Post Discharge Short Term Mortality in Hospitalized Patients with Community Acquired Pneumonia

ABSTRACT BACKGROUND: Individuals with cirrhosis have a chronic systemic inflammation associated with an immune dysfunction, affecting the progression of the liver disease. The neutrophil-lymphocyte ratio (NLR) was proposed as a marker of systemic inflammatory response and survival in patients with cirrhosis. OBJECTIVE: Evaluate the prognostic role of NLR in cirrhotic patients and its relation with inflammatory cytokines(IL-6, IL-10 and IL-17). METHODS: In this prospective study two groups were evaluated: 1) Stable cirrhotic in outpatient follow-up (n=193); 2) Hospitalized cirrhotic for acute decompensation for at least 48 hours (n=334) with admission and 48 hours tests evaluation. Circulating inflammatory cytokines were available for 130 hospitalized patients. RESULTS: In outpatients with stable cirrhosis, NLR correlated with MELD score and other variables associated with severity of disease. However, after a median of 32 months of follow up NLR was not associated with mortality (HR 1.058, 95%CI 0.900-1.243; P=0.495). In hospitalized patients, NLR at 48-hour after admission was independently associated with 90-day survival (HR 1.061, 95%CI 1.020-1.103; P=0.003) in multivariate Cox-regression analysis. The 90-day Kaplan-Meier survival probability was 87% for patients with a 48-hour NLR <3.6 and 62% for NLR ≥3.6 (P<0.001). Elevation of NLR in the first 48 hours was also independently associated with mortality (HR 2.038, 95%CI 1295-3207; P=0.002). The 90-day Kaplan-Meier survival probability was 83% when NLR did not increase and 62% when NLR increased (P<0.001). IL-6, IL-10 and IL-17 at admission were positively correlated with both admission and 48-hour NLR. Lower levels of baseline IL-10 were associated with NLR increase during first 48-hour. CONCLUSION: NLR evaluated at 48 hours of hospitalization and its early increase after admission were independently associated with short-term mortality in patients hospitalized for acute decompensation of cirrhosis.

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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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Glucocorticoids Are Associated With Increased Risk of Short-Term Mortality in Hospitalized Patients With Clostridium difficile-Associated Disease

The American Journal of Gastroenterology ◽

10.1038/ajg.2010.142 ◽

2010 ◽

Vol 105 (9) ◽

pp. 2040-2049 ◽

Cited By ~ 68

Author(s):

Rohit Das ◽

Paul Feuerstadt ◽

Lawrence J Brandt

Keyword(s):

Clostridium Difficile ◽

Hospitalized Patients ◽

Short Term ◽

Increased Risk ◽

Short Term Mortality

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

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2014-132802 ◽

2015 ◽

Vol 91 (1072) ◽

pp. 77-82 ◽

Cited By ~ 5

Author(s):

Marc Andre Pflug ◽

Timothy Tiutan ◽

Thomas Wesemann ◽

Harald Nüllmann ◽

Hans Jürgen Heppner ◽

...

Keyword(s):

External Validation ◽

Community Acquired Pneumonia ◽

Short Term ◽

Short Term Mortality

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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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Development of Imminent Mortality Predictor for Advanced Cancer (IMPAC), a Tool to Predict Short-Term Mortality in Hospitalized Patients With Advanced Cancer

Journal of Oncology Practice ◽

10.1200/jop.2017.023200 ◽

2018 ◽

Vol 14 (3) ◽

pp. e168-e175 ◽

Cited By ~ 6

Author(s):

Kerin Adelson ◽

Donald K.K. Lee ◽

Salimah Velji ◽

Junchao Ma ◽

Susan K. Lipka ◽

...

Keyword(s):

Life Expectancy ◽

End Of Life ◽

Advanced Cancer ◽

Median Survival ◽

End Of Life Care ◽

Hospitalized Patients ◽

Life Care ◽

Short Term ◽

Prognostic Tool ◽

Short Term Mortality

Purpose: End-of-life care for patients with advanced cancer is aggressive and costly. Oncologists inconsistently estimate life expectancy and address goals of care. Currently available prognostication tools are based on subjective clinical assessment. An objective prognostic tool could help oncologists and patients decide on a realistic plan for end-of-life care. We developed a predictive model (Imminent Mortality Predictor in Advanced Cancer [IMPAC]) for short-term mortality in hospitalized patients with advanced cancer. Methods: Electronic health record data from 669 patients with advanced cancer who were discharged from Yale Cancer Center/Smilow Cancer Hospital were extracted. Statistical learning techniques were used to develop a tool to estimate survival probabilities. Patients were randomly split into training (70%) and validation (30%) sets 20 times. We tested the predictive properties of IMPAC for mortality at 30, 60, 90, and 180 days past the day of admission. Results: For mortality within 90 days at a 40% sensitivity level, IMPAC has close to 60% positive predictive value. Patients estimated to have a greater than 50% chance of death within 90 days had a median survival time of 47 days. Patients estimated to have a less than 50% chance of death had a median survival of 290 days. Area under the receiver operating characteristic curve for IMPAC averaged greater than .70 for all time horizons tested. Estimated potential cost savings per patient was $15,413 (95% CI, $9,162 to $21,665) in 2014 constant dollars. Conclusion: IMPAC, a novel prognostic tool, can generate life expectancy probabilities in real time and support oncologists in counseling patients about end-of-life care. Potentially avoidable costs are significant.

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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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