Serum Prealbumin Improves the Sensitivity of Pneumonia Severity Index in Predicting 30-day Mortality of CAP Patients.

BACKGROUND: Serum prealbumin (PAB) is an effective tool to evaluate patients with malnutrition. In recent years, studies have shown that PAB is statistically reduced during the course of disease infection. The pneumonia severity index (PSI) scoring system is one of the most widely used scoring tools to evaluate the condition and prognosis of community acquired pneumonia (CAP) patients. However, few studies have reported on PSI combined with blood indicators to predict the prognosis of pneumonia. The aim of this study was to investigate the prognostic value of PAB combined with PSI in patients with CAP. METHODS: We retrospectively analyzed the data of 400 patients who met the inclusion criteria. Death and survival were selected as prognostic indicators of pneumonia. On the first day after admission, venous blood samples were taken to test PAB and PSI scores. Subject operating characteristic curve (ROC) was used to evaluate PSI, PAB, and PSI combined with PAB to predict 30-day mortality of CAP patients. RESULTS: The 30-day mortality rate of CAP patients was 10.5% (42/400). PAB and PSI score were independent risk factors for 30-day mortality in CAP patients. The sensitivity, specificity, positive predictive value, and negative predictive value of PAB predicting the death of CAP patients were 86.3%, 79%, 50.74%, and 95.83%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of PSI predicting the death of CAP patients were 74.80%, 63%, 33.71%, and 90.99%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the combined index predicting the death of CAP patients were 95.20%, 77.80%, 51.70% and 98.41%, respectively. CONCLUSIONS: Serum prealbumin is a relatively simple acquired index and an independent risk factor for death in CAP patients. Serum prealbumin improves the sensitivity of pneumonia severity index in predicting 30-day mortality of CAP patients.

Hyperglycemia and Hypokalemia in a 16-Year-Old Overweight Female Patient Misdiagnosed with Cushing Syndrome at First and Ultimately Diagnosed with Carney Complex Proven by PRKAR1A Gene Test: a Case Report and Literature Review.

BACKGROUND: Here we report on a 16-year-old female patient with typical Cushingoid features who was admitted because of purple striae, menostasis, and microsomia for 1 year, and laboratory tests showed hyperglycemia and hypokalemia. METHODS: For diagnosis, we employed a hormone test, abdominal and pituitary computed tomography scan, ultrasonography to detect endocrine and cardiocutaneous lesions. DNA sequencing to detect PRKAR1A gene mutation to make differential diagnosis for Cushing Syndrome. RESULTS: Hormone test revealed hypercortisolism, images demonstrated right adrenal nodular hyperplasia and hyperparathyroid hyperplasia. DNA sequencing analysis revealed a heterozygous C.680 G>A substitution in PRKAR1A. CONCLUSIONS: We describe here an atypical Carney Complex (CNC) patient magnified Cushing Syndrome with a nonsense mutation in the PRKAR1A gene, which cannot sustain the diagnosis except for the RKAR1A gene sequencing for analysis.

Right Lung Consolidation Combined Elevated Serum Neuron Specific Enolase Misdiagnosed as Lung Carcinoma Ultimately Confirmed Pulmonary Cryptococcosis by CT-guided Percutaneous Lung Biopsy: a Case Report and Literature Review.

BACKGROUND: Detection of serum neuron specific enolase (NSE) has high sensitivity and specificity in the diagnosis of lung carcinoma, especially in small cell lung carcinoma, but sometimes serum NSE provided limited help. We report a case of a patient with right lung consolidation combined with elevated serum neuron specific enolase which mimicked lung carcinoma and was ultimately confirmed as pulmonary cryptococcosis by CT-guided percutaneous lung biopsy. METHODS: Chest computed tomography (CT) scan and CT-guided percutaneous lung biopsy were performed for diagnosis and blood tests explored the latent etiology. RESULTS: The chest CT scan showed right lung consolidation and a pulmonary nodule in lingual segment of upper lobe of left (Figure1A - F). Serum cryptococcal antigen was positive. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary cryptococcosis (Figure 1G - I). CONCLUSIONS: Elevated NSE is not a specific index of lung cancer. Serum cryptococcal antigen and CT-guided percutaneous lung biopsy has high specificity in cryptococcal pneumonia.

