Laboratory Abnormalities in Patients With Bacterial Pneumonia

Sankaran, Ramkumar T.; Mattana, Joseph; Pollack, Simcha; Bhat, Premila; Ahuja, Tejinder S.; Patel, Archana; Singhal, Pravin C.

doi:10.1378/chest.111.3.595

Cited by 56 publications

(32 citation statements)

References 28 publications

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“…Hypoalbuminemia is also associated with higher pneumonia severity, higher mortality, higher hospital costs, and longer recovery time. [26][27][28] In the SMART-COP (low systolic blood pressure, multi-lobar chest radiography involvement, low albumin level, high respiratory rate, and tachycardia) assessment instrument, hypoalbuminemia is a factor in predicting the need for respiratory or vasopressors in patients with community-acquired pneumonia. 29 Moreover, besides being an indicator of the nutritional state of the patient, hypoalbuminemia has been related to liver imbalance in protein synthesis at the cost of a higher production of acute phase reactants and pro-inflammatory cytokines.…”

Section: Discussionmentioning

confidence: 99%

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

et al. 2011

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the Neumonía Adquirida en la Comunidad de la Comunidad Valenciana Study Group BACKGROUND: Hypoxemia may influence the prognosis of patients with mild pneumonia, regardless of the initial CURB-65 score (confusion, blood urea nitrogen > 20 mg/dL, respiratory rate > 30 breaths/min, blood pressure < 90/60 mm Hg, and age > 65 y). OBJECTIVE: To determine the risk factors associated with hypoxemia and the influence of hypoxemia on clinical outcomes in hospitalized patients with mild pneumonia. METHODS: We performed a multicenter prospective cohort study of 585 consecutive hospitalized patients with mild pneumonia (CURB-65 groups 0 and 1). We stratified the patients according to the presence of hypoxemia, defined as a P aO 2 / F IO 2 < 300 mm Hg on admission. We assessed the risk factors associated with hypoxemia, hypoxemia's influence on the course of pneumonia, and clinical outcomes (mortality, hospital stay, and need for intensive care unit admission), with multivariable regression. RESULTS: Fifty percent of the patients (294 cases) had hypoxemia on admission. The risk factors independently associated with hypoxemia were: bilateral radiological involvement (odds ratio 2.8, 95% CI 1.1-7.5), history of COPD (odds ratio 2.5, 95% CI 1.4 -4.3), and hypoalbuminemia (odds ratio 2.0, 95% CI 1.1-3.5). The hypoxemic patients had longer hospital stay, higher intensive care unit admission rate, higher rate of severe sepsis, and higher mortality than the non-hypoxemic patients. CONCLUSIONS: Hypoxemia in patients with mild pneumonia is independently associated with several adverse clinical and radiological variables, and the hypoxemic patients had worse clinical outcomes than the non-hypoxemic patients. Therefore, additional attention should be paid to the presence of hypoxemia, regardless of a low CURB-65 score.

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Section: Discussionmentioning

confidence: 99%

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

et al. 2011

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“…[48][49][50] In the non-thalassaemic population there is an increasing body of evidence that hypocholesterolaemia is associated with nosocomial infections and that hypocholesterolaemia is a risk factor for mortality in hospitalised patients. [51][52][53][54][55][56][57] It is therefore possible that and resulting in inhibition of platelet aggregation. 59 No study has yet evaluated whether hypocholesterolaemia further supports the well recognised procoagulant status of thalassaemic patients.…”

Section: Implications and Clinical Effectsmentioning

confidence: 99%

Hypocholesterolaemia in Thalassaemia – Pathogenesis, Implications and Clinical Effects

