Early differentiated CD28+ CD27+ T lymphocytes as a biomarker for short and long-term outcomes in older patients with pneumonia.

This study tested the hypothesis that a more senescent immune system would predict a worse outcome in older patients hospitalized for community-acquired pneumonia (CAP). CAP has long been responsible for high rates of mortality and readmissions among older people. Although immunosenescence is a key factor in the increased susceptibility to infections, there are no related biomarkers currently available in clinical practice. In this context, the aim of this prospective study was to identify immunosenescence-related biomarkers to predict outcomes in patients older than 65 years hospitalized for CAP. We evaluated 97 patients admitted to our hospital for CAP in 2019 and 2020. All patients were followed for 1 year. Our findings showed that elevated levels of early differentiated CD28+ CD27+ T cells at admission were associated with better short (2 months) and long-term (1 year) outcomes in terms of mortality and readmissions. Early differentiated CD28+ CD27+ CD4+ T cell counts were even better long-term predictors. In conclusion, early differentiated CD28+ CD27+ T cells could be useful biomarkers to identify high-risk older patients with CAP, helping clinicians with risk stratification and follow-up.

Mediastinitis aguda como complicación atípica de una mononucleosis infecciosa / Acute mediastinitis as a rare complication of an infectious mononucleosis

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Impacto de una intervención multidimensional en pacientes >= 65 años tras un ingreso por neumonía: estudio aleatorizado / Impact of a multidimensional intervention in elderly patients with community-acquired pneumonia: IMIEPCAP clinical trial

Introducción El objetivo principal del estudio es evaluar si una intervención multidimensional en los ancianos que han sido ingresados por neumonía disminuye los reingresos hospitalarios y el número de consultas a urgencias durante el año siguiente a la intervención. Metodología. Ensayo clínico no farmacológico unicéntrico con 2 grupos de estudio paralelos en los que los pacientes son asignados aleatoriamente. Se incluirán 314 pacientes (157 en cada grupo). Serán sujetos del estudio los pacientes ≥ 65 años con índice de Barthel ≥ 60 que ingresen por neumonía. El grupo intervención recibirá a los 2 meses del ingreso por neumonía una intervención geriátrica realizada por un médico y una enfermera en la que se incluyen los siguientes componentes: vacunación, nutrición, estado funcional, estado cognitivo y comorbilidades. El grupo control realizará el seguimiento convencional. Se evaluará al año de la intervención el número de ingresos, consultas a urgencias, estado funcional, supervivencia e institucionalización. Si esta intervención demostrara mejorar las variables estudiadas, dispondríamos de una intervención estandarizada y relativamente sencilla que nos permitiría mejorar los resultados de salud a nivel individual e indirectamente disminuir los costes relacionados con la asistencia a estos pacientes (AU)

Introduction. The main objective of this study is to determine whether a multidimensional intervention applied to elderly patients admitted to hospital due to pneumonia reduces re-admissions and emergency department visits in the year after the intervention. Methodology. This is a single-centre non-pharmacological randomised clinical trial with a parallel design. Three hundred and fourteen patients will be included (157 in each arm). Eligible patients will be ≥ 65 years old and with a Barthel index ≥ 60 that are admitted to hospital due to pneumonia. Participants will be randomised to multidimensional intervention or to control group. Two months after hospital discharge the intervention group will receive a geriatric intervention, carried out by a nurse and a physician. It will include assessment of co-morbidities, nutritional, functional and cognitive status, and immunisation. The control group will receive conventional follow-up. The number of re-admissions, visits to the emergency department, functional status, survival, and institutionalisation will be evaluated one year after intervention. If the intervention shows an improvement in the studied outcomes, it would allow us to improve individual outcomes, and indirectly reduce healthcare costs using a relatively simple, standardised tool (AU)

[Impact of a multidimensional intervention in elderly patients with community-acquired pneumonia: IMIEPCAP clinical trial]. / Impacto de una intervención multidimensional en pacientes ≥65años tras un ingreso por neumonía: estudio aleatorizado.

INTRODUCTION: The main objective of this study is to determine whether a multidimensional intervention applied to elderly patients admitted to hospital due to pneumonia reduces re-admissions and emergency department visits in the year after the intervention. METHODOLOGY: This is a single-centre non-pharmacological randomised clinical trial with a parallel design. Three hundred and fourteen patients will be included (157 in each arm). Eligible patients will be ≥65 years old and with a Barthel index ≥60 that are admitted to hospital due to pneumonia. Participants will be randomised to multidimensional intervention or to control group. Two months after hospital discharge the intervention group will receive a geriatric intervention, carried out by a nurse and a physician. It will include assessment of co-morbidities, nutritional, functional and cognitive status, and immunisation. The control group will receive conventional follow-up. The number of re-admissions, visits to the emergency department, functional status, survival, and institutionalisation will be evaluated one year after intervention. If the intervention shows an improvement in the studied outcomes, it would allow us to improve individual outcomes, and indirectly reduce healthcare costs using a relatively simple, standardised tool.