Predictors of mechanical ventilation and mortality in critically ill patients with COVID-19 pneumonia / Predictores de ventilación mecánica y mortalidad en pacientes críticos con neumonía por COVID-19

Objective To determine if potential predictors for invasive mechanical ventilation (IMV) are also determinants for mortality in COVID-19-associated acute respiratory distress syndrome (C-ARDS). Design Single center highly detailed longitudinal observational study. Setting Tertiary hospital ICU: two first COVID-19 pandemic waves, Madrid, Spain. Patients or participants : 280 patients with C-ARDS, not requiring IMV on admission. Interventions None. Main variables of interest : Target: endotracheal intubation and IMV, mortality. Predictors: demographics, hourly evolution of oxygenation, clinical data, and laboratory results. Results The time between symptom onset and ICU admission, the APACHE II score, the ROX index, and procalcitonin levels in blood were potential predictors related to both IMV and mortality. The ROX index was the most significant predictor associated with IMV, while APACHE II, LDH, and DaysSympICU were the most with mortality. Conclusions According to the results of the analysis, there are significant predictors linked with IMV and mortality in C-ARDS patients, including the time between symptom onset and ICU admission, the severity of the COVID-19 waves, and several clinical and laboratory measures. These findings may help clinicians to better identify patients at risk for IMV and mortality and improve their management. (AU)

Objetivo Determinar si las variables clínicas independientes que condicionan el inicio de ventilación mecánica invasiva (VMI) son los mismos que condicionan la mortalidad en el síndrome de distrés respiratorio agudo asociado con COVID-19 (C-SDRA). Diseño Estudio observacional longitudinal en un solo centro. Ámbito UCI, hospital terciario: primeras dos olas de COVID-19 en Madrid, España. Pacientes o participantes 280 pacientes con C-SDRA que no requieren VMI al ingreso en UCI. Intervenciones Ninguna. Principales variables de interés Objetivo: VMI y Mortalidad. Predictores: demográficos, variables clínicas, resultados de laboratorio y evolución de la oxigenación. Resultados El tiempo entre el inicio de los síntomas y el ingreso en la UCI, la puntuación APACHE II, el índice ROX y los niveles de procalcitonina en sangre eran posibles predictores relacionados tanto con la IMV como con la mortalidad. El índice ROX fue el predictor más significativo asociada con la IMV, mientras que APACHE II, LDH y DaysSympICU fueron los más influyentes en la mortalidad. Conclusiones Según los resultados obtenidos se identifican predictores significativos vinculados con la VMI y mortalidad en pacientes con C-ARDS, incluido el tiempo entre el inicio de los síntomas y el ingreso en la UCI, la gravedad de las olas de COVID-19 y varias medidas clínicas y de laboratorio. Estos hallazgos pueden ayudar a los médicos a identificar mejor a los pacientes en riesgo de IMV y mortalidad y mejorar su manejo. (AU)

Serum Krebs von den Lungen-6 is associated with in-Hospital mortality of patients with severe Community-Acquired Pneumonia: A retrospective cohort study.

BACKGROUND: Currently, no ideal biomarker can accurately stratify the risk of patients with severe community-acquired pneumonia (SCAP). This study aimed to evaluate the role of serum Krebs von den Lungen-6 (sKL-6) in predicting in-hospital mortality in adults with SCAP. METHODS: In this retrospective cohort study, 249 severe pneumonia adult patients were recruited between 6 May 2021 to 30 April 2023 in Xiangya Hospital of Central South University. The sKL-6 level within 48 h of admission was measured, and the primary outcome assessed was in-hospital mortality. Multivariable logistic regression analysis was performed to calculate adjusted odds ratios (OR) with 95% confidence intervals (CI). Survival curves were plotted and subgroup analyses were conducted, stratified by relevant covariates. RESULTS: A total of 249 patients were included in the study,with 124 patients having normal sKL-6 levels, and 125 patients having abnormal sKL-6 levels. The overall in-hospital mortality rate was 28.9% (72 out of 249 patients). Univariate and multivariate logistic regression analysis revealed that the patients with abnormal sKL-6 levels had a higher risk of in-hospital mortality compared to those with normal sKL-6 levels, both in the total SCAP patient population (OR: 5.38, 95%CI: 2.41-12.01, P < 0.001) and the non-COVID-19 SCAP patients subgroup (OR: 8.12, 95%CI: 3.16-20.84, P < 0.001). Subgroup and interaction analyses confirmed the stability of the relationship between sKL-6 levels and in-hospital mortality(P for interaction > 0.05). Kaplan-Meier survival curves showed that patients with abnormal sKL-6 levels had a higher in-hospital mortality rate than those with normal sKL-6 levels (P < 0.05). However, the results of restricted cubic spline plots(RCS) analysis demonstrated a nonlinear association between sKL-6 levels (as a continuous variable) and in-hospital mortality in patients with SCAP. Similar results were observed in non-COVID-19 SCAP patients. Furthermore, the receiver operating characteristic curve (ROC) analysis revealed that sKL-6 had superior predictive performance compared to existing biomarkers (e.g., APACHE-II, SOFA, BUN/Cr, PCT, and D-dimer) for in-hospital mortality in non-COVID-19 SCAP patients. CONCLUSION: sKL-6 is a practical and useful biomarker for predicting in-hospital mortality in patients with SCAP.

