scholarly journals Impact of Lymphocyte and Neutrophil Counts on Mortality Risk in Severe Community-Acquired Pneumonia with or without Septic Shock

2019 ◽  
Vol 8 (5) ◽  
pp. 754 ◽  
Author(s):  
Estel Güell ◽  
Marta Martín-Fernandez ◽  
Mari C. De la Torre ◽  
Elisabet Palomera ◽  
Mateu Serra ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Form ◽  
Community Acquired Pneumonia ◽  
Immunological Failure ◽  
Risk Of Mortality ◽  
Clinical Presentations ◽  
Severe Community Acquired Pneumonia ◽  
Time Of Admission ◽  
Single Blood Sample

Background: Community-acquired pneumonia (CAP) is a frequent cause of death worldwide. As recently described, CAP shows different biological endotypes. Improving characterization of these endotypes is needed to optimize individualized treatment of this disease. The potential value of the leukogram to assist prognosis in severe CAP has not been previously addressed. Methods: A cohort of 710 patients with CAP admitted to the intensive care units (ICUs) at Hospital of Mataró and Parc Taulí Hospital of Sabadell was retrospectively analyzed. Patients were split in those with septic shock (n = 304) and those with no septic shock (n = 406). A single blood sample was drawn from all the patients at the time of admission to the emergency room. ICU mortality was the main outcome. Results: Multivariate analysis demonstrated that lymphopenia <675 cells/mm3 or <501 cells/mm3 translated into 2.32- and 3.76-fold risk of mortality in patients with or without septic shock, respectively. In turn, neutrophil counts were associated with prognosis just in the group of patients with septic shock, where neutrophils <8850 cells/mm3 translated into 3.6-fold risk of mortality. Conclusion: lymphopenia is a preserved risk factor for mortality across the different clinical presentations of severe CAP (sCAP), while failing to expand circulating neutrophils counts beyond the upper limit of normality represents an incremental immunological failure observed just in those patients with the most severe form of CAP, septic shock.

Abstract P134: ASSOCIATION OF HYPERTENSION WITH MORTALITY RISK IN PATIENTS WITH COVID 19 PNEUMONIA IN A HOSPITAL IN MEXICO CITY

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
José Martín Alanís Naranjo ◽  
Gabriela Olguín Contreras ◽  
Cristo Raymundo Ibarra Jaimes
Keyword(s):  
Severe Pneumonia ◽  
Ground Glass Opacity ◽  
Cross Sectional Study ◽  
Community Acquired Pneumonia ◽  
P Value ◽  
Cross Sectional ◽  
Risk Of Mortality ◽  
Chest X Ray ◽  
Time Of Admission ◽  
First Time

Introduction: The world is currently suffering from the outbreak of a pandemic caused by the SARS-CoV-2 coronavirus, which causes the disease called COVID-19. This disease was reported for the first time in Wuhan, Hubei Province, China, on December 31, 2019. Hypertension, diabetes and cardiovascular disease are common among patients with COVID-19. In Mexico, information on the association between COVID-19 and hypertension is scarce. Methods: This investigation was a descriptive, observational and cross-sectional study that included patients over 18 years of age who had been hospitalized with laboratory-confirmed COVID-19 between April 6, 2020, and May 6, 2020, and exhibited chest X-ray abnormalities (ground-glass opacity, interstitial alterations and/or multilobar infiltrate). Severity of pneumonia (severe vs. nonsevere) at the time of admission was defined using the community-acquired pneumonia guidelines of the American Thoracic Society (ATS). Results: Information was collected from 89 patients with COVID-19 pneumonia, 34 of whom (38.2%) were hypertensive. When studying risk factors in hypertensive patients and their degree of statistical association with risk of mortality, only the severity of pneumonia stood out. The association between severe pneumonia and mortality was statistically significant (OR: 10.9, CI 1.19-99.6, p value = 0.034). Conclusions: Severity of pneumonia upon admission can be regarded as a marker of adverse clinical outcome in hypertensive COVID-19 patients. Among hypertensive COVID-19 patients, in-hospital mortality was high (68%); such mortality was higher in our study than has been reported in other series worldwide.