Persistent Mild Anemia and Hypercalcemia were Ignored as Normal Reaction Secondary to Oral Calcium Supplementation in a Steroid-Dependent Asthma Patient Ultimately Diagnosed as Multiple Myeloma: a Case Report and Literature Review.

BACKGROUND: Anemia can be secondary to many diseases and hypercalcemia can be secondary to oral calcium supplementation. For non-hematologists, anemia and hypercalcemia are usually ignored. Here we report a case of persistent mild anemia and hypercalcemia which were ignored as a normal reaction secondary to oral calcium supplementation in a steroid-dependent asthma patient; it was ultimately diagnosed as multiple myeloma. METHODS: Bone marrow puncture, combined serum, and urine laboratory indexes were performed for diagnosis. RESULTS: A bone marrow puncture specimen comprised 31.5% plasma cells. The serum and urine immunoelectrophoresis showed monoclonal kappa light chains. CONCLUSIONS: When anemia and hypercalcemia occur in an elderly patient, physicians should pay attention to multiple myeloma, especially when accompanied with vertebral and flat bone fractures.

Hemoptysis and High-Density Shadow of Both Lungs Combined with Elevated Serum G-Lipopolysaccharide Misdiagnosed as Bronchiectasis with Gram-Negative Bacterium Infection Ultimately Confirmed as Mycobacterium Iranicum Infection by CT-guided Percutaneous Lung Biopsy and Next Generation Sequencing (NGS): a Case Report and Literature Review.

BACKGROUND: G-lipopolysaccharide, a component of the cell wall of Gram-negative bacteria, is called lipopolysaccharide. The detection of G-lipopolysaccharide can be used for the early diagnosis of infectious diseases, but some-times G-lipopolysaccharide provides limited help. We report a case of a patient with hemoptysis and high-density shadow of both lungs combined with elevated serum G-lipopolysaccharide which mimicked bronchiectasis with Gram-negative bacterium infection. It was ultimately confirmed as Mycobacterium iranicum infection by CT-guided percutaneous lung biopsy and next generation sequencing. METHODS: The chest computed tomography (CT) scan, CT-guided percutaneous lung biopsy, and NGS were performed for diagnosis and blood tests explored for the latent etiology. RESULTS: The chest CT scan showed a high-density shadow of both lungs, atelectasis of right middle lobe, multiple enlarged lymph nodes in mediastinum and right hilum. Pathology of CT-guided percutaneous lung biopsy indicated fibrous tissue proliferation and granulation tissue formation and some alveolar epithelial cells slightly proliferated with focal carbon powder deposition in alveolar sacs and spaces. The lung tissue NGS confirmed Mycobacterium iranicum infection. CONCLUSIONS: Elevated serum G-lipopolysaccharide is not a specific index for infectious diseases. CT-guided percutaneous lung biopsy and lung tissue NGS has high specificity in pathogen detection of infectious diseases.

Increased Serum Sedimentation and Positive Tuberculosis Antibody Combined Multiple Pulmonary Nodules in Chest CT in a Middle-Aged Patient Firstly Misdiagnosed as Tuberculosis Proved as Sarcoidosis by CT Guided Percutaneous Lung Puncture Biopsy: a Case Report and Literature Review.

BACKGROUND: Tuberculosis is a common infectious disease in developing countries. Tuberculosis and sarcoidosis are difficult to differentiate. We presented an adult case with increased serum sedimentation and positive tuberculosis antibody combined with multiple pulmonary nodules in chest CT in a middle-aged patient firstly misdiagnosed as tuberculosis proved as sarcoidosis by CT guided percutaneous lung puncture biopsy. METHODS: Appropriate laboratory tests are carried out. The chest CT scan, bronchoscopy CT guided percutaneous lung puncture biopsy were performed for diagnosis. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed multiple pulmonary nodules in both lungs and multiple lymphadenopathy. The bronchoscopy demonstrated no abnormality. Pathology of CT guided percutaneous lung puncture biopsy showed non-caseous multiple granulomatous lesions and acid-fast staining was negative. CONCLUSIONS: When a patient has multiple pulmonary nodules and lymphadenopathy without obvious tuberculosis poisoning symptoms, physicians should pay attention to tuberculosis, sarcoidosis, and lung cancer. Pathology is crucial for the ultimate diagnosis.

