Short-term mortality of adult inpatients with community-acquired pneumonia: external validation of a modified CURB-65 score

Abstract Aims and objectives Acute-on-chronic hepatitis B liver failure (ACHBLF) is a critical clinical syndrome with a high short-term mortality evolved from chronic hepatitis B (CHB)-related liver disease. Prediction of mortality risk and early intervention can improve the prognosis of patients. This study aimed to develop and validate the nomogram for short-time mortality estimation in ACHBLF patients defined according to Asian Pacific Association for the Study of the Liver (APASL). Methods A study of 105 ACHBLF patients with 90-day follow up was performed to develop the nomogram. Patients were randomly assigned to derivation cohort (n = 75) and validation cohort (n = 35) according to 7:3. Concordance index (C-index), calibration curve and decision curve analysis (DCA) were used to evaluate the nomogram. We also compared the nomogram with APASL ACLF research consortium (AARC) score, model for end-stage liver disease (MELD) score, MELD with serum sodium (MELD-Na) score and albumin-bilirubin (ALBI) score. The nomogram was validated using an external cohort including 40 patients. Results The 28-day and 90-day mortality of 105 patients were respectively 49.52% and 55.24%. Albumin (ALB), international normalized ratio (INR) and estimated glomerular filtration rate (eGFR) were independent predictors for 28-day mortality; INR and eGFR were independent predictors for 90-day mortality. C-index of Nomogram-1 for 28-day mortality and Nomogram-2 for 90-day mortality were respectively 0.82 and 0.81. Calibration curve and Hosmer–Lemeshow test (Nomogram-1, 0.323; Nomogram-2, 0.231) showed optimal agreement between observed and predicted death. Areas under receiver operator characteristic curve(AUROC) of Nomogram-1(0.772) and Nomogram-2(0.771) were larger compared with AARC, MELD, MELD-Na and ALBI score. The results were well estimated in the external validation cohort. Conclusions This study highlighted the predictive value of eGFR, and the nomogram based on INR and eGFR could effectively estimate individualized risk for short-term mortality of ACHBLF patients defined according to APASL.

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Are pre-existing markers of chronic kidney disease associated with short-term mortality following acute community-acquired pneumonia and sepsis? A cohort study among older people with diabetes using electronic health records

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfu401 ◽

2015 ◽

Vol 30 (6) ◽

pp. 1002-1009 ◽

Cited By ~ 12

Author(s):

H. I. McDonald ◽

D. Nitsch ◽

E. R. C. Millett ◽

A. Sinclair ◽

S. L. Thomas

Keyword(s):

Chronic Kidney Disease ◽

Cohort Study ◽

Kidney Disease ◽

Electronic Health Records ◽

Older People ◽

Community Acquired Pneumonia ◽

Short Term ◽

Health Records ◽

Short Term Mortality ◽

Electronic Health

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Cardiovascular Events after Community-Acquired Pneumonia: A Global Perspective with Systematic Review and Meta-Analysis of Observational Studies

Journal of Clinical Medicine ◽

10.3390/jcm9020414 ◽

2020 ◽

Vol 9 (2) ◽

pp. 414 ◽

Cited By ~ 9

Author(s):

António Tralhão ◽

Pedro Póvoa

Keyword(s):

