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1.
Medicine (Baltimore) ; 100(11): e23656, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725924

RESUMO

ABSTRACT: Inflammation has been believed to contribute to coronavirus disease 2019 (COVID-19). Risk factors for death of COVID-19 pneumonia have not yet been well established.In this retrospective cohort study, we included the deceased patients in COVID-19 specialized ICU with laboratory-confirmed COVID-19 from Guanggu hospital area of Tongji Hospital from February 8th to March 30th. Demographic, clinical, laboratory, and outcome data were extracted from electronic medical records using a standard data collection form. We used Spearman rank correlation and Cox regression analysis to explore the risk factors associated with in-hospital death, especially the association between inflammatory cytokines and death.A total of 205 severe/critical COVID-19 pneumonia patients were admitted in the COVID-19 specialized ICU and 75 deceased patients were included in the final analysis. The median age of the deceasing patients was 70 years (IQR 65-79). The common symptoms were fever (78.9%), cough (70.4%), and expectoration (39.4%). The BNP and CRP levels were far beyond the normal reference range. In the Spearman rank correlation analysis, IL-8 was found to be significantly associated with the time from onset to death (rs= -0.30, P = .034) and that from admission to death (rs= -0.32, P = .019). Cox regression showed after adjusting age and sex, IL-8 levels were still significantly associated with the time from onset to death (P = .003) and that from admission to death (P  = .01).IL-8 levels were associated with in-hospital death in severe/critical COVID-19 patients, which could help clinicians to identify patients with high risk of death at an early stage.


Assuntos
/mortalidade , Interleucina-8/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Estado Terminal , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/mortalidade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença
2.
J Public Health Manag Pract ; 27(3): 233-239, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33762539

RESUMO

OBJECTIVE: To more comprehensively estimate COVID-19-related mortality in Los Angeles County by determining excess all-cause mortality and pneumonia, influenza, or COVID (PIC) mortality. DESIGN: We reviewed vital statistics data to identify deaths registered in Los Angeles County between March 15, 2020, and August 15, 2020. Deaths with an ICD-10 (International Classification of Diseases, Tenth Revision) code for pneumonia, influenza, or COVID-19 listed as an immediate or underlying cause of death were classified as PIC deaths. Expected deaths were calculated using negative binomial regression. Excess mortality was determined by subtracting the expected from the observed number of weekly deaths. The Department of Public Health conducts surveillance for COVID-19-associated deaths: persons who died of nontraumatic/nonaccidental causes within 60 days of a positive COVID-19 test result were classified as confirmed COVID-19 deaths. Deaths without a reported positive SARS-Cov-2 polymerase chain reaction result were classified as probable COVID-19 deaths if COVID-19 was listed on their death certificate or the death occurred 60 to 90 days of a positive test. We compared excess PIC deaths with the number of confirmed and probable COVID-19 deaths ascertained by surveillance. SETTING: Los Angeles County. PARTICIPANTS: Residents of Los Angeles County who died. MAIN OUTCOME MEASURE: Excess mortality. RESULTS: There were 7208 excess all-cause and 5128 excess PIC deaths during the study period. The Department of Public Health also reported 5160 confirmed and 323 probable COVID-19-associated deaths. CONCLUSIONS: The number of excess PIC deaths estimated by our model was approximately equal to the number of confirmed and probable COVID-19 deaths identified by surveillance. This suggests our surveillance definition for confirmed and probable COVID-19 deaths might be sufficiently sensitive for capturing the true burden of deaths caused directly or indirectly by COVID-19.


Assuntos
/mortalidade , Causas de Morte , Influenza Humana/mortalidade , Pandemias/estatística & dados numéricos , Pneumonia/mortalidade , Vigilância da População , Saúde Pública/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Influenza Humana/epidemiologia , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia
3.
BMC Pulm Med ; 21(1): 56, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33573635

RESUMO

BACKGROUND: The effects of comorbidities on chronic obstructive pulmonary disease (COPD) have been usually studied individually in the past. In this study, we aimed to investigate the comorbidities associated with mortality, the effect of multimorbidity on mortality and other factors associated with mortality among Korean COPD population. METHODS: The Korean National Health Insurance Service-National Sample Cohort version 2.0, collected between 2002 and 2015, was used. Among COPD patients [entire cohort (EC), N = 12,779], 44% of the participants underwent additional health examination, and they were analysed separately [health-screening cohort (HSC), N = 5624]. Fifteen comorbidities previously reported as risk factors for mortality were studied using Cox proportional hazards regression models. RESULTS: Total mortality rates were 38.6 per 1000 person-years (95% CI 37.32-40.01) and 27.4 per 1000 person-years (95% CI 25.68-29.22) in EC and HSC, respectively. The most common causes of death were disease progression, lung cancer, and pneumonia. Only some of the comorbidities had a direct impact on mortality. Multimorbidity, assessed by the number of comorbid diseases, was an independent risk factor of all-cause mortality in both cohorts and was a risk factor of respiratory mortality only in HSC. The Kaplan-Meier analysis showed significant differences in survival trajectories according to the number of comorbidities in all-cause mortality but not in respiratory mortality. Low BMI, old age and male sex were independent risk factors for both mortalities in both cohorts. CONCLUSIONS: The number of comorbidities might be an independent risk factor of COPD mortality. Multimorbidity contributes to all-cause mortality in COPD, but the effect of multimorbidity is less evident on respiratory mortality.