Fever with Positive EBV IgM Antibody Combined Multiple Subcutaneous Nodules on Lower Extremities and Cervical Lymphadenopathy Masquerading as Infectious Mononucleosis Proven as Subcutaneous Panniculitis-like T-cell Lymphoma by Subcutaneous Nodule Biopsy Consultation: a Case Report and Literature Review.

BACKGROUND: We report a case that presented as fever with positive Epstein-Barr Virus (EBV) IgM antibody combined with subcutaneous nodules on lower extremities and cervical lymphadenopathy firstly misdiagnosed as infectious mononucleosis, which was proven as subcutaneous panniculitis-like T-cell lymphoma by subcutaneous nodule biopsies. METHODS: Appropriate serum and bacteriological laboratory tests were carried out for the cause of fever. An ultrasound and subcutaneous nodule biopsies were performed. RESULTS: EBV IgM antibody was positive. An ultrasound revealed multiple subcutaneous nodules, which were prone to be lipoma on lower extremities and cervical lymphadenopathy. Subcutaneous nodule biopsies were firstly misdiagnosed as lipoma, while pathology consultation for the subcutaneous nodule biopsies diagnosed subcutaneous panniculitis-like T-cell lymphoma. CONCLUSIONS: When patients have persistent fever with positive EBV IgM antibody combined other system involvements, especially lymphadenopathy and multiple subcutaneous nodules, it should differentiate lymphoma from infectious diseases.

Negative (1,3)-ß-D-glucan and Elevated White Blood Cells Combined Procalcitonin Masquerading as Severe Pneumonia Eventually Diagnosed as Invasive Pulmonary Aspergillosis Proven by Bronchoalveolar Lavage Fluid Culture in a Diabetes Patient: a Case Report and Literature Review.

BACKGROUND: We report an invasive pulmonary aspergillosis (IPA) with negative (1,3)-ß-D-glucan and dynamically elevated white blood cells combined with procalcitonin proven by bronchoalveolar lavage fluid (BALF) culture. METHODS: Appropriate laboratory tests are carried out. Chest CTs were performed to assess the lungs. The cause of infection was determined using BALF culture. RESULTS: Serum (1,3)-ß-D-glucan was negative, white blood cells and procalcitonin were significantly higher than normal. The bronchoscopy revealed obvious necrotic detritus and pseudo membrane in the trachea, left and right main bronchi, and branches. BALF culture revealed the presence of Aspergillus. CONCLUSIONS: Negative (1,3)-ß-D-glucan is not safe to rule out invasive pulmonary aspergillosis. BALF culture is critical for IPA diagnosis.

Increased Serum Sedimentation and Positive Tuberculosis Antibody Combined Left Lung Consolidation in Chest CT Scan in an Adult Patient Firstly Misdiagnosed as Tuberculosis Proved as Foreign Body Aspiration in the Left Main Stem Bronchus by Bronchoscopy: a Case Report and Literature Review.

BACKGROUND: Foreign body aspiration is a rare entity in adults. We presented an adult case with recurrent pulmonary infection firstly misdiagnosed as tuberculosis, which proved as foreign body aspiration in the left main stem bronchus by bronchoscopy. METHODS: Appropriate laboratory tests are carried out. The chest CT scan and bronchoscopy were performed for diagnosis. RESULTS: Serum sedimentation was increased and tuberculosis antibody was positive. The chest CT scan showed left lung consolidation and small pleural exudate on the left side. Significant calcification can be seen near the left main bronchus. The bronchoscopy demonstrated plenty of yellow sputum in left main bronchus and a peanut shell completely obstructed the left main bronchus and peripheral granulation tissue hyperplasia. The peanut shell was removed and the left main trachea was unobstructed. CONCLUSIONS: When a patient has recurrent pulmonary infection, especially at the same site, physicians should pay attention to airway obstruction caused by foreign body, cancer and other causes of airway stenosis. Bronchoscopy is crucial for the ultimate diagnosis.