Ricchi¹,

Ammirabile²,

Maggio³

2010

European Oncology &Amp; Haematology

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Free cholesterol is a constituent of cell membranes. Apart from nucleus-free erythrocytes, all cells of the human body are able to synthesise cholesterol de novo. More than 100 enzymatic processes are involved in the complete biosynthesis of cholesterol, which is a complex and energy-consuming process.For this reason, several tissues prefer to assume cholesterol from plasma lipoproteins rather than from their own intracellular synthesis.Cholesterol devoted to plasma lipoprotein is synthesised in the liver and in the distal part of the small intestine.1 Chylomicron remnants are the vehicle of cholesterol intake from the diet to the liver. The hepatic cholesterol pools originating from chylomicron remnants and de novo synthesised cholesterol are combined and excreted as verylow-density lipoprotein (VLDL). Low-density lipoprotein (LDL), the ultimate catabolic product of VLDL, is the main source of cholesterol for human tissue, especially those with high cell turnover. Cholesterol is not only a fundamental element of cell membranes but also the principal precursor for steroid and sexual hormone biosynthesis. Furthermore, cholesterol, through its intermediary products such as farnesyl diphosphate and geranylgeranyl diphosphate, is involved in the regulation of ras-protein intracellular signal transduction.1 Hypercholesterolaemia in ThalassaemiaA large body of evidence from prospective and retrospective studies has clearly shown that patients affected by thalassaemia have reduced levels of TC with respect to healthy age-and sex-matched controls. 3-10Hypocholesterolaemia has been reported in all phenotypes of β-thalassaemia and has also been described in various haematological disorders associated with high erythropoietic activity.11-14 Table 1 shows cholesterol levels found in different reports exploring lipid profiles in young and adult patients affected by all phenotypes of thalassaemia.The majority of these studies have evaluated cholesterol level in young patients with severe thalassaemia (thalassaemia major and intermedia). As shown in Table 1, low levels of plasma cholesterol are evident among all ages of patients with thalassaemia major and intermedia.Almost all studies agree with the observation that of all the forms of thalassemia, thalassaemia intermedia patients show the most marked alterations in lipid profile. Conversely, no studies have identified a cholesterol cut-off value that could clearly distinguish patients with thalassaemia intermedia from those affected by thalassaemia major.Furthermore, hypocholesterolaemia is only one aspect in the more complex alteration of lipid profile involving LDL and HDL level observed in all thalassemia patients. In fact, most of the abovementioned studies reported that thalassaemia patients also have lower HDL and LDL levels than those observed in control patients.Many of these studies have also tried to identify within-patient factors correlating with cholesterol level; 4,8,9 data analysis of most reported studies failed to show any influence on cholesterol level of a...

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“…In this experiment, rHDL signifi cantly reduced LPS-induced activation of coagulation and fi brinolysis and collagen stimulated platelet aggregation 74 . Hypocholesterolemia has also been associated with the development of nosocomial infections [75][76][77][78] , especially in the postoperative period. Leardi et al 77 found the risk of postoperative infection to be 73 % among patients with a total cholesterol concentration of <2.7 mmol/L, compared with an incidence of infection of 35 % (p< 0.001) with a higher cholesterol concentration.…”

Section: Clinical Consequences Of Hypocholesterolemiamentioning

confidence: 99%

Hypocholesterolemia in Clinically Serious Conditions - Review

Vyroubal¹,

Chiarla²,

Giovannini³

et al. 2008

BIOMED PAP

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Background:Cholesterol is an essential component of cell membranes, precursor of steroids, biliary acids and other components of serious importance in live organism. Cholesterol synthesis is a complicated and energy-demanding process. Real daily need of cholesterol and mechanisms of decline cholesterol levels in critical ill are unknown. During stressful situations a signifi cant hypocholesterolaemia may be found. Hypocholesterolemia has been known for a number of years to be a signifi cant prognostic indicator of increased morbidity and mortality connected with a whole spectrum of pathological conditions. The aim of article is the elucidation of the role and importance of hypocholesterolaemia during the intensive care. . Methods and Results:We examined studies that are engaged in problems of hypocholesterolemia in critically ill. Very low levels of total as well as LDL cholesterol are most frequently found in serious polytrauma, after extensive surgery, in serious infections, in protracted hypovolemic shock. It is still not clear whether hypocholesterolemia refl ects only a serious metabolic disorder, which results from a life-threatening condition, or whether it has an active role in evolution and outcome.Conclusions: Hypocholesterolemia is commonly observed in critically ill patients. Nevertheless, it is not known whether it is a secondary manifestation of disease, or whether it actively contributes to deterioration of the disease. Although the contribution of hypocholesterolemia to mortality is modest compared with known risk factors such as increased severity of illness and the development of nosocomial infection, low serum lipid concentrations represent a potential therapeutic target in sepsis.

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Laboratory Abnormalities in Patients With Bacterial Pneumonia

Cited by 56 publications

References 28 publications

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

Hypoxemia Adds to the CURB-65 Pneumonia Severity Score in Hospitalized Patients With Mild Pneumonia

Hypocholesterolaemia in Thalassaemia – Pathogenesis, Implications and Clinical Effects

Hypocholesterolemia in Clinically Serious Conditions - Review

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