Assuntos
Neoplasias Pulmonares/mortalidade , Pneumonia/mortalidade , Doença Pulmonar Obstrutiva Crônica/mortalidade , Idoso , Asma/epidemiologia , Bronquiectasia/epidemiologia , Doenças Cardiovasculares/epidemiologia , Causas de Morte , Estudos de Coortes , Comorbidade , Diabetes Mellitus/epidemiologia , Neoplasias do Sistema Digestório/epidemiologia , Progressão da Doença , Dislipidemias/epidemiologia , Feminino , Refluxo Gastroesofágico/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Hepatopatias/epidemiologia , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Mortalidade , Multimorbidade , Osteoporose/epidemiologia , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Renal Crônica/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco , Neoplasias da Glândula Tireoide/epidemiologia
4.
Virol J ; 18(1): 33, 2021 02 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568204

RESUMO

PURPOSE: To investigate the predictive significance of different pneumonia scoring systems in clinical severity and mortality risk of patients with severe novel coronavirus pneumonia. MATERIALS AND METHODS: A total of 53 cases of severe novel coronavirus pneumonia were confirmed. The APACHE II, MuLBSTA and CURB-65 scores of different treatment methods were calculated, and the predictive power of each score on clinical respiratory support treatment and mortality risk was compared. RESULTS: The APACHE II score showed the largest area under ROC curve in both noninvasive and invasive respiratory support treatment assessments, which is significantly different from that of CURB-65. Further, the MuLBSTA score had the largest area under ROC curve in terms of death risk assessment, which is also significantly different from that of CURB-65; however, no difference was noted with the APACHE II score. CONCLUSION: For patients with COVID, the APACHE II score is an effective predictor of the disease severity and mortality risk. Further, the MuLBSTA score is a good predictor only in terms of mortality risk.


Assuntos
/diagnóstico , Pneumonia/diagnóstico , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , /terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Pneumonia/terapia , Pneumonia/virologia , Prognóstico , Curva ROC , Medição de Risco , Índice de Gravidade de Doença , Adulto Jovem
5.
JAMA Netw Open ; 4(2): e2037053, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33566109

RESUMO

Importance: Alpha 1-adrenergic receptor blocking agents (α1-blockers) have been reported to have protective benefits against hyperinflammation and cytokine storm syndrome, conditions that are associated with mortality in patients with coronavirus disease 2019 and other severe respiratory tract infections. However, studies of the association of α1-blockers with outcomes among human participants with respiratory tract infections are scarce. Objective: To examine the association between the receipt of α1-blockers and outcomes among adult patients hospitalized with influenza or pneumonia. Design, Setting, and Participants: This population-based cohort study used data from Danish national registries to identify individuals 40 years and older who were hospitalized with influenza or pneumonia between January 1, 2005, and November 30, 2018, with follow-up through December 31, 2018. In the main analyses, patients currently receiving α1-blockers were compared with those not receiving α1-blockers (defined as patients with no prescription for an α1-blocker filled within 365 days before the index date) and those currently receiving 5α-reductase inhibitors. Propensity scores were used to address confounding factors and to compute weighted risks, absolute risk differences, and risk ratios. Data were analyzed from April 21 to December 21, 2020. Exposures: Current receipt of α1-blockers compared with nonreceipt of α1-blockers and with current receipt of 5α-reductase inhibitors. Main Outcomes and Measures: Death within 30 days of hospital admission and risk of intensive care unit (ICU) admission. Results: A total of 528 467 adult patients (median age, 75.0 years; interquartile range, 64.4-83.6 years; 273 005 men [51.7%]) were hospitalized with influenza or pneumonia in Denmark between 2005 and 2018. Of those, 21 772 patients (4.1%) were currently receiving α1-blockers compared with a population of 22 117 patients not receiving α1-blockers who were weighted to the propensity score distribution of those receiving α1-blockers. In the propensity score-weighted analyses, patients receiving α1-blockers had lower 30-day mortality (15.9%) compared with patients not receiving α1-blockers (18.5%), with a corresponding risk difference of -2.7% (95% CI, -3.2% to -2.2%) and a risk ratio (RR) of 0.85 (95% CI, 0.83-0.88). The risk of ICU admission was 7.3% among patients receiving α1-blockers and 7.7% among those not receiving α1-blockers (risk difference, -0.4% [95% CI, -0.8% to 0%]; RR, 0.95 [95% CI, 0.90-1.00]). A comparison between 18 280 male patients currently receiving α1-blockers and 18 228 propensity score-weighted male patients currently receiving 5α-reductase inhibitors indicated that those receiving α1-blockers had lower 30-day mortality (risk difference, -2.0% [95% CI, -3.4% to -0.6%]; RR, 0.89 [95% CI, 0.82-0.96]) and a similar risk of ICU admission (risk difference, -0.3% [95% CI, -1.4% to 0.7%]; RR, 0.96 [95% CI, 0.83-1.10]). Conclusions and Relevance: This cohort study's findings suggest that the receipt of α1-blockers is associated with protective benefits among adult patients hospitalized with influenza or pneumonia.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Mortalidade Hospitalar , Hospitalização , Inflamação/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Unidades de Terapia Intensiva , Pneumonia/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , /patologia , Estudos de Coortes , Dinamarca , Feminino , Humanos , Inflamação/etiologia , Influenza Humana/mortalidade , Influenza Humana/patologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pandemias , Pneumonia/mortalidade , Pneumonia/patologia , Pontuação de Propensão , Índice de Gravidade de Doença
6.
Arterioscler Thromb Vasc Biol ; 41(3): e175-e182, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33535790