Impact of macrolide treatment on long-term mortality in patients admitted to the ICU due to CAP: a targeted maximum likelihood estimation and survival analysis.

INTRODUCTION: Patients with community-acquired pneumonia (CAP) admitted to the intensive care unit (ICU) have high mortality rates during the acute infection and up to ten years thereafter. Recommendations from international CAP guidelines include macrolide-based treatment. However, there is no data on the long-term outcomes of this recommendation. Therefore, we aimed to determine the impact of macrolide-based therapy on long-term mortality in this population. METHODS: Registered patients in the MIMIC-IV database 16 years or older and admitted to the ICU due to CAP were included. Multivariate analysis, targeted maximum likelihood estimation (TMLE) to simulate a randomised controlled trial, and survival analyses were conducted to test the effect of macrolide-based treatment on mortality six-month (6 m) and twelve-month (12 m) after hospital admission. A sensitivity analysis was performed excluding patients with Pseudomonas aeruginosa or MRSA pneumonia to control for Healthcare-Associated Pneumonia (HCAP). RESULTS: 3775 patients were included, and 1154 were treated with a macrolide-based treatment. The non-macrolide-based group had worse long-term clinical outcomes, represented by 6 m [31.5 (363/1154) vs 39.5 (1035/2621), p < 0.001] and 12 m mortality [39.0 (450/1154) vs 45.7 (1198/2621), p < 0.001]. The main risk factors associated with long-term mortality were Charlson comorbidity index, SAPS II, septic shock, and respiratory failure. Macrolide-based treatment reduced the risk of dying at 6 m [HR (95% CI) 0.69 (0.60, 0.78), p < 0.001] and 12 m [0.72 (0.64, 0.81), p < 0.001]. After TMLE, the protective effect continued with an additive effect estimate of - 0.069. CONCLUSION: Macrolide-based treatment reduced the hazard risk of long-term mortality by almost one-third. This effect remains after simulating an RCT with TMLE and the sensitivity analysis for the HCAP classification.

Hydrocortisone in Severe Community-Acquired Pneumonia.

BACKGROUND: Whether the antiinflammatory and immunomodulatory effects of glucocorticoids may decrease mortality among patients with severe community-acquired pneumonia is unclear. METHODS: In this phase 3, multicenter, double-blind, randomized, controlled trial, we assigned adults who had been admitted to the intensive care unit (ICU) for severe community-acquired pneumonia to receive intravenous hydrocortisone (200 mg daily for either 4 or 7 days as determined by clinical improvement, followed by tapering for a total of 8 or 14 days) or to receive placebo. All the patients received standard therapy, including antibiotics and supportive care. The primary outcome was death at 28 days. RESULTS: A total of 800 patients had undergone randomization when the trial was stopped after the second planned interim analysis. Data from 795 patients were analyzed. By day 28, death had occurred in 25 of 400 patients (6.2%; 95% confidence interval [CI], 3.9 to 8.6) in the hydrocortisone group and in 47 of 395 patients (11.9%; 95% CI, 8.7 to 15.1) in the placebo group (absolute difference, -5.6 percentage points; 95% CI, -9.6 to -1.7; P = 0.006). Among the patients who were not undergoing mechanical ventilation at baseline, endotracheal intubation was performed in 40 of 222 (18.0%) in the hydrocortisone group and in 65 of 220 (29.5%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.40 to 0.86). Among the patients who were not receiving vasopressors at baseline, such therapy was initiated by day 28 in 55 of 359 (15.3%) of the hydrocortisone group and in 86 of 344 (25.0%) in the placebo group (hazard ratio, 0.59; 95% CI, 0.43 to 0.82). The frequencies of hospital-acquired infections and gastrointestinal bleeding were similar in the two groups; patients in the hydrocortisone group received higher daily doses of insulin during the first week of treatment. CONCLUSIONS: Among patients with severe community-acquired pneumonia being treated in the ICU, those who received hydrocortisone had a lower risk of death by day 28 than those who received placebo. (Funded by the French Ministry of Health; CAPE COD ClinicalTrials.gov number, NCT02517489.).