Left Lung Neoplasms and Bilateral Pleural Effusion Combined Elevated Carcinoembryonic Antigen in Pleural Effusion with Negative Result of Thoracoscopy Pleural Biopsy Misdiagnosed as Lung Carcinoma Ultimately Confirmed Pulmonary Sarcomatoid Carcinoma by CT-guided Percutaneous Lung Biopsy: a Case Report and Literature Review.

BACKGROUND: Detection of carcinoembryonic Antigen (CEA) in pleural effusion has good clinical application value in differentiating benign and malignant pleural effusion, but sometimes CEA provides limited help. We report a case of a patient with left lung neoplasms combined with bilateral pleural effusion with increased CEA in the pleural effusion whose thoracoscopy pleural biopsy pathology was negative, mimicking lung carcinoma and ultimately confirmed as pulmonary sarcomatoid carcinoma by CT-guided percutaneous lung biopsy. METHODS: The chest computed tomography (CT) scan, thoracoscopy pleural biopsy, and CT-guided percutaneous lung biopsy were arranged to explore the etiology of pleural effusion. RESULTS: The chest CT scan showed bilateral pleural effusion with left lung neoplasms, pulmonary atelectasis, and left hilar enlargement. Pathology of thoracoscopy biopsy showed pleural inflammation with infiltration of inflammatory cells. Pathology of CT-guided percutaneous lung biopsy confirmed pulmonary sarcomatoid carcinoma. CONCLUSIONS: Elevated pleural effusion CEA is not a specific index of lung cancer. CT-guided percutaneous lung biopsy is appropriate for patients presenting with pleural diseases with lung neoplasms, especially when thoracoscopy pleural biopsy result was negative.

Persistent Anemia Combined Increased Serum Sedimentation (ESR) for More Than Two Years Firstly Misdiagnosed as Lymphoma Ultimately Confirmed Systemic Lymph Nodes Tuberculosis by Endobronchial Ultrasound-guided Transbronchial Needle Aspiration Pathology: a Case Report and Literature Review.

BACKGROUND: Anemia combined with increased serum sedimentation (ESR) can be secondary to many diseases and may be ignored when the patient had few clinical symptoms. We report a case of persistent anemia combined with ESR for more than 2 years firstly misdiagnosed as lymphoma. When she received a chest CT scan multiple enlarged lymph nodes were found. METHODS: The chest contrast-enhanced CT scan and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the right hilum enlarged lymph nodes were performed for diagnosis. RESULTS: The chest CT scan and EBUS showed multiple enlarged right hilum and mediastinum lymph nodes without calcification. Pathology of EBUS-TBNA showed multiple granulomas; Zeihl-Neelsen acid-fast stain was positive. CONCLUSIONS: Systemic lymph node tuberculosis is rarely seen in adult patients. In a young patient who has anemia combined with increased ESR should be excluded if those changes are secondary to tuberculosis.

Normal Tumor Markers and Increased Adenosine Deaminase in Pericardial Effusion Misdiagnosed as Tuberculous Pericarditis Ultimately Proven as Lung Adenocarcinoma with Pericardial Metastasis: a Case Report and Literature Review.

BACKGROUND: Elevated adenosine deaminase (ADA) and normal tumor markers in pericardial or pleural effusion are usually considered to be a specific manifestation of benign pericardial or pleural effusion. Here we report a case of lung adenocarcinoma with pericardial metastasis with elevated ADA and normal tumor markers in pericardial effusion. METHODS: Pericardiocentesis and lung puncture combined laboratory indexes and pathology were performed for diagnosis. RESULTS: Analysis of pericardial fluid revealed a white blood cell (WBC) count of 2,000 x 106/L (70% for lymphocytes) with an ADA level of 72.8 U/mL. Pathology of pericardial effusion found no malignant cells. Histopathology of percutaneous lung puncture showed adenocarcinoma. CONCLUSIONS: ADA and tumor markers were not a specific index in differential diagnosis between tuberculosis and metastasis in pericardial effusion.