RESUMO

OBJECTIVE: Although statins are widely prescribed lipid-lowering drugs, there are concerns about the safety of their use in the context of coronavirus disease 2019 (COVID-19), since statins increase the expression of ACE2 (angiotensin-converting enzyme 2). This study aimed to disclose the association between statins and 60-day COVID-19 mortality. Approach and Results: All patients hospitalized with laboratory-confirmed COVID-19 were enrolled in this study from January 19 to April 16, 2020, in Korea. We evaluated the association between the use of statins and COVID-19-related mortality in the overall and the nested 1:2 propensity score-matched study. Furthermore, a comparison of the hazard ratio for death was performed between COVID-19 patients and a retrospective cohort of patients hospitalized with pneumonia between January and June 2019 in Korea. The median age of the 10 448 COVID-19 patients was 45 years. Statins were prescribed in 533 (5.1%) patients. After adjusting for age, sex, and comorbidities, Cox regression showed a significant decrease in hazard ratio associated with the use of statins (hazard ratio, 0.637 [95% CI, 0.425-0.953]; P=0.0283). Moreover, on comparing the hazard ratio between COVID-19 patients and the retrospective cohort of hospitalized pneumonia patients, the use of statins showed similar benefits. CONCLUSIONS: The use of statins correlates significantly with lower mortality in patients with COVID-19, consistent with the findings in patients with pneumonia. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Pandemias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , /mortalidade , Criança , Pré-Escolar , Estudos de Coortes , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/mortalidade , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Hipertensão/mortalidade , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Pneumonia/mortalidade , Pontuação de Propensão , Modelos de Riscos Proporcionais , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/mortalidade , República da Coreia/epidemiologia , Estudos Retrospectivos , Adulto Jovem
7.
BMJ ; 372: n415, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33627311

RESUMO

OBJECTIVE: To assess excess all cause and cause specific mortality during the three months (1 January to 31 March 2020) of the coronavirus disease 2019 (covid-19) outbreak in Wuhan city and other parts of China. DESIGN: Nationwide mortality registries. SETTING: 605 urban districts and rural counties in China's nationally representative Disease Surveillance Point (DSP) system. PARTICIPANTS: More than 300 million people of all ages. MAIN OUTCOME MEASURES: Observed overall and weekly mortality rates from all cause and cause specific diseases for three months (1 January to 31 March 2020) of the covid-19 outbreak compared with the predicted (or mean rates for 2015-19) in different areas to yield rate ratio. RESULTS: The DSP system recorded 580 819 deaths from January to March 2020. In Wuhan DSP districts (n=3), the observed total mortality rate was 56% (rate ratio 1.56, 95% confidence interval 1.33 to 1.87) higher than the predicted rate (1147 v 735 per 100 000), chiefly as a result of an eightfold increase in deaths from pneumonia (n=1682; 275 v 33 per 100 000; 8.32, 5.19 to 17.02), mainly covid-19 related, but a more modest increase in deaths from certain other diseases, including cardiovascular disease (n=2347; 408 v 316 per 100 000; 1.29, 1.05 to 1.65) and diabetes (n=262; 46 v 25 per 100 000; 1.83, 1.08 to 4.37). In Wuhan city (n=13 districts), 5954 additional (4573 pneumonia) deaths occurred in 2020 compared with 2019, with excess risks greater in central than in suburban districts (50% v 15%). In other parts of Hubei province (n=19 DSP areas), the observed mortality rates from pneumonia and chronic respiratory diseases were non-significantly 28% and 23% lower than the predicted rates, despite excess deaths from covid-19 related pneumonia. Outside Hubei (n=583 DSP areas), the observed total mortality rate was non-significantly lower than the predicted rate (675 v 715 per 100 000), with significantly lower death rates from pneumonia (0.53, 0.46 to 0.63), chronic respiratory diseases (0.82, 0.71 to 0.96), and road traffic incidents (0.77, 0.68 to 0.88). CONCLUSIONS: Except in Wuhan, no increase in overall mortality was found during the three months of the covid-19 outbreak in other parts of China. The lower death rates from certain non-covid-19 related diseases might be attributable to the associated behaviour changes during lockdown.