Heart Failure ◽

Acute Coronary Syndromes ◽

Cardiovascular Events ◽

Observational Studies ◽

Meta Analysis ◽

Community Acquired Pneumonia ◽

Cardiac Complications ◽

Short Term ◽

Short Term Mortality ◽

Coronary Syndromes

Acute cardiovascular disease after community-acquired pneumonia is a well-accepted complication for which definitive treatment strategies are lacking. These complications share some common features but have distinct diagnostic and treatment approaches. We therefore undertook an updated systematic review and meta-analysis of observational studies reporting the incidence of overall complications, acute coronary syndromes, new or worsening heart failure, new or worsening arrhythmias and acute stroke, as well as short-term mortality outcomes. To set a framework for future research, we further included a holistic review of the interplay between the two conditions. From 1984 to 2019, thirty-nine studies were accrued, involving 92,188 patients, divided by setting (inpatients versus outpatients) and clinical severity (low risk versus high risk). Overall cardiac complications occurred in 13.9% (95% confidence interval (CI) 9.6–18.9), acute coronary syndromes in 4.5% (95% CI 2.9–6.5), heart failure in 9.2% (95% CI 6.7–12.2), arrhythmias in 7.2% (95% CI 5.6–9.0) and stroke in 0.71% (95% CI 0.1–3.9) of pooled inpatients. During this period, meta-regression analysis suggests that the incidence of overall and individual cardiac complications is decreasing. After adjusting for confounders, cardiovascular events taking place after community-acquired pneumonia independently increase the risk for short-term mortality (range of odds-ratio: 1.39–5.49). These findings highlight the need for effective, large trial based, preventive and therapeutic interventions in this important patient population.

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Can C-reactive protein-to-albumin ratio be a predictor of short-term mortality in community-acquired pneumonia?

The Annals of Clinical and Analytical Medicine ◽

10.4328/acam.20576 ◽

2021 ◽

Vol 12 (09) ◽

Keyword(s):

Community Acquired Pneumonia ◽

C Reactive Protein ◽

Short Term ◽

Albumin Ratio ◽

Reactive Protein ◽

Short Term Mortality

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Biomarkers for predicting short-term mortality in community-acquired pneumonia: A systematic review and meta-analysis

Journal of Infection ◽

10.1016/j.jinf.2016.01.002 ◽

2016 ◽

Vol 72 (3) ◽

pp. 273-282 ◽

Cited By ~ 34

Author(s):

Diego Viasus ◽

Gaspar Del Rio-Pertuz ◽

Antonella F. Simonetti ◽

Carolina Garcia-Vidal ◽

Jorge Acosta-Reyes ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Community Acquired Pneumonia ◽

Short Term ◽

Short Term Mortality

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Viral infection in community-acquired pneumonia: a systematic review and meta-analysis

European Respiratory Review ◽

10.1183/16000617.0076-2015 ◽

2016 ◽

Vol 25 (140) ◽

pp. 178-188 ◽

Cited By ~ 57

Author(s):

Michael Burk ◽

Karim El-Kersh ◽

Mohamed Saad ◽

Timothy Wiemken ◽

Julio Ramirez ◽

...

Keyword(s):

Systematic Review ◽

Viral Infection ◽

Primary Outcome ◽

Meta Analysis ◽

Community Acquired Pneumonia ◽

Secondary Outcome ◽

Test Results ◽

Short Term ◽

Short Term Mortality ◽

Oropharyngeal Swab

The advent of PCR has improved the identification of viruses in patients with community-acquired pneumonia (CAP). Several studies have used PCR to establish the importance of viruses in the aetiology of CAP.We performed a systematic review and meta-analysis of the studies that reported the proportion of viral infection detected via PCR in patients with CAP. We excluded studies with paediatric populations. The primary outcome was the proportion of patients with viral infection. The secondary outcome was short-term mortality.Our review included 31 studies. Most obtained PCR via nasopharyngeal or oropharyngeal swab. The pooled proportion of patients with viral infection was 24.5% (95% CI 21.5–27.5%). In studies that obtained lower respiratory samples in >50% of patients, the proportion was 44.2% (95% CI 35.1–53.3%). The odds of death were higher in patients with dual bacterial and viral infection (OR 2.1, 95% CI 1.32–3.31).Viral infection is present in a high proportion of patients with CAP. The true proportion of viral infection is probably underestimated because of negative test results from nasopharyngeal or oropharyngeal swab PCR. There is increased mortality in patients with dual bacterial and viral infection.

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