Neutrophil-to-Lymphocyte Ratio in Adult Community-Acquired Pneumonia Patients Correlates with Unfavorable Clinical Outcomes.

BACKGROUND: Despite the extensive improvement in antibiotic treatment and medical care, severe adult community-acquired pneumonia (CAP) remains as the significant cause of death worldwide. Earlier prognosis assessment and timely treatment in adult CAP patients are useful for prognosis. The neutrophil-to-lymphocyte ratio (NLR) in blood routine has a broad application possibility in assessing inflammatory reaction and prognosis. The aim of this study was to examine the relationship between NLR and inflammatory reaction and to unravel the usefulness of NLR in the assessment of clinical outcomes in adult CAP patients. METHODS: This retrospective study was conducted based on adult patients with a primary diagnosis of CAP. All patients included received a routine blood test and calculated NLR. All of the measurement data were analyzed with paired t-test and the enumeration data were analyzed with χ2 test. Multivariate analysis was performed to investigate the association between predictors (age, male, CURB-65 scores, comorbidity, NLR, and other inflammatory cells in blood routine) and unfavorable outcomes of CAP (ICU admission and 30-day mortality). Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of NLR in predicting unfavorable outcomes of CAP. RESULTS: One hundred fifty patients were included. Compared with favorable outcomes group, age, CURB-65 scores, WBC, neutrophil and lymphocyte counts, and NLR were elevated in unfavorable outcomes group (p < 0.05), gender and coexisting illness did not differ obviously. Multivariate logistic regression model analysis showed CURB-65 scores and NLR were independent predictors correlated with unfavorable outcomes (p < 0.05). The area under the ROC curve (AUC) of NLR was 0.81 (95% CI 0.73 to 0.89), the sensitivity was 81.00% and specificity was 72.8%. NLR is superior to CURB-65 in predicting unfavorable outcomes. NLR combined CURB-65 has better sensitivity and specificity (89.40% versus 91.30%). CONCLUSIONS: NLR is a simple, cheap, and rapidly available measurement in blood routine and is associated with unfavorable clinical outcomes in adult CAP patients.

High Serum Neuron-Specific Enolase (NSE) Level Firstly Ignored as Normal Reaction in a Small Cell Lung Cancer Patient: a Case Report and Literature Review.

BACKGROUND: High serum neuron-specific enolase (NSE) level has been in use as a tumor marker; however, some physicians may ignore NSE levels in serum, especially when the patients are asymptomatic. Here we report a case that a 51 year old female patient with no respiratory symptoms who had a NSE level which increased extremely over three months and was eventually diagnosed small cell lung cancer (SCLC). METHODS: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in right pulmonary hilar enlarged lymph node was performed for diagnosis. RESULTS: EBUS showed right pulmonary hilar lymph node enlargement. A TBNA biopsy histopathology diagnosed SCLC. CONCLUSIONS: We should pay attention to high serum NSE levels, especially when the index increased extremely over a short time.

Anemia Combined Significantly Increased High-Sensitivity C Reactive Protein and Lung Lesions Lead to the Diagnosis of Granulomatosis with Polyangiitis Proven by Lung Biopsy and Anti-neutrophil Cytoplasmic Antibody Test.

Background: To report an atypical case misdiagnosed as lung abscess over the past 2 months, but persistent anemia combined with significantly increased hs-CRP and lung lesions indicated systemic lesion, which led to the diagnosis of granulomatosis with polyangiitis proven by lung biopsy and anti-neutrophil cytoplasmic antibody test (ANCA).

Methods: The complete blood count, hs-CRP, and anti-neutrophil cytoplasmic antibody (ANCA) test were performed. The pathology consultation for the lung biopsy was arranged.

Results: Hemoglobin was 8.5 g/L, hs-CRP was > 200 mg/L, c-ANCA directed against anti-proteinase 3 (PR3) was positive, pathology consultation reported granulomatous inflammation.

 

 

 

 

Conclusions: When patients have multiple organ dysfunction combined with anemia and significantly increased hs-CRP, physicians should pay attention to systemic vasculitis.

