and prognosis of the disease. In addition, we wanted to investigate the relationship of presepsinin with procalcitonin, C-reactive protein and pneumonia severity scores. Methods: One hundred twenty-three patients over the age of 18 who presented with a diagnosis of pneumonia to the emergency department were included in the study. The vital signs, symptoms, examination findings, background information, laboratory results, and radiological imaging results of the patients were recorded. The 30-day mortality rates of the patients were determined. Results: A statistically significant difference was found between the presepsin levels of the patients diagnosed with pneumonia and those of healthy subjects (p < 0.05). The plasma presepsin levels of the patients who died (8.63 ± 6.46) were significantly higher than those of the patients who lived (5.82 ± 5.97) (p < 0.05). The plasma procalcitonin and C-reactive protein levels of the dead patients were significantly higher than those living (p < 0.05). A presepsin cut-off value of 3.3 ng/mL for 30-day mortality was established (AUROC, 0.65; specificity, 45%; sensitivity, 82%). Procalcitonin is the most successful biomarker in the determination of mortality (AUROC, 0.70). A significant correlation was available between presepsin and lactate, C-reactive protein and procalcitonin (p < 0.05). There was a significant correlation between the Pneumonia Severity Index values and presepsin levels (p < 0.001, r = 0.311). Conclusion: The plasma presepsin level can be utilized for diagnosing community-acquired pneumonia. Plasma presepsin, procalcitonin and C-reactive protein levels can be used to predict the severity and mortality of community-acquired pneumonia.

scholarly journals Sequencing Alpha-1 MZ Individuals Shows Frequent Biallelic Mutations

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Kimberly E. Foil ◽  
M. Gwen Blanton ◽  
Chris Sanders ◽  
Joannah Kim ◽  
Haitham S. Al Ashry ◽  
...  
Keyword(s):  
Severity Score ◽  
Small Sample Size ◽  
Genetic Counselor ◽  
Familial Risk ◽  
Small Sample ◽  
Smoking History ◽  
Augmentation Therapy ◽  
Clinical Trial Registration ◽  
Increased Risk ◽  
Severity Scores

Rationale. Individuals with a single Z mutation in the SERPINA1 gene that codes for alpha-1 antitrypsin (AAT) are at increased risk for COPD if they have ever-smoked. Whether additional variants alter the risk for COPD in this population remains unknown. Objectives. To determine whether additional SERPINA1 variants impact COPD development in a previously identified MZ (carrier) cohort. Methods. Individuals with prior MZ results and AAT serum level <16uM were recruited from the Alpha-1 Coded Testing study and Alpha-1 Foundation Research Registry. Participants completed smoking history, demographics, and COPD Severity Score (Range 0-33) using REDCap data capture. At-home finger-stick tests were performed for next generation sequencing (NGS) at the Biocerna LLC laboratory. A genetic counselor reviewed records and interviewed participants with additional variants by NGS. A Wilcoxon Rank Sum test was used to assess correlation between variants and the COPD severity score. Results. A second SERPINA1 variant of known or possible significance was identified in 6 (5.8%) participants. One each of ZZ, SZ, FZ, ZSmunich, ZM2obernburg, and Z/c.922G>T genotypes were identified. ZZ, SZ, and FZ are known pathogenic genotypes. Smunich is a likely pathogenic variant. M2obernburg and c.922G>T are variants of uncertain significance. The ZZ individual was on augmentation therapy when determined MZ by protease inhibitor (Pi) phenotyping; the others had limited targeted genotyping with MZ results. These six participants with biallelic variants had positive COPD severity scores >1. Presence of additional variants was not significantly associated with COPD symptoms in this small sample size. Conclusions. Some diagnosed MZ individuals instead have biallelic variants. Larger studies are needed to determine COPD-risk liability of variants. Accurate diagnosis impacts medical management and familial risk assessment. Pi phenotyping can be confounded by augmentation therapy and liver transplantation. Because a normal M allele may be reported in the absence of tested mutation(s) in AATD genotyping, clinicians should consider clinical circumstances and laboratory methods when selecting and interpreting AATD tests. Advanced testing, including NGS, may be beneficial for select individuals with prior MZ results. Clinical Trial Registration. This study was registered with clinicaltrials.gov (NCT NCT02810327).

scholarly journals Prognostic assessment in community-acquired pneumonia by pneumonia severity scores and biomarkers

Critical Care ◽  
2010 ◽  
Vol 14 (Suppl 1) ◽  
pp. P75
Author(s):  
F Dusemund ◽  
W Albrich ◽  
P Schuetz ◽  
B Müller
Keyword(s):  
Community Acquired Pneumonia ◽  
Pneumonia Severity ◽  
Prognostic Assessment ◽  
Severity Scores

scholarly journals Abdominal Obesity Phenotype Predicts COVID-19 Chest X-Ray Severity Score better than General Obesity

2021 ◽  
Author(s):  
Alexis Elias Malavazos ◽  
Francesco Secchi ◽  
Sara Basilico ◽  
Gloria Capitanio ◽  
Sara Boveri ◽  
...  
Keyword(s):  
Waist Circumference ◽  
Abdominal Obesity ◽  
Risk Ratio ◽  
Severity Score ◽  
Multivariable Analysis ◽  
Hospitalized Patients ◽  
General Obesity ◽  
X Ray ◽  
Severity Scores ◽  
Better Than

Abstract PurposeChest x-ray (CXR) severity score and general obesity are predictive risk factors for COVID-19 hospital admission. However, the relationship between abdominal obesity and CXR severity score has not yet been fully explored.MethodsThis retrospective cohort study analyzed the association of different adiposity indexes, including waist circumference and body mass index (BMI), with CXR severity score in 215 hospitalized patients with COVID-19.ResultsPatients with abdominal obesity had significantly higher CXR severity scores and higher rates of these scores than those without abdominal obesity (P<0.001; P=0.001, respectively). While, there were no significant differences between BMI classes (P=0.104; P=0.271, respectively). Waist circumference and waist-to-height ratio (WHtR) correlated more closely with CXR severity score than BMI (r=0.43, P<0.001; r=0.41, P<0.001; r=0.17, P=0.012, respectively). The area under the curves (AUCs) for waist circumference and WHtR were significantly higher than those for BMI for distinguishing a high CXR severity score (≥8) (0.68 [0.60-0.75] and 0.67 [0.60-0.74] vs 0.58 [0.51-0.66], P=0.001). Multivariable analysis indicated abdominal obesity (risk ratio: 1.75, 95% CI: 1.25-2.45, P<0.001), bronchial asthma (risk ratio: 1.73, 95% CI: 1.07-2.81, P=0.026) and oxygen saturation at admission (risk ratio: 0.96, 95% CI: 0.94-0.97, P<0.001) as the only independent predictors of a high CXR severity score. ConclusionAbdominal obesity might predict a high CXR severity score better than general obesity in hospitalized patients with COVID-19. Therefore, when performing clinical hospital practices, waist circumference should be assessed, and patients with abdominal obesity should be monitored closely when hospitalized.

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