Lymphocytopenia as a Predictor of Mortality in Patients with ICU-Acquired Pneumonia

Background: Intensive care unit-acquired pneumonia (ICU-AP) is a severe complication in patients admitted to the ICU. Lymphocytopenia is a marker of poor prognosis in patients with community-acquired pneumonia, but its impact on ICU-AP prognosis is unknown. We aimed to evaluate whether lymphocytopenia is an independent risk factor for mortality in non-immunocompromised patients with ICU-AP. Methods: Prospective observational cohort study of patients from six ICUs of an 800-bed tertiary teaching hospital (2005 to 2016). Results: Of the 473 patients included, 277 (59%) had ventilator-associated pneumonia (VAP). Receiver operating characteristic (ROC) analysis of the lymphocyte counts at diagnosis showed that 595 cells/mm3 was the best cut-off for discriminating two groups of patients at risk: lymphocytopenic group (lymphocyte count <595 cells/mm3, 141 patients (30%)) and non-lymphocytopenic group (lymphocyte count ≥595 cells/mm3, 332 patients (70%)). Patients with lymphocytopenia presented more comorbidities and a higher sequential organ failure assessment (SOFA) score at the moment of pneumonia diagnosis. Also, 28-day mortality and 90-day mortality were higher in patients with lymphocytopenia (28-day: 38 (27%) versus 59 (18%), 90-day: 74 (53%) versus 111 (34%)). In the multivariable model, <595 cells/mm3 resulted to be an independent predictor for 90-day mortality (Hazard Ratio 1.41; 95% Confidence Interval 1.02 to 1.94). Conclusion: Lymphocytopenia is an independent predictor of 90-day mortality in non-immunocompromised patients with ICU-AP.

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Quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) and St. John Sepsis Surveillance Agent to Detect Patients at Risk of Sepsis: An Observational Cohort Study

American Journal of Medical Quality ◽

10.1177/1062860617692034 ◽

2017 ◽

Vol 33 (1) ◽

pp. 50-57 ◽

Cited By ~ 11

Author(s):

Robert C. Amland ◽

Bharat B. Sutariya

Keyword(s):

At Risk ◽

Cohort Study ◽

Organ Failure ◽

Observational Cohort Study ◽

Failure Assessment ◽

Patients At Risk ◽

Observational Cohort

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Positive fluid balance within the first 72 hours in the intensive care unit is associated with higher mortality in adult patients

Research Society and Development ◽

10.33448/rsd-v10i14.22377 ◽

2021 ◽

Vol 10 (14) ◽

pp. e498101422377

Author(s):

Natália Linhares Ponte Aragão ◽

Arnaldo Aires Peixoto Júnior ◽

Carlos Augusto Ramos Feijó ◽

Marina Parente Albuquerque ◽

Francisco Albano de Meneses

Keyword(s):

Fluid Balance ◽

Adult Patients ◽

Independent Factor ◽

Risk Of Death ◽

Icu Stay ◽

Tertiary Teaching ◽

Observational Cohort ◽

Tertiary Teaching Hospital ◽

Optimal Cutoff Point ◽

Relative Risk Of Death

Objective: To identify the association between cumulative fluid balance in the first 72 hours of ICU stay and outcomes. Methodology: retrospective observational cohort with data analysis of adult patients hospitalized in an ICU of a tertiary teaching hospital. Results: a total of 86 patients who remained in the ICU for more than 72 hours were evaluated. The fluid balance in the first 72 hours was higher in the subgroup of patients who died in the ICU (5210.3 ± 2787.7 vs. 3017.4 ± 2847.2 mL, p = 0.004). The fluid balance in the first 72 hours was an independent factor directly associated with death in the ICU (OR: 1,000; p = 0.009). The area under the ROC curve was 0.7119 (95% CI: 0.58-0.84, p = 0.005). The optimal cutoff point for the fluid balance in the first 72 hours as a predictor of death in the ICU was + 3.900mL and the relative risk of death among those who presented a fluid balance higher than this value was 1.702 (95% CI: 1, 15-2.53, p = 0.009). Conclusion: an association was identified between the cumulative value in the fluid balance in the first 72 hours of ICU stay and the highest risk of death, which is an independent factor of the patient's severity at admission.

