Corrigendum: Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency.

This corrects the article DOI: 10.1038/srep22911.

Low T3 syndrome is a strong predictor of poor outcomes in patients with community-acquired pneumonia.

Low T3 syndrome was previously reported to be linked to poor clinical outcomes in critically ill patients. The aim of this study was to evaluate the predictive power of low T3 syndrome for clinical outcomes in patients with community-acquired pneumonia (CAP). Data for 503 patients were analyzed retrospectively, and the primary end point was 30-day mortality. The intensive care unit (ICU) admission rate and 30-day mortality were 8.3% and 6.4% respectively. The prevalence of low T3 syndrome differed significantly between survivors and nonsurvivors (29.1% vs 71.9%, P < 0.001), and low T3 syndrome was associated with a remarkable increased risk of 30-day mortality and ICU admission in patients with severe CAP. Multivariate logistic regression analysis produced an odds ratio of 2.96 (95% CI 1.14-7.76, P = 0.025) for 30-day mortality in CAP patients with low T3 syndrome. Survival analysis revealed that the survival rate among CAP patients with low T3 syndrome was lower than that in the control group (P < 0.01). Adding low T3 syndrome to the PSI and CURB-65 significantly increased the areas under the ROC curves for predicting ICU admission and 30-day mortality. In conclusion, low T3 syndrome is an independent risk factor for 30-day mortality in CAP patients.

Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency.

Aim of this study was to develop a new simpler and more effective severity score for community-acquired pneumonia (CAP) patients. A total of 1640 consecutive hospitalized CAP patients in Second Affiliated Hospital of Zhejiang University were included. The effectiveness of different pneumonia severity scores to predict mortality was compared, and the performance of the new score was validated on an external cohort of 1164 patients with pneumonia admitted to a teaching hospital in Italy. Using age ≥ 65 years, LDH > 230 u/L, albumin < 3.5 g/dL, platelet count < 100 × 10(9)/L, confusion, urea > 7 mmol/L, respiratory rate ≥ 30/min, low blood pressure, we assembled a new severity score named as expanded-CURB-65. The 30-day mortality and length of stay were increased along with increased risk score. The AUCs in the prediction of 30-day mortality in the main cohort were 0.826 (95% CI, 0.807-0.844), 0.801 (95% CI, 0.781-0.820), 0.756 (95% CI, 0.735-0.777), 0.793 (95% CI, 0.773-0.813) and 0.759 (95% CI, 0.737-0.779) for the expanded-CURB-65, PSI, CURB-65, SMART-COP and A-DROP, respectively. The performance of this bedside score was confirmed in CAP patients of the validation cohort although calibration was not successful in patients with health care-associated pneumonia (HCAP). The expanded CURB-65 is objective, simpler and more accurate scoring system for evaluation of CAP severity, and the predictive efficiency was better than other score systems.

Hepatitis C virus nonstructural protein specific T cells are associated with virological responses to combination therapy in chronic HCV patients.

BACKGROUND: Virus-specific T-cell responses play a major role in antiviral immune response. However, the effect of hepatitis C virus (HCV)-specific T-cell responses on combination therapy still remains controversial. AIMS: To identify the association between HCV-specific T cell responses and efficiency of combination therapy. METHODS: To address this issue, a longitudinal analysis of HCV-specific T-cell responses to overlapping peptides covering HCV-nonstructural protein (NS) was performed using ELISpot assay in 48 chronically infected HCV-1b patients during combination treatment with peginterferon-alfa and ribavirin. RESULTS: Fifty-two percent of chronic HCV patients showed detectable HCV-NS3, NS4 or NS5A specific T-cell responses before therapy, with NS3 appearing to be the most immunodominant protein followed by NS5A and NS4. In addition, the percentage of patients responding to peptide stimulation was higher in patients with sustained virological response (SVR) when compared with those without SVR. Dynamics of HCV-NS-specific T-cell responses were further analysed; we found that HCV-specific T-cell responses maintained higher levels at 12 weeks into treatment in patients with SVR. In contrast, HCV-specific T-cell responses in patients without SVR declined significantly at 4 weeks into treatment and maintained low levels at 12 weeks. CONCLUSION: We found that the HCV-specific T-cell responses were associated with good viral control in patients with combination therapy.

[The effect of proliferation and differentiation of CD8+ T cells on the progression in patients co-infected with HIV and HCV].

OBJECTIVE: To investigate the effect of proliferation and differentiation of CD8 T cells on the progression in patients co-infected with HIV and HCV. METHODS: To address this issue, the presences of CD57 and CD28 in the surface of CD8+ T-cell were monitored using flow cytometry in 20 patients co-infected with HIV and HCV and 20 patients infected with HCV alone. The proliferation and differentiations of CD8+ T cell were compared hetween patients co-infected with HIV and HCV and ones with HCV infection alone, to clarify the association hetween the function of CU and the progression of disease. RESULTS: A high presence (28.84 +/- 4.49)% of CD57 in the surface of CD8+ T-cell in the patients with HIV/HCV co-infections was found, comparing with a low presence (8.24% +/- 5.05%) of CU57 in the patients with HCV infection alone, the difference hetween these two groups is significant (P < 0.001). Moreover, A clear linear regression hetween the percentage of CD57CD8t T and HCV viral load (log) was identified (P = 0.023, R2 = 0.21). In addition, the differentiations of CD8 T cells were compared between patients with HIV/HCV co-infection and mono-HCV infection: the dominant cells in patients with mono-HCV infection were ones in intermediate stage, while, a late differentiation process of CU8 T cells might he associated with HIV/HCV co-infection. CONCLUSION: The differences of proliferation and differentiation of CTL. are significant, between HIV/HCV co- infection and mono-HCV infection. Lower proliferation and late stage of differentiations of CD8 T cell might affect the clearance of hepatitis C virus, weaken CU immunological response and induce chronic inflammation, finally will accelerate the progression of HCV infection.