Factors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study

Espinoza, Rodolfo; Silva, José Roberto Lapa e; Bergmann, Anke; Melo, Ulisses de Oliveira; Calil, Flávio Elias; Santos, Robson Correa; Salluh, Jorge I.

doi:10.1016/j.jcrc.2018.11.024

Cited by 35 publications

(36 citation statements)

References 29 publications

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“…Other studies, mostly involving general populations of critically ill patients, demonstrated that poor performance status and high acute severity are the main drivers of medium to late higher morbidity and mortality [46,47]. Late diagnosis of clinical severity, expressed as longer length of time between hospital and ICU admission, was also associated with poor outcome [23,48]. This variable is even present within some ICU prognostic scores, such as the SAPS 2 and 3 [18,49].…”

Section: Discussionmentioning

confidence: 99%

Short‐ and medium‐term prognosis of HIV‐infected patients receiving intensive care: a Brazilian multicentre prospective cohort study

et al. 2020

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The characteristics of critically ill HIV-positive patients and the causes of their admission to intensive care units (ICUs) are only known through retrospective and unicentric studies. This study aims to fill this knowledge gap. Methods This is a prospective, multicentre cohort study of short-and medium-term prognostic factors. The setting consisted of ICUs of three tertiary referral hospitals from the three largest metropolitan areas in Brazil in the period January 2014 to November 2015. In all, 161 HIV patients over 18 years old were included. Results The clinical data of the outcomes (ICU mortality, hospital mortality and 90-day survival) were extracted from medical records using the REDCap â️ web-based form and analysed with the MedCalc â️ application. Median age was 41.7 [interquartile range (IQR): 34-50] years, the Simplified Acute Physiologic Score 3 (SAPS 3) was 64 (IQR: 56-74), and the Sequential Organ Failure Assessment Score (SOFA) was 6 (IQR: 4-9) points. The main causes of admission were sepsis (54.5%) and acute respiratory failure (13.7%). ICU and hospital mortality rates were 32.3% and 40.4%, respectively. In a multivariate analysis, time until ICU admission ≥ 3 days (P = 0.0013), performance status (Eastern Cooperative Oncology Group score, P = 0.0344), coma (Glasgow Coma Scale ≤ 8 points, P = 0.0213) and sepsis (P = 0.0003) were associated with increased hospital mortality. Coma (P = 0.0002) and sepsis (P = 0.0008) were independently associated with 90-day survival. Conclusions Delayed ICU admission and the severity of critical illness determine the short-and medium-term mortality rates of HIV-infected patients admitted to the ICU, rather than factors associated with HIV infection. These results suggest that prognostic factors of HIV-infected patients in the ICU are similar to those of non-HIV-infected populations.

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Section: Discussionmentioning

confidence: 99%

Short‐ and medium‐term prognosis of HIV‐infected patients receiving intensive care: a Brazilian multicentre prospective cohort study

et al. 2020

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“…Patients with severe community acquired pneumonia (SCAP) are usually complicated with hypoxemia, acute kidney injury (AKI), sepsis and required intensive care unit (ICU) care [1,2]. Although the broadspectrum antibiotic and advanced oxygen support are used commonly in the therapeutic regimen, the death in SCAP patients remains as high as 36% [3].…”

Section: Introductionmentioning

confidence: 99%

Lung Microbiota is Associated with Bacterial Detection and with Clinical Improvements in Severe Community-Acquired Pneumonia Patients

Wang

et al. 2020

Preprint

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Abstract Background: Few studies have described the key features of the lung microbiota in patients with severe community-acquired pneumonia (SCAP). We conducted the study to identify the association between the lung microbiota on admission and the clinical prognosis in SCAP patients. Methods: The consecutive SCAP patients admitted from intensive care unit (ICU) were enrolled prospectively. 16S rRNA gene sequencing was applied to bronchoalveolar lavage fluid (BALF) collected within 48 hours. The clinical information was recorded during the stay of hospitalization. The primary endpoint was the rate of clinical improvements defined as a decrease of 2 categories and above on a 7-category ordinal scale within 14 days following bronchoscopy.Results: Sixty-seven patients were included. Multivariable Permutational multivariate analysis of variance (PERMANOVA) found that bacterial detection had the strongest independent relationship with the lung microbiota (R2=0.033; p=0.018), followed by acute kidney injury (AKI R2=0.032; p=0.011) and plasma MIP-1beta level (R2=0.027; p=0.044). Random forest identified that families Prevotellaceae, Moraxellaceae, Staphylococcaceae were the biomarkers related to bacterial detection. In the patients with positive bacteriology results, the mean relative abundance of families Prevotellaceae and Actinomycetaceae decreased while families Moraxellaceae, Staphylococcaceae and Streptococcaceae increased. Multivariable Cox regression showed that the increase in alpha-diversity and the abundance of families Prevotellaceae and Actinomycetaceae were associated with clinical improvements.Conclusions: The bacterial detection and patients’ intrinsic factors were associated with the lung microbiota. The increased alpha diversity and the enrichment of families Prevotellaceae and Actinomycetaceae in the lung microbiota were associated with clinical improvements.

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“…Multiple biomarkers and several established models have been used to assess the severity of CAP to improve management of CAP patients [5][6][7], and among these models, the CURB-65 score is recommended in the guidelines for the diagnosis and treatment of adult CAP in Europe, America and China. The CURB-65 scoring system was created by the British thoracic society in 2003 and requires only five parameters (including confusion, urea >7 mmol/L, respiratory rate ≥30/min, low systolic < 90 mmHg or diastolic ≤ 60 mmHg blood pressure, age≥65 years) with 1 point for each item and a total maximum score of 5 points.…”

Section: Introductionmentioning

confidence: 99%

“…The role of PCT in infectious diseases such as sepsis has been described by Assicot et al [13]. Thus, it can be used as a prognostic indicator for infectious diseases [7,14].…”

Section: Introductionmentioning

confidence: 99%

Lymphocyte Count and Serum PCT L ev els Improve the Sensitivity of CURB-65 in Prediction of 30-day Mortality of Patients with Community-acquired Pneumonia

Zhang

Tao

Liu

et al. 2019

Preprint

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Factors associated with mortality in severe community-acquired pneumonia: A multicenter cohort study

Cited by 35 publications

References 29 publications

Short‐ and medium‐term prognosis of HIV‐infected patients receiving intensive care: a Brazilian multicentre prospective cohort study

Short‐ and medium‐term prognosis of HIV‐infected patients receiving intensive care: a Brazilian multicentre prospective cohort study

Lung Microbiota is Associated with Bacterial Detection and with Clinical Improvements in Severe Community-Acquired Pneumonia Patients

Lymphocyte Count and Serum PCT L ev els Improve the Sensitivity of CURB-65 in Prediction of 30-day Mortality of Patients with Community-acquired Pneumonia

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