Assuntos
/mortalidade , Causas de Morte , Adulto , China/epidemiologia , Surtos de Doenças , Feminino , Humanos , Masculino , Doenças não Transmissíveis/mortalidade , Pneumonia/mortalidade , Vigilância da População , Sistema de Registros , Ferimentos e Lesões/mortalidade
8.
Am J Emerg Med ; 42: 49-54, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33450707

RESUMO

INTRODUCTION: Low muscle mass is associated with an increased mortality risk due to medical comorbidities such as chronic obstructive pulmonary disease, cardiovascular disease, and cerebrovascular disease. Computed tomography (CT) has been identified as the gold standard for measuring body composition. We evaluated the relationship between the L1 SMI measured from CT and in-hospital mortality in patients with community-acquired pneumonia (CAP). METHODS: From January 2015 to June 2015, 311 patients who were diagnosed with CAP and underwent CT in the ED were retrospectively analyzed. Multivariate binary logistic regression analysis was used to assess independent predictors of in-hospital mortality. All variables with a significance level < 0.1 by univariate analysis were included in a multivariate logistic regression model. The primary outcome was all-cause in-hospital mortality. RESULTS: Among the 311 patients, 33 (10.6%) died. We divided the patients into two groups based on the optimal sex-specific cut-off value of the L1 SMI (45 cm2/m2 in males and 40 cm2/m2 in females). A low L1 SMI was present in 90 (28.9%) of the 311 patients. In multivariate analysis, low L1 SMI, diabetes mellitus, albumin and APACHE II score were significantly associated with in-hospital mortality (aOR 3.39, 3.73, 0.09 and 1.10, respectively). CONCLUSION: SMI assessment at L1 is achievable in patients with CAP receiving routine chest CT, and the L1 SMI is associated with high in-hospital mortality, more hospitalizations and ventilator application in patients with CAP in the ED. This could help establish an early strategy for critical care of patients with L1 SMI obtained by chest CT for diagnosis in CAP patients in the ED.


Assuntos
Infecções Comunitárias Adquiridas/mortalidade , Mortalidade Hospitalar , Músculo Esquelético/patologia , Pneumonia/mortalidade , Sarcopenia/complicações , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/patologia , Infecções Comunitárias Adquiridas/terapia , Cuidados Críticos , Feminino , Hospitalização , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Pneumonia/complicações , Pneumonia/patologia , Pneumonia/terapia , Respiração Artificial , Estudos Retrospectivos , Sarcopenia/diagnóstico por imagem , Sarcopenia/patologia , Tomografia Computadorizada por Raios X
9.
J Stroke Cerebrovasc Dis ; 30(4): 105605, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33482567

RESUMO

BACKGROUND: Pneumonia, the most common post-acute ischemic stroke (AIS) infection, accounts for up to 30% of deaths after a stroke. Multiple chronic inflammatory diseases, such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease, are associated with increased risk of stroke and stroke morbidity. This study assessed the relationship between chronic inflammatory diseases and stroke-associated pneumonia (SAP). METHODS: Using data from the 2015-2017 National Inpatient Sample, we classified hospital discharges with a diagnosis of AIS as having ulcerative colitis, Crohn's disease, rheumatoid arthritis, psoriasis, systemic lupus erythematosus, other chronic inflammatory diseases, multiple chronic inflammatory diseases, or none. With multivariable logistic regression, we assessed for associations between chronic inflammatory disease and in-hospital SAP or death. RESULTS: Among AIS discharges, there was a decreased risk of SAP among those with psoriasis or other chronic inflammatory diseases (adjusted odds ratio (aOR) 0.70, 95%CI 0.63-0.99; aOR 0.64, 95%CI, 0.46-0.89, respectively), compared to those without psoriasis and without other chronic inflammatory disease, respectively. Rheumatoid arthritis, psoriasis, and other chronic inflammatory diseases were associated with reduced in-hospital mortality (aOR 0.89, 95%CI 0.78-1.00; aOR 0.77, 95%CI 0.59-1.00; aOR 0.69, 95%CI 0.50-0.94, respectively). CONCLUSIONS: The risk of SAP and in-hospital mortality varies by chronic inflammatory disease - psoriasis and other chronic inflammatory diseases are associate with reduced rates of SAP, whereas rheumatoid arthritis, psoriasis and other chronic inflammatory disease were associated with reduced in-hospital mortality. Further investigations are needed to determine a relationship between the potential role of immunomodulation and the reduction in SAP and mortality in chronic inflammatory diseases.


Assuntos
Inflamação/epidemiologia , Pneumonia/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Inflamação/diagnóstico , Inflamação/mortalidade , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Estados Unidos/epidemiologia , Adulto Jovem
10.
Rev. medica electron ; 42(6): 2560-2574, nov.-dic. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150037