Tuberculosis Antibody and Tuberculin Positive Tests Initially Misdiagnosed as Active Tuberculosis in a Broncholithiasis Patient with Recurrent Hemoptysis and Fever Proven by Lung Lobectomy.

BACKGROUND: To report a case of broncholithiasis with recurrent hemoptysis and fever initially misdiagnosed as active tuberculosis. METHODS: The chest contrast-enhanced CT scan, electronic bronchoscope, and ultrathin bronchoscope were performed leading to the diagnosis of broncholithiasis, open lung lobectomy was done after thoracic surgery consultation. RESULTS: The chest contrast-enhanced CT scan showed a high-density intratracheal shadow and calcified lymph nodes. Ultrathin bronchoscopy manifested calcified lesions located at the distal portion of the right lower lobe bronchus. Histopathology of lobectomy showed lithiasis in the right lower lobe tracheobronchial tree. CONCLUSIONS: We should pay attention to calcified intratracheal lesions and make differential diagnosis with tuberculosis, especially when accompanied with calcified lymph nodes and fever.

Elevated Plasma D-Dimer in Adult Community-Acquired Pneumonia Patients is Associated with an Increased Inflammatory Reaction and Lower Survival.

BACKGROUND: Community-acquired pneumonia (CAP) is a common infectious disease. Inflammatory reaction and prognosis assessment in adult CAP patients are useful for CAP site of care decisions. Most CAP patients were diagnosed in an out-patient or emergency department, so a simple, cheap and rapidly available measurement to assess inflammatory reaction and prognosis has the prospect of broad application. The aim of this study was to investigate the usefulness of plasma D-Dimer in assessment of inflammatory reaction and prognosis in adult CAP patients. METHODS: A retrospective study was conducted. All adult patients with a primary diagnosis of CAP were included and were evaluated by peripheral plasma D-Dimer test. All of the measurement data were analyzed with paired t-test and the enumeration data were analyzed with χ2 test. Correlative factor analysis was performed between D-Dimer levels and serum inflammatory markers (WBC, hs-CRP, PCT) and prognostic indexes (ICU admission and 30-day mortality). Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of D-Dimer in predicting ICU admission and/or 30-day mortality. RESULTS: One hundred fifty patients were included. Compared with non-D-Dimer elevated group, serum inflammatory markers (WBC, hs-CRP, PCT) and prognostic indexes (ICU admission and 30-day mortality) were elevated in the D-Dimer elevated group (p < 0.05). D-Dimer had positive correlation with serum inflammatory markers (WBC, hs-CRP, PCT), the rates of ICU admission and 30-day mortality, and scores of CURB-65. The AUC of ROC curve of D-Dimer was 0.880 (95% CI 0.823 to 0.936), the sensitivity was 80.4% and specificity was 79.8%, D-Dimer levels are superior to hs-CRP and PCT in predicting 30-day mortality and/or ICU admission according to AUCs of the ROC curves. CONCLUSIONS: Elevated plasma D-Dimer in adult CAP patients is associated with an increased inflammatory reaction and ICU admission and 30-day mortality. It can be a simple, cheap, and rapidly available measurement to assess inflammatory reaction and prognosis in adult CAP patients.

Positive Serum Beta-D-glucan by G Test and Aspergillus Fumigatus Sputum Culture Mimic Invasive Pulmonary Aspergillosis in a Pulmonary Nocardia Patient: a Case Report and Literature Review.

BACKGROUND: Invasive pulmonary aspergillosis and nocardia overlap in clinical and radiological presentations, so differentiating between nocardia and invasive pulmonary aspergillosis is confusing. Though sputum culture could distinguish between nocardia and aspergillus fumigatus, but for the ultimate diagnosis, sputum culture provided limited help. Here we report a case of a patient with positive G test and aspergillus fumigatus sputum culture mimic invasive pulmonary aspergillosis ultimately diagnosed as nocardia through bronchoalveolar lavage culture combined metagenomic next-generation sequencing (NGS). METHODS: Bronchoalveolar lavage culture combined metagenomic NGS for infectious diseases were performed for diagnosis. RESULTS: Bronchoalveolar lavage culture combined metagenomic next-generation sequencing showed Nocardia Gelsenkirchen. CONCLUSIONS: Positive G test and sputum culture were not specific, while bronchoalveolar lavage culture and NGS gave more information for a differential diagnosis between nocardia and aspergillus fumigatus.