Association of body mass index and weight change with pneumonia mortality in a Japanese population: Japan Public Health Center-based Prospective Study.

BACKGROUND: Accumulating evidence suggests that pneumonia mortality is lower for individuals with high body mass index (BMI) compared to normal BMI, but it remains unclear whether weight change during adulthood influences subsequent mortality due to pneumonia in Asian populations, who have a relatively lean body mass. This study aimed to examine the association of BMI and weight change over 5 years with the subsequent risk of pneumonia mortality in a Japanese population. METHODS: The present analysis included 79,564 Japan Public Health Center (JPHC)-based Prospective Study participants who completed a questionnaire between 1995 and 1998 were followed for death through 2016. BMI was categorized into four groups: underweight (<18.5 kg/m2), normal weight (BMI: 18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (BMI: ≥30.0 kg/m2). Weight change was defined as the difference of body weight between questionnaire surveys with a 5-year interval. Cox proportional hazards regression was used to estimate hazard ratios of baseline BMI and weight change for pneumonia mortality. RESULTS: During a median follow-up of 18.9 y, we identified 994 deaths from pneumonia. Compared with participants with normal weight, an elevated risk was observed among those who were underweight (hazard ratio = 2.29, 95% confidence interval [CI]: 1.83-2.87), whereas a decreased risk was found among those who were overweight (hazard ratio = 0.63, 95% CI: 0.53-0.75). Regarding weight change, the multivariable-adjusted hazard ratio (95% CI) of pneumonia mortality for a weight loss of 5 kg or more versus a weight change of less than 2.5 kg was 1.75 (1.46-2.10), whereas that for a weight gain of 5 kg or more was 1.59 (1.27-2.00). CONCLUSION: Underweight and greater weight change was associated with an increase in the risk of pneumonia mortality in Japanese adults.

Predictores de muerte en pacientes hospitalizados por neumonía adquirida en la comunidad / Predictors of death in patients hospitalized for community-acquired pneumonia

Fundamento: la neumonía adquirida en la comunidad constituye un importante problema de salud dada su elevada incidencia y relación con la mortalidad. Objetivo: Evaluar la asociación de factores seleccionados con la letalidad en pacientes hospitalizados por neumonía adquirida en la comunidad. Método: estudio descriptivo que incluyó 1.809 pacientes con neumonía hospitalizados entre los años 2012 y 2020. Fueron evaluados factores relacionados con el paciente, con la enfermedad y con la intervención terapéutica, como variables independientes; como variable dependiente fue considerado el estado al alta. En el análisis estadístico, que incluyó análisis bivariado y multivariado (regresión logística), se utilizó el odds ratio y su intervalo de confianza de 95%. Resultados: Se demostró asociación significativa entre varias condiciones evaluadas y la letalidad por neumonía; los factores que mostraron mayor fuerza de asociación fueron la edad de 60 años o más (OR 4,8[2,9;7,9]), el estado de gravedad al ingreso (OR 2,7[2;3,5]), el encamamiento durante la hospitalización (OR 2,5[1,9;3,3]), el encamamiento previo al ingreso (OR 2[1,5;2,7]), el no tratamiento adecuado de las comorbilidades (OR 1,8[1,07;3,3]) y la extensión radiológica del proceso neumónico más allá de un lóbulo (OR 1,7[1,3;2,2]). Conclusiones: Se reafirma el relevante papel que desempeñan una serie de factores relacionados con condicionantes del paciente, con la propia enfermedad y con la intervención médica, en las probabilidades de morir por esta afección. (AU)