scholarly journals Severe Community-Acquired Pneumonia due to Acinetobacter baumannii in North America: Case Report and Review of the Literature

2018 ◽  
Vol 5 (3) ◽  
Author(s):  
David P Serota ◽  
Mary Elizabeth Sexton ◽  
Colleen S Kraft ◽  
Federico Palacio
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Acute Respiratory Distress Syndrome ◽  
Case Report ◽  
North America ◽  
Acinetobacter Baumannii ◽  
Distress Syndrome ◽  
Community Acquired Pneumonia ◽  
Review Of The Literature ◽  
Severe Community Acquired Pneumonia

Abstract Acinetobacter baumannii is a rare but emerging cause of fulminant community-acquired pneumonia (CAP-AB). We describe a patient from a rural area who developed acute respiratory distress syndrome and septic shock. We describe risk factors and characteristics of this syndrome and review published cases of CAP-AB from North America.

scholarly journals Predictors of Severe Leptospirosis: A Multicentre Observational Study From Central Malaysia

2021 ◽  
Author(s):  
Noraini Philip ◽  
Leslie Thian Lung Than ◽  
Anim Md S ◽  
Muhamad Yazli Yuhana ◽  
Zamberi Sekawi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Severe Form ◽  
Severe Illness ◽  
Clinical Predictors ◽  
Multicenter Observational Study ◽  
Clinical Presentations ◽  
Kidney Involvement ◽  
Severe Leptospirosis ◽  
High Level

Abstract Background: Leptospirosis is a re-emerging disease with vast clinical presentations ranges from subclinical or mild, to severe and fatal outcomes. Though leptospirosis can be managed well if diagnosed earlier, similar clinical presentations by several other febrile illnesses or co-infections often result in mis- or underdiagnosis, thereby lead to severe illness. Identification of clinical predictors for the severe form of the disease plays a crucial role in reducing disease complication and mortality. Therefore, we aimed to determine the clinical predictors associated with severe illness among leptospirosis patients from Central Malaysia through a prospective multicenter observational study. Methods: Data were collected from case records of 83 confirmed leptospirosis patients comprising of 33 severe and 50 mild. Statistical analysis was performed using χ2 and multivariable logistic regression test with Epi info software. Results: We identified mechanical ventilation, AKI, septic shock, creatinine level of >1.13mg/dL, ALT >50IU, AST >50IU, and platelet <150 x 109/L as factors associated with severe illness. AKI, ALT >50IU and platelet <150 x 109/L were defined as the independent factors for severity. Conclusions: Lungs, liver and kidney involvement, and septic shock were found as the prognostic factors for severe leptospirosis. AKI, high level of ALT and low level of platelets were found to be independent predictors of severity.

scholarly journals Response Adjusted for Days of Antibiotic Risk (RADAR): evaluation of a novel method to analyze antibiotic stewardship interventions

2017 ◽  
Author(s):  
Valentijn A. Schweitzer ◽  
Maarten van Smeden ◽  
Douwe F. Postma ◽  
Jan Jelrik Oosterheert ◽  
Marc J.M. Bonten ◽  
...  
Keyword(s):  
Relative Risk ◽  
Clinical Outcome ◽  
Antibiotic Stewardship ◽  
Sample Size Calculation ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Beta Lactam ◽  
Risk Of Mortality ◽  
Novel Method ◽  
Severe Community Acquired Pneumonia