Neutrophil-to-Lymphocyte Ratio Improves the Accuracy and Sensitivity of Pneumonia Severity Index in Predicting 30-Day Mortality of CAP Patients.

BACKGROUND: The pneumonia severity index (PSI) scoring system is one of the tools used to evaluate and predict the prognosis of patients with community-acquired pneumonia (CAP). Although PSI has been widely used in clinical studies of pneumonia, it is still rare to combine it with blood indexes to predict the prognosis of pneumonia. Neutrophil-to-lymphocyte ratio (NLR) is a promising candidate predictor of mortality in CAP patients. The aim of this study was to investigate the efficacy of pneumonia severity index combined with NLR in predicting 30-day mortality in CAP patients. METHODS: We conducted a retrospective study. We analyzed data on 400 non-immune individuals over the age of 18 in this study. All patients received blood routine measurement and PSI score calculation after admission. The primary outcome measures were mortality and survival in CAP patients. The sensitivity and specificity of PSI score, NLR, and the combination of PSI score and NLR in predicting 30-day mortality were assessed using the subject operating characteristic curve (ROC). RESULTS: Data from 400 patients were analyzed, in which the 30-day mortality was 10.5% (42/400). The AUC of NLR and PSI in predicting 30-day mortality of CAP patients were 0.81 (95% CI 0.73 - 0.89) and 0.94 (95% CI 0.90 - 0.98), respectively, with statistically significant differences (p = 0.00). The sensitivity and specificity of NLR were 0.80 and 0.7, respectively. The sensitivity and specificity of PSI were 0.78 and 0.94, respectively. The combined AUC of the two indicators for predicting death in CAP patients was 0.95 (95% CI 0.92 - 0.99), and the sensitivity and specificity were 0.85 and 0.94, respectively. CONCLUSIONS: Neutrophil-to-lymphocyte ratio improves the accuracy and sensitivity of the pneumonia severity index in predicting 30-day mortality of CAP patients.

Elevated Red Blood Cell Distribution Width Combined White Blood Cell in Peripheral Blood Routine Have a Better Sensitivity than CURB-65 Scores in Predicting ICU Admission and Mortality in Adult Community-Acquired Pneumonia Patients.

Background: Scoring systems including CURB-65 and Pneumonia Severity Index (PSI) and novel or traditional biomarkers including procalcitonin (PCT) and c-reactive protein (CRP) are very significant for understanding the severity and prognosis in community-acquired pneumonia (CAP) patients, while prognostic items are useful for CAP prognostication and point-of-care decisions. The aim of this study was to investigate the usefulness of peripheral blood routine items in predicting ICU admission and 30-day mortality in CAP patients.

Methods: A retrospective study was conducted. All adult patients with a primary diagnosis of CAP were included and peripheral blood routine tests were evaluated. Univariate analysis and multivariate logistic regression analysis were used to explore association of risk factors with 30-day mortality among CAP patients. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of peripheral blood routine items and compared with CURB-65 scores in predicting ICU admission and/or 30-day mortality.

Results: One hundred fifty patients were included and compared with non-ICU admission patients. There was a statistically significant difference in age, co-existing illness, RDW, WBC, and CURB-65 scores ranking in ICU admission patients (p < 0.05). In multivariate logistic regression analysis, we found RDW, WBC, and CURB-65 ≥ 3 scores increased the risk of 30-day mortality by 4.01, 1.65, and 3.43 times, respectively. The area under the curve (AUC) of ROC curves of RDW combined with WBC and CURB-65 was 0.786 (95% CI 0.701 to 0.876) and 0.836 (95% CI 0.764 to 0.908), respectively and the sensitivity was 84.0% and 60.0%, respectively, and the specificity 66.7% and 93.7%, respectively.

Conclusions: Elevated RDW and WBC increased mortality in adult CAP patients, RDW combined with WBC had a better sensitivity than CURB-65 scores in predicting ICU admission and/or mortality in CAP patients.