RESUMO

RESUMEN Introducción: la neumonía adquirida en la comunidad es la enfermedad infecciosa que conlleva una mayor mortalidad en los países desarrollados. El diagnóstico pasa por varios momentos, el cuadro clínico, la analítica y las imágenes. Objetivos: realizar la validación externa de un modelo matemático predictivo de mortalidad en pacientes ingresados por neumonía grave adquirida en la comunidad. Material y métodos: estudio longitudinal prospectivo (cohorte) con un grupo, con todos los pacientes que ingresaron en la Unidad de Cuidados intensivos emergentes con el diagnóstico de neumonía adquirida en la comunidad en el Hospital Militar Dr. Carlos J. Finlay, de febrero de 2018 hasta marzo del 2019. El universo estuvo constituido por 160 pacientes y no se tomó muestra alguna. Resultados: índice de Kappa K=1. Test Hosmer Lemenshow 0,650 con elevado ajuste. Resultados del modelo con sensibilidad= 79%. Especificidad: 91% con (VPP): 80 y (VPN)= 91. RR: 9,1. Área bajo la Curva = 0997. Porcentaje de aciertos en la regresión logística de 88,4 %. Conclusiones: el modelo propuesto constituyo una herramienta útil en la detección temprana de pacientes con riesgo de muerte a corto plazo. Permitió unificar en una sola variable el resultado de otras que aparentemente no tienen relación entre ellas; con lo que se hace más fácil la interpretación de los resultados, toda vez que este refleja, el conjunto y no la individualidad (AU).


SUMMARY Introduction: community-acquired pneumonia is the infectious disease leading to higher mortality in developed countries. The diagnosis goes through several moments, clinical symptoms, analytics, and images. Objective: to perform the external validation of a predictive mathematical model of mortality in patients admitted by serious community-acquired pneumonia. Methods: longitudinal prospective (cohort) study with a group formed with all patients who were admitted to the Emergent Intensive Care Unit in the Military Hospital ¨Dr. Carlos Juan Finlay¨ with the diagnosis of community-acquired pneumonia, from February 2018 to March 2019. The universe was formed by 160 patients and no sample was chosen. Results: Kappa index K= 1. Hosmer Lemenshow test= 0.650 with a high adjustment. Result of the model with sensibility= 79 %. Specificity= 91 % with (APV) = 80 and (NPV) = 91. RR= 9.1. Area under the curve= 0997. Percentage of correctness in logistic regression of 88.4 %. Conclusions: The proposed model was a useful tool in the early detection of patients at near-term death risk. It allowed to unite in an only variant the result of others that apparently are not related one to another, making it easier the interpretation of the results, since it reflects the whole and not the individuality (AU).


Assuntos
Humanos , Masculino , Feminino , Idoso , Pneumonia/mortalidade , Idoso/fisiologia , Pneumonia/complicações , Pneumonia/diagnóstico , Cuidados Críticos/métodos , Previsões/métodos , Assistência ao Paciente/métodos
11.
N Z Med J ; 133(1527): 26-38, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332326

RESUMO

AIM: To describe the context surrounding the deaths of homeless people in New Zealand and to determine the proportion of deaths that could be considered amenable to healthcare. METHOD: We used coroners' findings related to 171 deaths of persons with "no fixed abode" at the time of death, from 2008 to 2019. Recent lists of amenable mortality from the New Zealand Ministry of Health and the Office of National Statistics in the UK were combined to determine the rate of amenable mortality. RESULTS: The life expectancy of homeless persons identified in this sample was 30 years shorter than in the housed population, with a mean age of death of 45.7 years. Deaths occurred mainly alone, in public spaces (56.1%) or in private vehicles (14%). Three-quarters (75.8%) of homeless persons died from conditions amenable to timely and effective healthcare interventions, mostly from natural causes (45.7%) and suicide (41.5%). CONCLUSION: Homeless people experience considerable challenges when accessing the healthcare system, as uncovered by the dramatic rate of amenable mortality. Our findings highlight the urgent need to implement specific models of care that are designed to meet the social and healthcare needs of homeless persons and address the significant health inequalities they experience.


Assuntos
Causas de Morte , Atestado de Óbito , Pessoas em Situação de Rua/estatística & dados numéricos , Expectativa de Vida , Acidentes/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/mortalidade , Transtornos Relacionados ao Uso de Álcool/prevenção & controle , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Criança , Etanol/envenenamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Nova Zelândia/epidemiologia , Pneumonia/mortalidade , Pneumonia/prevenção & controle , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos , Adulto Jovem
12.
Environ Health Perspect ; 128(12): 127004, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33325772

RESUMO

BACKGROUND: Environmental cadmium exposure is widespread. In humans, cadmium is poorly excreted, triggers pulmonary inflammation, reduces pulmonary function, and enhances lung injury by respiratory syncytial virus. OBJECTIVES: We examined the association of cadmium burden with mortality related to influenza or pneumonia. METHODS: This prospective analysis of the National Health and Nutrition Examination Survey (NHANES) included 7,173 and 8,678 participants ≥45 years of age enrolled in NHANES-III and NHANES 1999-2006, respectively. Associations were evaluated between cadmium and mortality from influenza or pneumonia during a median follow-up of 17.3 y (NHANES-III, based on creatinine-corrected urine cadmium) and 11.4 y (NHANES 1999-2006, based on blood cadmium). Survey-weighted Cox proportional hazard models were used to compute hazard ratios (HRs) comparing the mortality of individuals at the 80th vs. the 20th percentile of cadmium concentrations. RESULTS: In NHANES-III, after adjustment for sex, race/ethnicity, education, body mass index, serum cholesterol, hypertension, and NHANES phase (or cycle), the HR comparing influenza or pneumonia mortality among participants with creatinine-corrected urinary cadmium in the 80th vs. 20th percentile was 1.15 (95% CI: 1.05, 1.26; p=0.002) in the population as a whole and 1.27 (95% CI: 1.12, 1.43; p=0.002) among never smokers. In NHANES 1999-2006, adjusted HRs for the 80th vs. 20th percentile of blood cadmium were 1.14 (95% CI: 0.96, 1.36; p=0.15) for the overall population and 1.71 (95% CI: 0.95, 3.09; p=0.07) in never smokers. DISCUSSION: Among middle-aged and older adults in the United States, higher cadmium burdens are associated with higher mortality from influenza or pneumonia. This raises the possibility that cadmium may worsen outcomes from COVID-19 infections. https://doi.org/10.1289/EHP7598.


