Mortality prediction using clinical and laboratory features in elderly patients with severe community-acquired pneumonia

Abstract

Background: Severe community-acquired pneumonia (SCAP) is a serious health threat in elderly individuals, and a prospective, observational study was conducted to explore the prognostic factors.Methods: Patients (≥65 years old) with SCAP that had an intensive care unit (ICU) stay >24 h were recruited at our center. Clinical and laboratory data were collected and various assessment scores were calculated. The follow-up period was censored at the date of death or at hospital discharge, whichever came first.Results: A total of 120 elderly patients with SCAP were included. Among them, 61 were cured (survival group) and 59 died due to SCAP (mortality group). Multivariate logistic regression analysis showed that chronic obstructive pulmonary disorder (COPD, β=2.061, P=0.008) and CD3+CD4+ T cell count (β=−0.019, P=0.017) were independent prognostic factors for death in elderly patients with SCAP. The area under the receiver operating characteristic (ROC) curve (AUROC) for the age-and gender-adjusted model was estimated to be 0.915 [95% confidence interval (CI): 0.858-0.972] for mortality, and the sensitivity and specificity of the model were 91.53% and 86.89%, respectively.Conclusions: Our findings suggest that COPD and the CD3+CD4+ T cell count are independent prognostic factors for mortality, and the constructed model was moderately accurate in the prediction of mortality for elderly patients with SCAP.

CD4+ T cells related to disease severity in elderly and frailty community‐acquired pneumonia patients: A retrospective cohort study

“…Several studies have revealed that decreased CD4 + T cells indicate higher mortality. In a study enrolled 120 elderly SCAP patients, decreased CD4 + T cells were independent prognostic factors of mortality 8 . Similarly, a recent study about elderly patients with pneumonia showed that lower levels of CD4 + T cells were observed in the early deceased group than the late deceased patients or survivors 27 .…”

“…Several studies have been conducted in elderly patients, and found the relationship between CAP and various subtype T cells, such as CD4 + T cells and Treg cells. In a recent study, elderly SCAP patients showed lower CD4 + T cells in survival group than that of mortality group 8 …”

“…In a recent study, elderly SCAP patients showed lower CD4 + T cells in survival group than that of mortality group. 8 Frailty develops as a consequence of age-related decline in physiological function, and relates to poor prognosis under minor stressor events. 9 Immunosenescent modifications affect the entire immune system, including innate and adaptive immunity.…”

Clinical features of omicron SARS-CoV-2 variants infection associated with co-infection and ICU-acquired infection in ICU patients

“…When we classified the type of mechanical ventilation as invasive ventilation or not, there was a significant difference between co-infection and ICU-acquired infection (p = 0.003). The length of ICU stay for patients with co-infection was 14 days (Range, 7.5-26.5) while that for patients with ICU-acquired infection was 24 days (Range, [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], and further analysis revealed that there was a borderline significant difference in the length of ICU stay between these two groups (p = 0.079). Besides, 18 patients (38.30%) were death and 29 (61.70%) alive in day-28.…”

Clinical value of glucocorticoids for severe community-acquired pneumonia: A systematic review and meta-analysis based on randomized controlled trials

“…To further investigate the sources of heterogeneity, we performed subgroup analyses of studies related to COVID-19 and studies related to other pathogens. We found that subgroup analysis did not significantly reduce the source of heterogeneity, Juling 2020 [25] RCT [30] RCT Exp-group 43, Age 57 Cont-group 43, Age 55 2020 interim guidance of World Health Organization Methylprednisolone 1.0 mg/kg/d through d 7 Yang Qing 2018 [31] RCT Exp-group 40 [32] RCT Exp-group 30, Age (79. and the results of subgroup analysis showed that glucocorticoids increased the length of hospital stay in patients with COVID-19 (MD = 0.20, CI: 0.02-0.39) (Fig. 6), but glucocorticoids had no effect on the length of hospital stay in patients with sCAP caused by other pathogens (MD = −0.27, CI: −0.60 to 0.06).…”