scholarly journals No Harmful Effects of Steroids in Severe Exacerbations of COPD Associated With Influenza

2021 ◽  
Author(s):  
Severin Studer ◽  
Werner Albrich ◽  
Florent Baty ◽  
Frank Rassouli ◽  
Frederike Waldeck ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Respiratory Infections ◽  
Influenza Season ◽  
Influenza Infection ◽  
Standard Of Care ◽  
Icu Admission ◽  
Patient Morbidity ◽  
Acute Exacerbations ◽  
Harmful Effects ◽  
Rehospitalisation Rate

Abstract Background: COPD has large impact on patient morbidity and mortality worldwide. Acute exacerbations (AECOPD) are mostly triggered by respiratory infections including influenza. While corticosteroids are strongly recommended in AECOPD, they are potentially harmful during influenza. We aimed to evaluate if steroid treatment for AECOPD due to influenza may worsen outcomes.Methods: A retrospective analysis of a Swiss nationwide hospitalisation database was conducted identifying all AECOPD hospitalisations between 2012 and 2017. In separate analyses, outcomes concerning length-of-stay (LOS), in-hospital mortality, rehospitalisation rate, admission to intensive care unit (ICU), empyema and aspergillosis were compared between AECOPD during and outside influenza season; AECOPD with and without laboratory confirmed influenza; and AECOPD plus pneumonia with and without laboratory confirmed influenza. Results: Patients hospitalised for AECOPD during influenza season showed shorter LOS and fewer ICU admissions but higher rehospitalisation rates compared to those hospitalised outside influenza season. Patients with confirmed influenza infection had lower in-hospital mortality and rehospitalisation rates but higher risk for ICU admission than those without confirmed influenza. In patients with AECOPD plus pneumonia, there was a higher risk of ICU admission for those with laboratory-confirmed influenza compared to those without.Conclusions: Using different indicators for influenza as the likely cause of AECOPD, we found no consistent evidence of worse outcomes of AECOPD due to influenza. Assuming that most of these patients received corticosteroids, as it is accepted standard of care throughout Switzerland, this study provides important information and supports the current practice of using corticosteroids for AECOPD independent of the influenza status.

scholarly journals Acute exacerbations of idiopathic pulmonary fibrosis: Does clinical stratification or steroid treatment matter?

2019 ◽  
Vol 16 ◽  
pp. 147997311986933 ◽  
Author(s):  
Sandra Cuerpo ◽  
Jorge Moisés ◽  
Fernanda Hernández-González ◽  
Mariana Benegas ◽  
Jose Ramirez ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Hospital Mortality ◽  
Respiratory Infections ◽  
Clinical Status ◽  
Systemic Steroids ◽  
Steroid Dose ◽  
Length Of Treatment ◽  
Acute Exacerbations ◽  
Independent Association

Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) is defined as a sudden acceleration of the disease with the appearance of pulmonary infiltrates superimposed on the characteristic pattern of IPF that leads to a significant decline in lung function. It has high in-hospital mortality rates, despite medical treatment with systematic steroids. We sought to investigate whether there were in-hospital mortality differences according to clinical stratification (AE, suspected AE, or AE of known cause) and/or treatment with systemic steroids. We reviewed the clinical characteristics and outcomes of patients with IPF admitted to our hospital during the years 2003–2014 due to a worsening of their clinical status. We identified 50 IPF patients, 9 with AE (18%), 12 with suspected exacerbation (24%), and 29 with AE of known cause (58%), mostly respiratory infections. In-hospital mortality was similar in the three groups (33% vs. 17% vs. 34%, respectively). Likewise, we did not find differences between them with respect to the use of systemic steroids (length of treatment duration or total dose). Nevertheless, there was an independent association between in-hospital mortality and high average daily steroid dose. We did not observe significant differences in prognosis or use of systemic steroids according to current diagnostic stratification groups in patients hospitalized because of an exacerbation of IPF.

Clinical symptoms cannot predict influenza infection during the 2013 influenza season in Bavaria, Germany

2015 ◽  
Vol 144 (5) ◽  
pp. 1045-1051 ◽  
Author(s):  
H. CAMPE ◽  
S. HEINZINGER ◽  
C. HARTBERGER ◽  
A. SING
Keyword(s):  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Influenza Season ◽  
Influenza Infection ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Case Definition ◽  
Influenza Surveillance ◽  
Case Definitions ◽  
Laboratory Confirmation