Assuntos
/mortalidade , Cádmio/sangue , Poluentes Ambientais/sangue , Influenza Humana/mortalidade , Pneumonia/mortalidade , Idoso , Idoso de 80 Anos ou mais , /complicações , Exposição Ambiental , Feminino , Humanos , Influenza Humana/sangue , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Pneumonia/sangue , Pneumonia/complicações , Modelos de Riscos Proporcionais , Estudos Prospectivos , Estados Unidos/epidemiologia
13.
Arch. bronconeumol. (Ed. impr.) ; 56(12): 792-800, dic. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-199073

RESUMO

AIM: We examined fifteen years trends (2001-2015) in the use of non-invasive ventilation (NIV), invasive mechanical ventilation (IMV) or both (NIV+IMV) among patients hospitalized for community acquired pneumonia (CAP). We also analyzed trends overtime and the influence of patient factors in the in-hospital mortality (IHM) after receiving NIV, IMV or NIV + IMV. METHODS: Observational retrospective epidemiological study. Our data source was the Spanish National Hospital Discharge Database. RESULTS: Over a total of 1,486,240 hospitalized patients with CAP, we identified 56,158 who had received ventilator support in Spain over the study period. Of them, 54.82% received NIV, 37.04% IMV and 8.14% both procedures. The use of NIV and NIV + IMV increased significantly (p < 0.001) over time (from 0.91 to 12.84 per 100.000 inhabitant and from 0.23 to 1.19 per 100.000 inhabitants, respectively), while the IMV utilization decreased (from 3.55 to 2.79 per 100,000 inhabitants; p < 0.001). Patients receiving NIV were the oldest and had the highest mean value in the Charlson comorbidity index (CCI) score and readmission rate. Patients who received only IMV had the highest IHM. Factors associated with IHM for all groups analyzed included age, comorbidities and readmission. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV + IMV. CONCLUSIONS: We found an increase in NIV use and a decline in IMV utilization in patients hospitalized for CAP over the study period. Patients receiving NIV were the oldest and had the highest CCI score and readmission rate. IHM decreased significantly over time in patients with CAP who received NIV, IMV and NIV + IMV


OBJETIVO: Estudiamos las tendencias a lo largo de 15 años (2001-2015) en el uso de la ventilación no invasiva (VNI), la ventilación mecánica invasiva (VMI) o ambas (VNI + VMI) en los pacientes hospitalizados por neumonía adquirida en la comunidad (NAC). También analizamos las tendencias en el tiempo y la influencia de los factores del paciente en la mortalidad hospitalaria (MH) después de recibir VNI, VMI o VNI + VMI. MÉTODOS: Estudio epidemiológico retrospectivo observacional. Nuestra fuente de datos fue el Registro de Altas de los Hospitales (CMBD) del Sistema Nacional de Salud. RESULTADOS: En un total de 1.486.240 pacientes hospitalizados por NAC, identificamos a 56.158 que habían recibido soporte ventilatorio en España durante el período a estudio. De ellos, el 54,82% recibió VNI, el 37,04% VMI y el 8,14% ambos procedimientos. El uso de VNI y VNI + VMI aumentó significativamente (p < 0,001) con el tiempo (de 0,91 a 12,84 por habitante y de 0,23 a 1,19 por cada 100.000 habitantes, respectivamente), mientras que la utilización de la VMI disminuyó (de 3,55 a 2,79 por cada 100.000 habitantes; p < 0,001). Los pacientes que recibieron VNI fueron los más ancianos y presentaban el valor medio más alto de puntuación en el índice de comorbilidad de Charlson (CCI, por sus siglas en inglés) y en la tasa de reingreso. Los pacientes que recibieron solo VMI presentaron la MH más alta. Los factores asociados a la MH para todos los grupos analizados incluyeron la edad, las comorbilidades y el reingreso. La MH disminuyó significativamente con el tiempo en los pacientes con NAC que recibieron VNI, VMI y VNI + VMI. CONCLUSIONES: Encontramos un aumento en el uso de VNI y una disminución en la utilización de VMI en pacientes hospitalizados por NAC durante el período a estudio. Los pacientes que recibieron VNI fueron los más ancianos y tenían la puntuación más alta en el CCI y la tasa de reingreso más elevada. La MH disminuyó significativamente con el tiempo en los pacientes con NAC que recibieron VNI, VMI y VNI + VMI