Background: community-acquired pneumonia is an important health problem given its high incidence and relationship with mortality. Objective: to evaluate the association of selected factors with lethality in patients hospitalized for community-acquired pneumonia. Method: descriptive study that included 1,809 patients with pneumonia hospitalized between 2012 and 2020. Factors related to the patient, the disease, and the therapeutic intervention were evaluated as independent variables; The state at discharge was considered as the dependent variable. In the statistical analysis, which included bivariate and multivariate analysis (logistic regression), the odds ratio and its 95% confidence interval were used. Results: a significant association was demonstrated between several conditions evaluated and the lethality due to pneumonia; the factors that showed the greatest strength of association were age 60 years or older (OR 4.8[2.9;7.9]), severity status at admission (OR 2.7[2;3.5] ), bedridden during hospitalization (OR 2.5[1.9;3.3]), bedridden prior to admission (OR 2[1.5;2.7]), failure to adequately treat comorbidities ( OR 1.8[1.07;3.3]) and radiological extension of the pneumonic process beyond one lobe (OR 1.7[1.3;2.2]). Conclusions: the relevant role played by a series of factors related to the patient's conditions, to the disease itself and to medical intervention, in the chances of dying from this condition is reaffirmed. (AU)

Protocolo clínico de atendimento de pneumonia adquirida na comunidade para Pronto-Socorro Infantil do Hospital do Servidor Público Municipal de São Paulo / Clinical protocol for community-acquired pneumonia care for the Children's Emergency Room of the Hospital do Servidor Público Municipal de São Paulo

A pneumonia adquirida na comunidade (PAC) é a infecção aguda do parênquima pulmonar que ocorre no meio comunitário. A PAC representa a maior causa de morbidade e mortalidade em todo o mundo em crianças abaixo de cinco anos. Nesta faixa etária, a etiologia viral é a mais comum; porém, dentre as causas bacterianas, o Streptoccocus pneumoniae é o mais prevalente. As manifestações clínicas variam de acordo com o patógeno, hospedeiro e da gravidade da doença, sendo geralmente descrita com tosse, febre e desconforto respiratório. A PAC complicada é a pneumonia que, apesar do uso de antibióticos, evolui com complicações locais ou sistêmicas. Nos pacientes hospitalizados, as hemoculturas devem ser consideradas para auxiliar no diagnóstico etiológico e planejamento terapêutico. O tratamento inicial deve ser iniciado empiricamente com antibióticos. Caso haja necessidade de hospitalização, hemoculturas devem ser consideradas para auxiliar na propedêutica. Após implementação das vacinas pneumocócicas, principalmente após introdução da vacina pneumocócica 13 valente (PCV 13), houve redução significativa dos casos de pneumonia bacteriana e também da necessidade hospitalização. Diante de tal realidade, a elaboração do trabalho possui como objetivo a melhora dos procedimentos e a padronização dos atendimentos da população pediátrica com um quadro clínico sugestivo pneumonia adquirida na comunidade, que procura o serviço de Pronto Atendimento Infantil do Hospital do Servidor Público Municipal de São Paulo (HSPM), ao construir um protocolo clínico de atendimento específico para a doença. O presente trabalho objetiva elaborar um protocolo clínico de atendimento de pneumonia adquirida na comunidade no Hospital do Servidor Público Municipal de São Paulo, contribuindo na assistência médica dos pacientes pediátricos. Apesar do grande avanço com a introdução das vacinas pneumocócicas, a PAC ainda representa uma importante causa de mortalidade na população infantil, sendo fundamental a elaboração de protocolos clínicos para abordar corretamente os pacientes que recorrem a um Pronto Socorro Infantil. Protocolos clínicos são diretrizes fundamentadas nas melhores práticas para a abordagem e tratamento de determinadas doenças, baseadas em evidência científica. O presente trabalho objetiva a melhora dos procedimentos e a uniformização dos atendimentos da população pediátrica com pneumonia, que procura o serviço de Pronto Atendimento Infantil do Hospital do Servidor Público Municipal de São Paulo (HSPM), com a construção de um protocolo clínico de atendimento específico para a doença, a partir da revisão de literatura atualizada, cujo período de vigência seguirá os progressos científicos sobre o tema. Palavras-chave: Pneumonia Adquirida da Comunidade. Protocolos clínicos. Pediatria. Serviços Médicos de Emergência. Vacinas Pneumocócicas

Teeth record pneumonia-and racism.