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Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

The Brazilian Journal of Infectious Diseases ◽

10.1016/s1413-8670(11)70186-6 ◽

2011 ◽

Vol 15 (3) ◽

pp. 262-267

Author(s):

Claudia Figueiredo Mello ◽

Marinella Della Negra

Keyword(s):

Teaching Hospital ◽

Community Acquired Pneumonia ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

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Lung microbiota predict invasive pulmonary aspergillosis and its outcome in immunocompromised patients

Thorax ◽

10.1136/thoraxjnl-2020-216179 ◽

2021 ◽

pp. thoraxjnl-2020-216179

Author(s):

Anaïs Hérivaux ◽

Jesse R Willis ◽

Toine Mercier ◽

Katrien Lagrou ◽

Samuel M Gonçalves ◽

...

Keyword(s):

Fungal Infections ◽

Invasive Pulmonary Aspergillosis ◽

Alpha Diversity ◽

Immunocompromised Patients ◽

Pulmonary Aspergillosis ◽

Cytokines And Chemokines ◽

Lung Microbiome ◽

Patients At Risk ◽

Observational Cohort ◽

Clinical Variation

RationaleRecent studies have revealed that the lung microbiota of critically ill patients is altered and predicts clinical outcomes. The incidence of invasive fungal infections, namely, invasive pulmonary aspergillosis (IPA), in immunocompromised patients is increasing, but the clinical significance of variations in lung bacterial communities is unknown.ObjectivesTo define the contribution of the lung microbiota to the development and course of IPA.Methods and measurementsWe performed an observational cohort study to characterise the lung microbiota in 104 immunocompromised patients using bacterial 16S ribosomal RNA gene sequencing on bronchoalveolar lavage samples sampled on clinical suspicion of infection. Associations between lung dysbiosis in IPA and pulmonary immunity were evaluated by quantifying alveolar cytokines and chemokines and immune cells. The contribution of microbial signatures to patient outcome was assessed by estimating overall survival.Main resultsPatients diagnosed with IPA displayed a decreased alpha diversity, driven by a markedly increased abundance of the Staphylococcus, Escherichia, Paraclostridium and Finegoldia genera and a decreased proportion of the Prevotella and Veillonella genera. The overall composition of the lung microbiome was influenced by the neutrophil counts and associated with differential levels of alveolar cytokines. Importantly, the degree of bacterial diversity at the onset of IPA predicted the survival of infected patients.ConclusionsOur results reveal the lung microbiota as an understudied source of clinical variation in patients at risk of IPA and highlight its potential as a diagnostic and therapeutic target in the context of respiratory fungal diseases.

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Impact of macrolide therapy on mortality of HIV-infected patients with community-acquired pneumonia in a tertiary teaching hospital

Brazilian Journal of Infectious Diseases ◽

10.1590/s1413-86702011000300014 ◽

2011 ◽

Vol 15 (3) ◽

pp. 262-267

Author(s):

Claudia Figueiredo Mello ◽

Marinella Della Negra

Keyword(s):

Teaching Hospital ◽

Community Acquired Pneumonia ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

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Community acquired pneumonia-current scenario among immunocompromised patients in a tertiary care hospital

International Journal of Bioassays ◽

10.21746/ijbio.2016.01.004 ◽

2016 ◽

Vol 5 (01) ◽

pp. 4715

Author(s):

A. V. Sowmya* ◽

G. Jayalakshmi ◽

David Agatha

Keyword(s):