SUMMARYFor influenza surveillance and diagnosis typical clinical symptoms are traditionally used to discriminate influenza virus infections from infections by other pathogens. During the 2013 influenza season we performed a multiplex assay for 16 different viruses in 665 swabs from patients with acute respiratory infections (ARIs) to display the variety of different pathogens causing ARI and to test the diagnostic value of both the commonly used case definitions [ARI, and influenza like illness (ILI)] as well as the clinical judgement of physicians, respectively, to achieve a laboratory-confirmed influenza diagnosis. Fourteen different viruses were identified as causing ARI/ILI. Influenza diagnosis based on clinical signs overestimated the number of laboratory-confirmed influenza cases and misclassified cases. Furthermore, ILI case definition and physicians agreed in only 287/651 (44%) cases with laboratory confirmation. Influenza case management has to be supported by laboratory confirmation to allow evidence-based decisions. Epidemiological syndromic surveillance data should be supported by laboratory confirmation for reasonable interpretation.

scholarly journals Incidence and Outcomes of Acute Kidney Injury in Patients Admitted to Hospital With COVID-19: A Retrospective Cohort Study

2021 ◽  
Vol 8 ◽  
pp. 205435812110277
Author(s):  
Tyler Pitre ◽  
Angela (Hong Tian) Dong ◽  
Aaron Jones ◽  
Jessica Kapralik ◽  
Sonya Cui ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Kidney Injury ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Disease Severity ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Kidney Injury ◽  
Icu Admission

Background: The incidence of acute kidney injury (AKI) in patients with COVID-19 and its association with mortality and disease severity is understudied in the Canadian population. Objective: To determine the incidence of AKI in a cohort of patients with COVID-19 admitted to medicine and intensive care unit (ICU) wards, its association with in-hospital mortality, and disease severity. Our aim was to stratify these outcomes by out-of-hospital AKI and in-hospital AKI. Design: Retrospective cohort study from a registry of patients with COVID-19. Setting: Three community and 3 academic hospitals. Patients: A total of 815 patients admitted to hospital with COVID-19 between March 4, 2020, and April 23, 2021. Measurements: Stage of AKI, ICU admission, mechanical ventilation, and in-hospital mortality. Methods: We classified AKI by comparing highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We calculated the unadjusted and adjusted odds ratio for the stage of AKI and the outcomes of ICU admission, mechanical ventilation, and in-hospital mortality. Results: Of the 815 patients registered, 439 (53.9%) developed AKI, 253 (57.6%) presented with AKI, and 186 (42.4%) developed AKI in-hospital. The odds of ICU admission, mechanical ventilation, and death increased as the AKI stage worsened. Stage 3 AKI that occurred during hospitalization increased the odds of death (odds ratio [OR] = 7.87 [4.35, 14.23]). Stage 3 AKI that occurred prior to hospitalization carried an increased odds of death (OR = 5.28 [2.60, 10.73]). Limitations: Observational study with small sample size limits precision of estimates. Lack of nonhospitalized patients with COVID-19 and hospitalized patients without COVID-19 as controls limits causal inferences. Conclusions: Acute kidney injury, whether it occurs prior to or after hospitalization, is associated with a high risk of poor outcomes in patients with COVID-19. Routine assessment of kidney function in patients with COVID-19 may improve risk stratification. Trial registration: The study was not registered on a publicly accessible registry because it did not involve any health care intervention on human participants.

scholarly journals Seasonal Influenza and Low Flu Vaccination Coverage as Important Factors Modifying the Costs and Availability of Hospital Services in Poland: A Retrospective Comparative Study

2021 ◽  
Vol 18 (10) ◽  
pp. 5173
Author(s):  
Robert Susło ◽  
Piotr Pobrotyn ◽  
Lidia Brydak ◽  
Łukasz Rypicz ◽  
Urszula Grata-Borkowska ◽  
...  
Keyword(s):  
Influenza Season ◽  
Influenza Infection ◽  
Hospital Staff ◽  
University Hospital ◽  
Control Group ◽  
Admission Rates ◽  
Risk Of Death ◽  
The Mean ◽  
Retrospective Comparative Study ◽  
The Cost

Introduction: Influenza infection is associated with potential serious complications, increased hospitalization rates, and a higher risk of death. Materials and Methods: A retrospective comparative analysis of selected indicators of hospitalization from the University Hospital in Wroclaw, Poland, was carried out on patients with confirmed influenza infection in comparison to a control group randomly selected from among all other patients hospitalized on the respective wards during the 2018–2019 influenza season. Results: The mean laboratory testing costs for the entire hospital were 3.74-fold higher and the mean imaging test costs were 4.02-fold higher for patients with confirmed influenza than for the control group; the hospital expenses were additionally raised by the cost of antiviral therapy, which is striking when compared against the cost of a single flu vaccine. During the 2018–2019 influenza season, influenza infections among the hospital patients temporarily limited the healthcare service availability in the institution, which resulted in reduced admission rates to the departments related to internal medicine; the mean absence among the hospital staff totaled approximately 7 h per employee, despite 7.3% of the staff having been vaccinated against influenza at the hospital’s expense. Conclusions: There were significant differences in the hospitalization indicators between the patients with confirmed influenza and the control group, which markedly increased the hospital care costs in this multi-specialty university hospital.