Research raises standards for working with anthropological collections.

Performance of host-response biomarkers to risk-stratify children with pneumonia in Bhutan.

Pneumonia is the leading cause of post-neonatal death amongst children under five years of age; however, there is no simple triage tool to identify children at risk of progressing to severe and fatal disease. Such a tool could assist for early referral and prioritization of care to improve outcomes and enhance allocation of scarce resources. We compared the performance of inflammatory and endothelial activation markers in addition to clinical signs or scoring scales to risk-stratify children hospitalized with pneumonia at the national referral hospital of Bhutan with the goal of predicting clinical outcome. Of 118 children, 31 evolved to a poor prognosis, defined as either mortality, admission in the paediatric intensive care unit, requirement of chest drainage or requirement of more than five days of oxygen therapy. Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) was the best performing biomarker and performed better than clinical parameters. sTREM-1 levels upon admission had good predictive accuracy to identify children with pneumonia at risk of poor prognosis. Our findings confirm that immune and endothelial activation markers could be proactively used at first encounter as risk-stratification and clinical decision-making tools in children with pneumonia; however, further external validation is needed.

Tendencias en la mortalidad por neumonía en adultos en Chile, 2000-2016 / Trends in adult pneumonia mortality in Chile, 2000-2016

Objetivo: Analizar y modelar los cambios en la tendencia de la mortalidad por neumonía en la población mayor de 15 años de Chile, entre los años 2000 y 2016. Métodos: Estudio epidemiológico basado en información de bases de datos públicas de estadísticas vitales del Departamento de Estadística e Información en Salud (DEIS) y del Instituto Nacional de Estadística (INE) del Ministerio de Salud (MINSAL) de Chile. Los casos fueron identificados por los códigos CIE-10 J12-J18. Se calculó la tasa de mortalidad estandarizada por edad, según sexo y grupo etario. Se utilizó el análisis de regresión Joinpoint para modelar la mortalidad y estimar el porcentaje de cambio anual (CPA) en las tasas e identificar cambios significativos en las tendencias. Se utilizó el cambio del CPA como medida de resumen. Resultados: Durante el período de estudio, la tasa de mortalidad por neumonía en Chile disminuyó significativamente en un 61,9%, desde 56,3 muertes por 100.000 habitantes el año 2000 a 21,7 muertes por 100.000 habitantes en el año 2016, con un CPA de −4,2%, (p < 0,05). El 90% de los fallecidos tenían más de 65 años. Conclusiones: Las tasas de mortalidad por neumonía en Chile en mayores de 15 años muestran una tendencia a la disminución sostenida significativa en el período comprendido entre los años 2000 y 2016.

Objective: To analyze and model changes in the pneumonia mortality trend in the population over 15 years old of Chile, between 2000 and 2016. Methods: Epidemiological study based on information from public databases of vital statistics of the Department of Health Statistics and Information (DEIS) and the National Institute of Statistics (INE) of the Ministry of Health (MINSAL) of Chile. The cases were identified by the codes ICD-10 J12-J18. We calculated age-standardized overall mortality, according to sex and age group. Joinpoint regression analysis was used to model mortality and estimate the annual percentage of change (APC) in rates and identify significant changes in trends. APC was used as a summary measure. Results: During the period studied, the pneumonia mortality rate in Chile decreased significantly by 61.9%. Mortality rate diminished from 56.3 deaths per 100,000 inhabitants in 2000 to 21.7 deaths per 100,000 inhabitants in 2016 with an APC of −4.2%, (p < 0.05). Almost 90% of the deceased were over 65 years old. Conclusions: Mortality rates for pneumonia in Chile in people over 15 years of age show a significant sustained decreasing trend in the period between 2000 and 2016.