Diabetes Mellitus ◽

Antimicrobial Therapy ◽

Tertiary Care ◽

Community Acquired Pneumonia ◽

Polymicrobial Infection ◽

Resistance Pattern ◽

Care Hospital ◽

Immunocompromised Patients ◽

Drug Resistant ◽

Etiologic Agents

Pneumonia is a common illness accounting for majority of hospitalizations worldwide with significant mortality and morbidity. Antimicrobial therapy, being the main stay of treatment, the choices of antibiotics depends on the nature of the etiologic agents and the host factors. The current study was aimed to identify the bacterial & fungal etiologic agents of Community Acquired Pneumonia (CAP) in Immunocompromised (IC) patients, with their antimicrobial resistant pattern and to analyze the associated immunocompromised states. Various respiratory samples from study group of 75 immunocompromised patients with features of pneumonia were collected, processed and the isolates were identified with their antimicrobial susceptibility& resistance pattern according to CLSI guidelines. The results were analyzed statistically. Diabetes mellitus is the most common immunocompromised state (48%) associated with CAP. Monomicrobial and polymicrobial infection rates were 80.36% and 19.64% respectively. Gram negative pathogens and fungal pathogens were identified in 60% and 25.37% of culture positive cases respectively. Diabetes mellitus is commonly found in association with polymicrobial infection (19.44%) and fungal infection (16.66%). Drug resistant strains comprise about 75% of MRSA strains, 72.72 % of ESBL producers and 3.44% of Amp C producers. As the number of elderly people with associated IC state is on rise, with change in the pattern of microbial etiologic agents causing CAP, a prior knowledge of the host and microbial factors will help in formulating empirical antimicrobial therapy and proper treatment thereby curbing the spread of infections by drug resistant pathogens and the associated morbidity and mortality.

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Factors Impacting CTCA Quality in a Major Tertiary Teaching Hospital

Heart Lung and Circulation ◽

10.1016/j.hlc.2021.06.212 ◽

2021 ◽

Vol 30 ◽

pp. S189

Author(s):

I. Button ◽

J. Bradley ◽

R. Roberts-Thomson ◽

B. Lorraine

Keyword(s):

Teaching Hospital ◽

Tertiary Teaching ◽

Tertiary Teaching Hospital

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Using Technology to Promote Patient Engagement in Nutrition Care: A Feasibility Study

Nutrients ◽

10.3390/nu13020314 ◽

2021 ◽

Vol 13 (2) ◽

pp. 314

Author(s):

Shelley Roberts ◽

Wendy Chaboyer ◽

Zane Hopper ◽

Andrea P. Marshall

Keyword(s):

Patient Satisfaction ◽

Patient Engagement ◽

Early Discharge ◽

Nutritional Risk ◽

Dietary Intakes ◽

Intervention Delivery ◽

Nutrition Care ◽

Tertiary Teaching ◽

Hospital Patients ◽

Tertiary Teaching Hospital

Empowering patients to participate in nutrition care during hospitalisation may improve their dietary intakes and associated outcomes. This study tested the acceptability and feasibility of a technology-based intervention to engage hospital patients in nutrition care at a tertiary teaching hospital in Australia. The hospital used an electronic foodservice system (EFS), by which patients ordered meals via bedside computers. Adults at nutritional risk received the nutrition technology (NUTRI-TEC) intervention, involving nutrition assessment, education on nutrition requirements and training on using the EFS to enter food intakes and monitor nutrition goals. Acceptability was assessed using patient satisfaction and engagement surveys. Feasibility was assessed by evaluating the intervention delivery/fidelity and patient recruitment/retention. Patients’ dietary intakes were observed daily to indicate the intervention’s effects and assess the accuracy of the patient-recorded intakes. Descriptive and inferential statistics were used to analyse the data. Of the 71 patients recruited, 49 completed the study (55% male; median (IQR) age 71 (65–78) years; length of stay 10 (7–14) days). Patient satisfaction with NUTRI-TEC was high. Intervention delivery and fidelity targets were met but recruitment (≥50%) and retention (≥75%) targets were not; only 31% of patients agreed to participate and 69% completed the study (mostly due to unexpected/early discharge). Patient- and researcher-recorded dietary intakes correlated strongly, indicating patients can record food intakes accurately using technology. This study highlights the important role technology is likely to play in facilitating patient engagement and improving care during hospitalisation.

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