Does Infection Site Matter? A Systematic Review of Infection Site Mortality in Sepsis

2016 ◽  
Vol 32 (8) ◽  
pp. 473-479 ◽  
Author(s):  
Christine A. Motzkus ◽  
Roger Luckmann
Keyword(s):  
Hospital Mortality ◽  
Respiratory Infections ◽  
Source Control ◽  
Soft Tissue Infections ◽  
Infection Site ◽  
Treatment Protocols ◽  
Disease States ◽  
Pubmed Database ◽  
The Impact ◽  
Lower Mortality Risk

Purpose: Sepsis treatment protocols emphasize source control with empiric antibiotics and fluid resuscitation. Previous reviews have examined the impact of infection site and specific pathogens on mortality from sepsis; however, no recent review has addressed the infection site. This review focuses on the impact of infection site on hospital mortality among patients with sepsis. Methods: The PubMed database was searched for articles from 2001 to 2014. Studies were eligible if they included (1) one or more statistical models with hospital mortality as the outcome and considered infection site for inclusion in the model and (2) adult patients with sepsis, severe sepsis, or septic shock. Data abstracted included stage of sepsis, infection site, and raw and adjusted effect estimates. Nineteen studies were included. Infection sites most studied included respiratory (n = 19), abdominal (n = 19), genitourinary (n = 18), and skin and soft tissue infections (n = 11). Several studies found a statistically significant lower mortality risk for genitourinary infections on hospital mortality when compared to respiratory infections. Conclusion: Based on studies included in this review, the impact of infection site in patients with sepsis on hospital mortality could not be reliably estimated. Misclassification among infections and disease states remains a serious possibility in studies on this topic.

scholarly journals Respiratory events in ward are associated with later intensive care unit (ICU) admission and hospital mortality in onco-hematology patients not admitted to ICU after a first request

PLoS ONE ◽  
2017 ◽  
Vol 12 (7) ◽  
pp. e0181808 ◽  
Author(s):  
Laure Doukhan ◽  
Magali Bisbal ◽  
Laurent Chow-Chine ◽  
Antoine Sannini ◽  
Jean Paul Brun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Icu Admission ◽  
Respiratory Events

scholarly journals Reduced generation of lung tissue–resident memory T cells during infancy

2017 ◽  
Vol 214 (10) ◽  
pp. 2915-2932 ◽  
Author(s):  
Kyra D. Zens ◽  
Jun Kui Chen ◽  
Rebecca S. Guyer ◽  
Felix L. Wu ◽  
Filip Cvetkovski ◽  
...  
Keyword(s):  
T Cells ◽  
Memory T Cells ◽  
Respiratory Infections ◽  
Influenza Infection ◽  
Life Stage ◽  
Human Infant ◽  
Respiratory Pathogens ◽  
Infant Mouse ◽  
Adult Mice ◽  
Resident Memory T Cells

Infants suffer disproportionately from respiratory infections and generate reduced vaccine responses compared with adults, although the underlying mechanisms remain unclear. In adult mice, lung-localized, tissue-resident memory T cells (TRMs) mediate optimal protection to respiratory pathogens, and we hypothesized that reduced protection in infancy could be due to impaired establishment of lung TRM. Using an infant mouse model, we demonstrate generation of lung-homing, virus-specific T effectors after influenza infection or live-attenuated vaccination, similar to adults. However, infection during infancy generated markedly fewer lung TRMs, and heterosubtypic protection was reduced compared with adults. Impaired TRM establishment was infant–T cell intrinsic, and infant effectors displayed distinct transcriptional profiles enriched for T-bet–regulated genes. Notably, mouse and human infant T cells exhibited increased T-bet expression after activation, and reduction of T-bet levels in infant mice enhanced lung TRM establishment. Our findings reveal that infant T cells are intrinsically programmed for short-term responses, and targeting key regulators could promote long-term, tissue-targeted protection at this critical life stage.

scholarly journals A 2018/2019. évi légúti szezonban influenzaszerű betegséggel kórházban ellátott felnőtt betegek klinikai és mikrobiológiai jellemzése

2020 ◽  
Vol 161 (52) ◽  
pp. 2179-2187
Author(s):  
Boglárka Laky ◽  
Bálint Gergely Szabó
Keyword(s):  
Influenza A ◽  
Primary Outcome ◽  
Influenza Season ◽  
Respiratory Viruses ◽  
Complication Rates ◽  
Icu Admission ◽  
B Virus ◽  
All Cause Mortality ◽  
Significant Burden ◽  
Observational Cohort