Validación del instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años / Validation of the instrument to measure environmental factors associated with pneumonia in children under 5 years of age

La neumonía es una infección respiratoria que afecta a los pulmones y puede llevar a la muerte. Los niños menores de 5 años pueden adquirir la enfermedad a través de bacterias, virus y hongos, lo cual puede generarse por ciertos factores ambientales no propicios. Objetivos: Validar el instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años que acuden a consulta externa del hospital Martin Icaza del Cantón Babahoyo, julio - diciembre 2020; determinar la confiabilidad del instrumento para medir los factores ambientales asociados a neumonía en niños menores de 5 años. Materiales y métodos: Se utiliza un diseño no experimental, con enfoque mixto, método deductivo, de tipo transversal, de campo, prospectivo. Se aplicó un plan piloto con el fin de identificar la validez, coherencia y pertinencia del instrumento, y a su vez determinar la confiabilidad del mismo con base al criterio de expertos. El componente cuantitativo constó de un plan piloto a 16 padres, donde 8 niños padecían neumonía, mientras los 8 restantes no; en tanto que la entrevista se realizó a dos representantes de niños con neumonía. Resultados: La validación de los instrumentos vino dada por tres profesionales que fueron seleccionados por su experiencia y prestigio, estos calificaron la validez, pertinencia y coherencia donde se obtuvo la ponderación de muy confiable. Los resultados mostraron que la enfermedad se transmite por contacto con personas que padecen estas enfermedades (62.5%), los principales síntomas son la tos, fiebre y dolor de garganta (50.0%), las personas viven con 4 o 5 personas en la misma casa (56.3%) y poseen animales (75.0%). Se identificó efectos emocionales negativos, tales como desesperación, ansiedad, tristeza, depresión e impotencia. Conclusión: El instrumento analizado es válido, coherente y pertinente, siendo muy confiable para su aplicación(AU)

Pneumonia is a respiratory infection that affects the lungs and can lead to death. Children under 5 years of age can acquire the disease through bacteria, viruses and fungi, which can be generated by certain unfavorable environmental factors. Objectives: To validate the instrument to measure the environmental factors associated with pneumonia in children under 5 years of age who attend the outpatient clinic of the Martin Icaza hospital in Babahoyo Canton, July - December 2020; determine the reliability of the instrument to measure the environmental factors associated with pneumonia in children under 5 years of age. Materials and methods: A non-experimental design is used, with a mixed approach, deductive method, cross-sectional, field, prospective. A pilot plan was applied in order to identify the validity, coherence and relevance of the instrument, and in turn determine its reliability based on expert criteria. The quantitative component consisted of a pilot plan for 16 parents, where 8 children suffered from pneumonia, while the remaining 8 did not; while the interview was conducted with two representatives of children with pneumonia. Results: The validation of the instruments was given by three professionals who were selected for their experience and prestige, they qualified the validity, relevance and coherence where the weighting of very reliable was obtained. The results showed that the disease is transmitted by contact with people suffering from these diseases (62.5%), the main symptoms are cough, fever and sore throat (50.0%), people live with 4 or 5 people in the same house (56.3%) and own animals (75.0%). Negative emotional effects were identified, such as despair, anxiety, sadness, depression and helplessness. Conclusion: The analyzed instrument is valid, coherent and pertinent, being very reliable for its application(AU)

Ceftaroline in severe community-acquired pneumonia

Severe community-acquired pneumonia (SCAP) is associated with high mortality. Factor such as early adequate antibiotic therapy, delay in intensive care unit (ICU) care and pneumonia caused by resistant pathogens are associated with worseoutcomes in SCAP patients. Ceftaroline is a fifth-generationcephalosporin with bactericidal activity against Gram-positivepathogens (including methicillin-resistant Staphylococcus aureus [MRSA] and multidrug-resistant Streptococcus pneumoniae) and common Gram-negative organisms. The efficacy andsafety for the treatment of pneumonia was evaluated in threerandomized control trials were ceftaroline demonstrated superiority against ceftriaxone for the treatment of pneumoniain hospitalized patients with Pneumonia Severity Index (PSI)III – IV. (AU)

Cefiderocol

Cefiderocol is a new siderophore cephalosporin with potent in vitro activity against gram-negative bacilli includingEnterobacterales that produce all kinds of carbapenemases andnon-fermenting Gram-negative with difficult-to-treat resistance. As a β-lactam, its efficacy is optimized in extended-perfusion and requires dose adjustment in renal dysfunction andhyperclearance. Its efficacy has been validated in three clinical trials, one of them in the treatment of hospital-acquiredpneumonia and ventilator-associated pneumonia. The clinicaltrial aimed at difficult-to-treat gram-negatives achieved theclinical and microbiological target, but the increase in mortalityobserved in the cefiderocol arm makes it necessary to demonstrate efficacy in real clinical practice. Cefiderocol is a goodoption among the new β-lactams for the treatment of pneumonia caused by Gram-negative bacilli carbapenem-resistant (AU)