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/terapia , Pneumonia/terapia , Respiração Artificial/tendências , Estudos Retrospectivos , Pneumonia/mortalidade , Infecções Comunitárias Adquiridas/mortalidade , Respiração Artificial/mortalidade , Mortalidade Hospitalar , Estatísticas não Paramétricas , Hospitalização , Distribuição por Idade e Sexo , Fatores de Tempo , Espanha/epidemiologia , Comorbidade
14.
Rev. medica electron ; 42(6): 2530-2539, nov.-dic. 2020. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1150035

RESUMO

RESUMEN Introducción: aquellos países con alto grado de envejecimiento poblacional muestran asociaciones importantes con diferentes enfermedades, por ejemplo, la neumonía adquirida en la comunidad y la depresión en los ancianos. Objetivos: relacionar la depresión con la mortalidad y evaluar efectos de los antidepresivos, en los pacientes con neumonía adquirida en la comunidad, ingresados en la Unidad de Cuidados Intensivos del Hospital Militar Central "Dr. Carlos J. Finlay". Materiales y métodos: se realizó un estudio analítico, longitudinal prospectivo, con todos los pacientes con neumonía adquirida en la comunidad, ingresados en la Unidad de Cuidados Intensivos Emergentes, del Hospital Militar "Dr. Carlos J. Finlay". Periodo correspondiente a enero del 2018 hasta abril del 2019 que cumplieron con los criterios de inclusión. El universo lo constituyó 160 pacientes. Resultados: existieron 55 pacientes con síntomas de depresión previos al ingreso, (34 %). El 78 % de fallecidos presentaron depresión al ingreso. La edad media de los no deprimidos fue de 74, la más alta de los deprimidos fue de 80,80. No presentaron signos de depresión 93 pacientes vivos y 43 que la presentaron y fallecieron con una gran significación estadística p 0,000. RR 6,8. Se observó una marcada relación entre la mortalidad y el no recibir tratamiento para la depresión, (37) p 0,000. Conclusiones: la neumonía y la depresión son enfermedades que tienen una relación íntima. Esta asociación cuenta con una elevada mortalidad, así como el impacto del tratamiento antidepresivo en la evolución del paciente es definitorio en el ámbito de los cuidados intensivos (AU).


ABSTRACT Introduction: those countries with a high level of population ageing show important associations to different diseases, for example, community acquired pneumonia and depression in elder people. Objectives: to establish the relationship of depression with mortality and to evaluate the effect of antidepressants in patients with community-acquired pneumonia admitted in the Intensive Care Unit of the Central Military Hospital "Dr. Carlos J. Finlay". Materials and methods: a prospective, longitudinal, analytic study was carried out with all patients with community-acquired pneumonia, admitted in the Intensive Care Unit of the Central Military Hospital "Dr. Carlos J. Finlay" in the period from January 2018 until April 2019, who fulfilled the inclusion criteria. The universe were 160 patients. Results: there were 55 patients with depression symptoms before the admission. 78 % of the deceased showed depression at the admittance. The medium age of the non-depressed ones was 74 years; the highest age of the depressed ones was 80.80 years. 93 living patients did not present depression signs, and 43 presented them and died with a great statistical significance p: 0.000 RR: 6.8. A remarked relation was observed between mortality and not receiving treatment for depression (37) p 0,000. Conclusions: pneumonia and depression are diseases having a tight relationship. This association yields a high mortality, and the impact of the anti-depression treatment on the patient's evolution is defining in the intensive care settings (AU).


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso Fragilizado , Depressão/diagnóstico , Pneumonia/diagnóstico , Pneumonia/mortalidade , Pneumonia/psicologia , Cuidados Críticos/métodos , Serviços de Saúde para Idosos/tendências , Imunidade/fisiologia
15.
PLoS One ; 15(12): e0244367, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362262

RESUMO

BACKGROUND: New York City (NYC) reported a higher pneumonia and influenza death rate than the rest of New York State during 2010-2014. Most NYC pneumonia and influenza deaths are attributed to pneumonia caused by infection acquired in the community, and these deaths typically occur in hospitals. METHODS: We identified hospitalizations of New York State residents aged ≥20 years discharged from New York State hospitals during 2010-2014 with a principal diagnosis of community-setting pneumonia or a secondary diagnosis of community-setting pneumonia if the principal diagnosis was respiratory failure or sepsis. We examined mean annual age-adjusted community-setting pneumonia-associated hospitalization (CSPAH) rates and proportion of CSPAH with in-hospital death, overall and by sociodemographic group, and produced a multivariable negative binomial model to assess hospitalization rate ratios. RESULTS: Compared with non-NYC urban, suburban, and rural areas of New York State, NYC had the highest mean annual age-adjusted CSPAH rate at 475.3 per 100,000 population and the highest percentage of CSPAH with in-hospital death at 13.7%. NYC also had the highest proportion of CSPAH patients residing in higher-poverty-level areas. Adjusting for age, sex, and area-based poverty, NYC residents experienced 1.3 (95% confidence interval [CI], 1.2-1.4), non-NYC urban residents 1.4 (95% CI, 1.3-1.6), and suburban residents 1.2 (95% CI, 1.1-1.3) times the rate of CSPAH than rural residents. CONCLUSIONS: In New York State, NYC as well as other urban areas and suburban areas had higher rates of CSPAH than rural areas. Further research is needed into drivers of CSPAH deaths, which may be associated with poverty.