Összefoglaló. Bevezetés, célkitűzés: Az influenzaszezonban fellépő, elsősorban virális megbetegedések jelentős morbiditási és mortalitási teherrel rendelkeznek. Célunk volt az influenzaszerű betegséggel (ILI) és akut légúti betegséggel (ARI) kórházba felvett felnőtt betegek mikrobiológiai és klinikai karakterisztikájának leírása. Módszerek: Egycentrumos, obszervációs kohorszvizsgálatunk során a 2018/2019. évi légúti szezonban a Dél-pesti Centrumkórház – Országos Hematológiai és Infektológiai Intézet Infektológiai Osztályára ILI/ARI diagnózissal felvett betegek eseteit dolgoztuk fel a kórház elektronikus adatbázisának segítségével. Bevonásra azon betegek kerültek, akiknél légúti PCR-vizsgálat történt. A bevont betegeket alcsoportokra osztottuk: klinikai ILI/ARI, PCR-pozitív ILI/ARI influezavírussal, PCR-pozitív ILI/ARI más vírussal. Elsődleges kimenetelnek a komplikált betegséglefolyást, másodlagos kimenetelnek a kórházi összhalálozást, az intenzív osztályos (ICU-) felvételt, az osztályos ápolás hosszát (LOS) és az ICU LOS-t választottuk. Statisztikai összehasonlításra a Mann–Whitney-féle U-próbát, a Fisher-féle egzakt tesztet használtuk. Eredmények: A bevont 112 eset 42,8%-ában igazolódott influenza A- vagy B-vírus, 7,1%-ban egyéb légúti vírus, második leggyakrabban az RSV etiológiai szerepe. Megelőző kórházi ellátás szignifikánsan gyakrabban fordult elő PCR-pozitív ILI/ARI esetekben (23,2% vs. 42,8%; p = 0,04); ugyanezen betegek körében a panaszok kezdetétől a diagnózisig eltelt idő kb. 1 nappal rövidebb volt (3,0 ± 4,0 vs. 4,0 ± 5,0 nap; p = 0,02). A komplikációk gyakoriságát hasonló nagyságúnak találtuk (46,4% vs. 51,8%; p = 0,72), a leggyakoribb szövődmény a tüdőgyulladás volt (45,5%). ICU-felvételre az esetek 5,4%-ában volt szükség, a kórházi összhalálozás 3,6%-nak adódott. A medián LOS 8,5 ± 8,0 nap, a medián ICU LOS ideje 20,5 ± 30,5 nap volt. Következtetés: A vizsgált légúti szezonban ILI/ARI diagnózissal felvett betegek jelentős részében influenza-, kisebb hányadban egyéb légúti vírusok voltak felelősek a klinikumért. A leggyakoribb szövődmény a pneumonia volt. A légúti PCR-vizsgálat lehetőséget nyújthat az etiológia tisztázására. Orv Hetil. 2020; 161(52): 2179–2187. Summary. Introduction, objectives: A significant burden of morbidity and mortality is caused by seasonal outbreaks of respiratory viruses. Our aim was to identify clinical and microbiological differences among adult patients hospitalized with acute respiratory infection (ARI) or influenza-like illness (ILI). Methods: A single-center observational cohort study was conducted at South Pest Central Hospital, National Institute of Hematology and Infectious Diseases during the 2018/2019 influenza season. Patients were identified using the hospital database, and included in the study if respiratory PCR sampling was done during hospital stay. Subgroups were created according to the identified etiology: clinical ILI/ARI (no PCR positivity), PCR positive ILI/ARI with influenza, PCR positive ILI/ARI with other virus(es). Primary outcome was the occurrence of any complication, secondary outcomes were in-hospital all-cause mortality, intensive care unit (ICU) admission, length of stay (LOS) and ICU LOS. For statistical analysis, Mann–Whitney and Fisher’s tests were used. Results: From 112 identified cases, 42.8% were caused by influenza A or B, 7.1% by other viruses, notably RSV. PCR positivity frequently associated with prior hospitalization (23.2% vs. 42.8%; p = 0.04), and shorter time from symptom onset to diagnosis (3.0 ± 4.0 vs. 4.0 ±5.0 days, p = 0.02). Complication rates were similar among subgroups (46.4% vs. 51.8%; p = 0.72), with pneumonia as a leading complication (45.5%). ICU admission was necessary in 5.4%, in-hospital all-cause mortality was 3.6%. Median LOS and ICU LOS were 8.5 ± 8.0 and 20.5 ± 30.5 days, respectively. Conclusion: During the 2018/2019 season, most ILI/ARI cases were caused by influenza, but other respiratory viruses could also be detected in lower rates. Pneumonia was the most common complication. Respiratory PCR sampling might provide a feasible way of etiology identification. Orv Hetil. 2020; 161(52): 2179–2187.

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