Aspiration pneumonia

The growing population of older people worldwide represents a great challenge for health systems. The elderly are atincreased risk of infectious diseases such as pneumonia, whichis associated with increased morbidity and mortality relatedmainly to age-related physiological changes in the immunesystem (immunosenescence), the presence of multiple chronic comorbidities, and frailty. In pneumonia, microaspiration isrecognized as the main pathogenic mechanism; while macroaspiration which refers to the aspiration of a large amountof oropharyngeal or upper gastrointestinal content passingthrough the vocal cords and trachea into the lungs is identified as “aspiration pneumonia”. Although there are strategiesfor the prevention and management of patients with pneumonia that have been shown to be effective in older people withpneumonia, more research is needed on aspiration pneumonia,its risk factors and outcomes, especially since there are no specific criteria for its diagnosis and consequently, the studies onaspiration pneumonia include heterogeneous populations.Keywords: pneumonia, aspiration, elderly (AU)

Bacteremic pneumococcal pneumonia: arrhythmogenic disease

No disponible

Predictors of in-hospital mortality of COVID-19 patients and the role of telemetry in an internal medicine ward during the third phase of the pandemic.

OBJECTIVE: The first pandemic phase of COVID-19 in Italy was characterized by high in-hospital mortality ranging from 23% to 38%. During the third pandemic phase there has been an improvement in the management and treatment of COVID-19, so mortality and predictors may have changed. A prospective study was planned to identify predictors of mortality during the third pandemic phase. PATIENTS AND METHODS: From 15 December 2020 to 15 May 2021, 208 patients were hospitalized (median age: 64 years; males: 58.6%); 83% had a median of 2 (IQR,1-4) comorbidities; pneumonia was present in 89.8%. Patients were monitored remotely for respiratory function and ECG trace for 24 hours/day. Management and treatment were done following the timing and dosage recommended by international guidelines. RESULTS: 79.2% of patients necessitated O2-therapy. ARDS was present in 46.1% of patients and 45.4% received non-invasive ventilation and 11.1% required ICU treatment. 38% developed arrhythmias which were identified early by telemetry and promptly treated. The in-hospital mortality rate was 10%. At multivariate analysis independent predictors of mortality were: older age (R-R for≥70 years: 5.44), number of comorbidities ≥3 (R-R 2.72), eGFR ≤60 ml/min (RR 2.91), high d-Dimer (R-R for≥1,000 ng/ml:7.53), and low PaO2/FiO2 (R-R for <200: 3.21). CONCLUSIONS: Management and treatment adherence to recommendations, use of telemetry, and no overcrowding appear to reduce mortality. Advanced age, number of comorbidities, severe renal failure, high d-Dimer and low P/F remain predictors of poor outcome. The data help to identify current high-risk COVID-19 patients in whom management has yet to be optimized, who require the greatest therapeutic effort, and subjects in whom vaccination is mandatory.

A Broad Learning System to Predict the 28-Day Mortality of Patients Hospitalized with Community-Acquired Pneumonia: A Case-Control Study.

This study was to conduct a model based on the broad learning system (BLS) for predicting the 28-day mortality of patients hospitalized with community-acquired pneumonia (CAP). A total of 1,210 eligible CAP cases from Chifeng Municipal Hospital were finally included in this retrospective case-control study. Random forest (RF) and an eXtreme Gradient Boosting (XGB) models were used to develop the prediction models. The data features extracted from BLS are utilized in RF and XGB models to predict the 28-day mortality of CAP patients, which established two integrated models BLS-RF and BLS-XGB. Our results showed the integrated model BLS-XGB as an efficient broad learning system (BLS) for predicting the death risk of patients, which not only performed better than the two basic models but also performed better than the integrated model BLS-RF and two well-known deep learning systems-deep neural network (DNN) and convolutional neural network (CNN). In conclusion, BLS-XGB may be recommended as an efficient model for predicting the 28-day mortality of CAP patients after hospital admission.