ABSTRACTOBJECTIVESThe Response Adjusted for Days of Antibiotic Risk (RADAR)-statistic was proposed to improve efficiency of antibiotic stewardship trials. We studied the behavior of RADAR in a non-inferiority trial in which a beta-lactam monotherapy strategy (BL, n=656) was non-inferior to fluoroquinolone monotherapy (FQL, n=888) for moderately-severe community-acquired pneumonia (CAP) patients.METHODSPatients were ranked according to clinical outcome, using five or eight categories, and antibiotic use. RADAR was calculated as the probability that the BL group had a more favorable ranking than the FQL group. To investigate the sensitivity of RADAR to detrimental clinical outcome we simulated increasing rates of 90-day mortality in the BL group and performed the RADAR and non-inferiority analysis.RESULTSThe RADAR of the BL-group compared to the FQL group was 60.3% (95% confidence interval 57.9%-62.7%) using five and 58.4% (95% CI 56.0%-60.9%) using eight clinical outcome categories, all in favor of BL. Sample sizes for RADAR were 250 and 580 patients per study arm using five or eight clinical outcome categories, respectively, reflecting 38% and 89% of the original non-inferiority sample size calculation. With simulated mortality rates, loss of non-inferiority of the BL-group occurred at a relative risk of 1.125 in the conventional analysis, whereas using RADAR the BL-group lost superiority at a relative risk of mortality of 1.25 and 1.5, with eight and five clinical outcome categories, respectively.CONCLUSIONSRADAR favored BL over FQL therapy for CAP. Although RADAR required fewer patients than conventional non-inferiority analysis, the statistic was less sensitive to detrimental outcomes.

scholarly journals Lactate as a Predictor in Severe Pneumonia

2015 ◽  
Vol 15 (1) ◽  
pp. 29-34
Author(s):  
Darta Ose ◽  
Arvids Berzins ◽  
Krista Grigorovica ◽  
Andris Klucniks ◽  
Olegs Sabelnikovs
Keyword(s):  
Septic Shock ◽  
Blood Lactate ◽  
Mortality Risk ◽  
Lactate Level ◽  
Prognostic Significance ◽  
Severe Pneumonia ◽  
Serum Lactate ◽  
Community Acquired Pneumonia ◽  
University Hospital ◽  
Severe Community Acquired Pneumonia

Summary Introduction. There are many discussions that one of the mortality risk markers for patients admitted to intensive care unit (ICU) with different etiology shock is admission blood lactate level. It is believed that serum lactate could be used as an early marker of mortality risk determination. We are not aware about research studies regarding admission serum lactate prognostic significance in patients with severe community acquired pneumonia (CAP) in first 24 hours after admission to ICU in Latvia. Aim of the study. 1. To evaluate the prognostic significance of the first lactate level in patients with severe pneumonia. To compare the statistical data of different blood lactate levels (LAC1, LAC2, LAC3, LAC4, LACMAX, LACMIN). 2. To find admission lactate reference level which is attributed to significant increase of mortality. 3. To compare with other markers and scoring systems like: PCT (procalcitonin), CRP (C-reactive protein), CURB-65 (pneumonia severity score), APACHEII (Acute Physiology and Chronic Health Evaluation II). Material and methods. This is a retrospective observational study in which data were collected on all patients admitted to ICUwith pneumonia and sepsis and/or septic shock in two major Hospitals of Republic of Latvia (Eastern Clinical university hospital and Pauls Stradins Clinical university hospital) with primary diagnosis of severe community acquired pneumonia (CAP). We compared the relationship between lactate values that were collected in 24 hour period after admission in ICU and ICU mortality. Results. In this study we analyzed data from consecutive 73 patients with severe CAP and sepsis and/or septic shock and we observed statistically significant difference between the first lactate level (LAC1) in survivors (2.7 [1.9-3.2] (mmol/l) and non-survivors 4.9 [4.3-7.5] (mmol/l); p<0.001).According to data patients with LAC1<3.0 (mmol/l) mortality risk was 0%, patients with LAC1 3.0 - 4.0 (mmol/l) risk was 42.1%, while patients with LAC1>4.0 (mmol/l) mortality risk reached 89.7%. Lactate level measurements in first 24 hours after arrival into the ICU have had high ability to stratify non-survivor patients: LAC1 (0.96), LAC2 (0.98), LAC3 (0.97), LAC4 (0.92), (AUC). Incomparison with other prognostic markers sensitivity and specificity following results were obtained: CRP (0.59), PCT (0.98), APACHE II (0.98), CURB-65 (0.63). Conclusions. Summarizing data on patients with severe pneumonia and sepsis and/or septic shock admission lactate in first 24 hours have significant independent predictive value. In first 24 hours after admission in ICU higher mortality were observed if LAC1 was >3 (mmol/l). Data proves for the patients with severe pneumonia LAC1 is having similar prognostic ability like APACHEII and PCT, and significantly better prognostic ability than CRP and CURB-65.

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