Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation

Tejerina, Eva; Frutos‐Vivar, Fernando; Restrepo, Marcos I.; Anzueto, Antonio; Pálizas, Fernando; González, Marco; Apezteguía, Carlos; Abroug, Fékri; Matamis, Dimitros; Bugedo, Guillermo; Esteban, Andrés

doi:10.1016/j.jcrc.2005.05.010

Cited by 39 publications

(26 citation statements)

References 18 publications

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“…The 1-year survival curves were similar for primary pneumonia irrespective of source of diagnosis, and comparable to previous estimates of survival after community-acquired pneumonia [14,15]. Survival after community-acquired sepsis tended to be underestimated by the HDR, but survival after sepsis is generally reported to be lower than that found in this study, possibly indicating that the HDR actually selected a more representative group of sepsis patients [16,17].…”

Section: Discussionsupporting

confidence: 86%

Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Gedeborg

Furebring

Michaëlsson

2007

Journal of Clinical Epidemiology

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Section: Discussionsupporting

confidence: 86%

Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Gedeborg

Furebring

Michaëlsson

2007

Journal of Clinical Epidemiology

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“…These concerns are substantiated further by previous studies that proved L-selectin to be crucial for neutrophil recruitment (27) as well as for survival during bacterial pneumonia (28). A recent clinical study also identified ARF as an independent variable associated with death in the course of communityacquired pneumonia (29).…”

Section: Discussionmentioning

confidence: 67%

Acute Uremia but Not Renal Inflammation Attenuates Aseptic Acute Lung Injury

Zarbock¹,

Schmolke²,

Spieker³

et al. 2006

Journal of the American Society of Nephrology

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Acute renal failure (ARF) remains a major clinical challenge, especially in the intensive care setting. Mortality of ARF combined with acute lung injury (ALI) is even higher and may reach 80%. Recent studies have suggested a remote effect of ARF on pulmonary homeostasis. However, it is unknown whether and to what extent ARF clinically affects pulmonary function, in particular oxygenation. For elucidation of the impact of ARF on aseptic ALI, a murine two-hit model that consists of acute uremia (AU) and subsequent ALI was developed. AU was induced by renal ischemia-reperfusion (inflammatory AU) or bilateral nephrectomy (noninflammatory AU). ALI was initiated by intratracheal HCl instillation and characterized by severe, PMN-dependent decrease in arterial partial pressure of O 2 (>70%) in nonuremic mice. Uremic mice, by contrast, showed a significant protection from ALI (decrease in arterial partial pressure of O 2 <40%); this was independent of the type of AU. Reconstitution experiments, in which uremic neutrophils were injected into nonuremic mice and vice versa, identified uremic neutrophils as the primary mediators. Between normal and uremic neutrophils, there were no differences in apoptosis or superoxide production. Pulmonary recruitment of uremic neutrophils, however, was significantly attenuated compared with that of normal neutrophils. This defect was associated with altered surface expression of L-selectin; sialyl Lewis x , an L-selectin counterreceptor, previously was proved to be critical in aseptic ALI. In conclusion, it is shown that AU but not renal inflammation attenuates aseptic, neutrophil-dependent ALI and exerts an anti-inflammatory effect by attenuating pulmonary neutrophil recruitment.

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“…The mortality in our cohort was associated with age, APACHE II, and SAPS II, but not with gender and race. 31 …”

Section: Discussionmentioning

confidence: 99%

4G/5G Polymorphism of Plasminogen Activator Inhibitor -1 Gene Is Associated with Mortality in Intensive Care Unit Patients with Severe Pneumonia

Sapru

Hansen²,

Ajayi³

et al. 2009

Anesthesiology

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Background Higher plasma and pulmonary edema fluid levels of plasminogen activator inhibitor-1 (PAI-1) are associated with increased mortality in patients with pneumonia and acute lung injury. The 4G allele of the 4G/5G polymorphism of the PAI-1 gene is associated with higher PAI-1 levels and an increased incidence of hospitalizations for pneumonia. The authors hypothesized that the 4G allele would be associated with worse clinical outcomes (mortality and ventilator-free days) in patients with severe pneumonia. Methods The authors enrolled patients admitted with severe pneumonia in a prospective cohort. Patients were followed until hospital discharge. DNA was isolated from blood samples, and genotyping detection for the PAI-1 4G/5G polymorphism was carried out using Taqman-based allelic discrimination. Results A total of 111 patients were available for analysis. Distribution of genotypes was 4G/4G 26 of 111 (23%), 4G/5G 59 of 111 (53%), and 5G/5G 26 of 111 (23%). Of 111 patients, 32 (29%) died before hospital discharge and 105 patients (94%) received mechanical ventilation. Patients with the 4G/4G and the 4G/5G genotypes had higher mortality (35% vs. 8%, P = 0.007) and fewer ventilator-free days (median 4 vs. 13, P = 0.04) compared to patients with the 5G/5G genotype. Conclusions The 4G allele of the 4G/5G polymorphism in the PAI-1 gene is associated with fewer ventilator-free days and increased mortality in hospitalized patients with severe pneumonia. These findings suggest that PAI-1 may have a role in pathogenesis and that the 4G/5G polymorphism may be an important biomarker of risk in patients with severe pneumonia.

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Prognosis factors and outcome of community-acquired pneumonia needing mechanical ventilation

Cited by 39 publications

References 18 publications

Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Diagnosis-dependent misclassification of infections using administrative data variably affected incidence and mortality estimates in ICU patients

Acute Uremia but Not Renal Inflammation Attenuates Aseptic Acute Lung Injury

4G/5G Polymorphism of Plasminogen Activator Inhibitor -1 Gene Is Associated with Mortality in Intensive Care Unit Patients with Severe Pneumonia

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