Behavior of clinical and humoral variables on admission as predictors of death in patients with community-acquired pneumonia. Comparative study between adults and older adults. / Comportamiento de variables clínicas y humorales al ingreso, como predictores de fallecimiento en pacientes con neumonía adquirida en la comunidad. Estudio comparativo entre adultos y adultos mayores

Community-acquired pneumonia is recognized as one of the main infectious health problems worldwide. The objective was to determine the condition of predictors of death for a group of selected clinical conditions, and for laboratory variables frequently used in practice. Study with descriptive design, which included 967 patients with pneumonia hospitalized between 2016 and 2019, and whose information was obtained from clinical records. Statistical treatment included bivariate and multivariate analysis (logistic regression); it was used the ratio of crossed products (odds ratio) and its 95% confidence interval. Several manifestations were significantly more frequent in older adults: dyspnea (OR 1.5[1.07,2.1]), absence of productive cough (OR 1.7 [1.3, 2.4]), neuropsychological manifestations (OR 2 [1.4,2.8]), tachypnea (OR 1.5 [1.1,2.1]), arterial hypotension (OR 2.1 [1.2,3.6]), anemia (OR 1.6[1.2,2.2]), elevated creatinine (OR 1.6[1.2,2.3]) and hypoproteinemia (OR 3.3[1.9,5.7]); showed a significant association with death: absence of productive cough, neuropsychological manifestations, temperature below 36 degrees Celsius, blood pressure below 110/70 mmHg, respiratory rate above 20 per minute, hemoglobin below 100 g/L, erythrosedimentation greater than 20 mm/L, leukopenia less than 5 x 109/L and serum creatinine above 130 micromol/L. As conclusions certain clinical and laboratory conditions present in the patient at the time of hospital admission, of routine exploration in the comprehensive assessment of the patient, were predictors of death. Additionally, the existence of evident differences in the number of conditions with a predictive nature of death between the population with pneumonia under 60 years of age and the elderly, as well as in the frequency of these conditions in both subgroups, is verified.

La neumonía adquirida en la comunidad está reconocida como uno de los principales problemas de salud de tipo infeccioso al nivel mundial. La investigación tuvo como objetivo determinar el carácter de predictores de fallecimiento de un grupo de condiciones clínicas seleccionadas, y de variables de laboratorio de uso frecuente en la práctica. Se realizó un estudio con diseño descriptivo, que incluyó a 967 pacientes con neumonía hospitalizados entre 2016 y 2019, y cuya información se obtuvo de los expedientes clínicos. El tratamiento estadístico incluyó análisis bivariante y multivariado (regresión logística); como estadígrafo se utilizó la razón de productos cruzados (odds ratio) y su intervalo de confianza de 95%. Entre los resultados se destacan los siguientes: varias manifestaciones fueron significativamente más frecuentes en los adultos mayores: disnea (OR 1,5[1,07;2,1]), ausencia de tos productiva (OR 1,7[1,3;2,4]), manifestaciones neuropsicológicas (OR 2[1,4;2,8]), taquipnea (OR 1,5[1,1;2,1]), hipotensión arterial (OR 2,1[1,2;3,6]), anemia (OR 1,6[1,2;2,2]), creatinina elevada (OR 1,6[1,2;2,3]) e hipoproteinemia (OR 3,3[1,9;5,7]); mostraron asociación significativa con el fallecimiento: ausencia de tos productiva, manifestaciones neuropsicológicas, temperatura por debajo de 36 grados Celsius, tensión arterial inferior a 110/70 mmHg, frecuencia respiratoria por encima de 20 por minuto, hemoglobina inferior a 100 g/L, velocidad de sedimentación eritrocitaria superior a 20 mm/L, leucopenia inferior a 5 x 109/L y creatinina sérica por encima de 130 micromol/L. Se concluye que ciertas condiciones clínicas y de laboratorio presentes en el paciente al momento del ingreso hospitalario, de exploración habitual en la valoración integral del enfermo, constituyeron predictores de fallecimiento. Adicionalmente, se comprueba la existencia de evidentes diferencias en el número de condiciones con carácter predictor de muerte entre la población con neumonía menor de 60 años y los adultos mayores, así como en la frecuencia de estas condiciones en ambos subgrupos.