Assuntos
Infecções Comunitárias Adquiridas/virologia , Hospitalização/estatística & dados numéricos , Influenza Humana/epidemiologia , Pneumonia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Humanos , Influenza Humana/mortalidade , Masculino , Pessoa de Meia-Idade , Mortalidade , Cidade de Nova Iorque/epidemiologia , Pneumonia/mortalidade , Pobreza , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adulto Jovem
16.
In Vivo ; 34(6): 3735-3746, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33144492

RESUMO

BACKGROUND/AIM: This study investigated the correlation of chest computed tomography (CT), findings, graded using two different scoring methods, with clinical and laboratory features and disease outcome, including a novel clinical predictive score, in patients with novel coronavirus-infected pneumonia (NCIP). PATIENTS AND METHODS: In this retrospective, observational study, CT scan of 92 NCIP patients admitted to Policlinico Tor Vergata, were analyzed using a quantitative, computed-based and a semiquantitative, radiologist-assessed scoring system. Correlations of the two radiological scores with clinical and laboratory features, the CALL score, and their association with a composite adverse outcome were assessed. RESULTS: The two scores correlated significantly with each other (ρ=0.637, p<0.0001) and were independently associated with age, LDH, estimated glomerular filtration rate, diabetes, and with the composite outcome, which occurred in 24 patients. CONCLUSION: In NCIP patients, two different radiological scores correlated with each other and with several clinical, laboratory features, and the CALL score. The quantitative score was a better independent predictor of the composite adverse outcome than the semiquantitative score.


Assuntos
Infecções por Coronavirus/diagnóstico por imagem , Pneumonia Viral/diagnóstico por imagem , Pneumonia/diagnóstico por imagem , Tórax/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/virologia , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia/mortalidade , Pneumonia/fisiopatologia , Pneumonia/virologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Tórax/fisiopatologia , Tórax/virologia , Tomografia Computadorizada por Raios X
17.
Epidemiol Infect ; 148: e241, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32998791

RESUMO

A recently developed pneumonia caused by SARS-CoV-2 has quickly spread across the world. Unfortunately, a simplified risk score that could easily be used in primary care or general practice settings has not been developed. The objective of this study is to identify a simplified risk score that could easily be used to quickly triage severe COVID-19 patients. All severe and critical adult patients with laboratory-confirmed COVID-19 on the West campus of Union Hospital, Wuhan, China, from 28 January 2020 to 29 February 2020 were included in this study. Clinical data and laboratory results were obtained. CURB-65 pneumonia score was calculated. Univariate logistic regressions were applied to explore risk factors associated with in-hospital death. We used the receiver operating characteristic curve and multivariate COX-PH model to analyse risk factors for in-hospital death. A total of 74 patients (31 died, 43 survived) were finally included in the study. We observed that compared with survivors, non-survivors were older and illustrated higher respiratory rate, neutrophil-to-lymphocyte ratio, D-dimer and lactate dehydrogenase (LDH), but lower SpO2 as well as impaired liver function, especially synthesis function. CURB-65 showed good performance for predicting in-hospital death (area under curve 0.81, 95% confidence interval (CI) 0.71-0.91). CURB-65 ⩾ 2 may serve as a cut-off value for prediction of in-hospital death in severe patients with COVID-19 (sensitivity 68%, specificity 81%, F1 score 0.7). CURB-65 (hazard ratio (HR) 1.61; 95% CI 1.05-2.46), LDH (HR 1.003; 95% CI 1.001-1.004) and albumin (HR 0.9; 95% CI 0.81-1) were risk factors for in-hospital death in severe patients with COVID-19. Our study indicates CURB-65 may serve as a useful prognostic marker in COVID-19 patients, which could be used to quickly triage severe patients in primary care or general practice settings.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Pneumonia/mortalidade , Índice de Gravidade de Doença , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Feminino , Humanos , L-Lactato Desidrogenase/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Estudos Retrospectivos
18.
Epidemiol Infect ; 148: e264, 2020 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-33115546

RESUMO

Deaths are frequently under-estimated during emergencies, times when accurate mortality estimates are crucial for emergency response. This study estimates excess all-cause, pneumonia and influenza mortality during the coronavirus disease 2019 (COVID-19) pandemic using the 11 September 2020 release of weekly mortality data from the United States (U.S.) Mortality Surveillance System (MSS) from 27 September 2015 to 9 May 2020, using semiparametric and conventional time-series models in 13 states with high reported COVID-19 deaths and apparently complete mortality data: California, Colorado, Connecticut, Florida, Illinois, Indiana, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania and Washington. We estimated greater excess mortality than official COVID-19 mortality in the U.S. (excess mortality 95% confidence interval (CI) 100 013-127 501 vs. 78 834 COVID-19 deaths) and 9 states: California (excess mortality 95% CI 3338-6344) vs. 2849 COVID-19 deaths); Connecticut (excess mortality 95% CI 3095-3952) vs. 2932 COVID-19 deaths); Illinois (95% CI 4646-6111) vs. 3525 COVID-19 deaths); Louisiana (excess mortality 95% CI 2341-3183 vs. 2267 COVID-19 deaths); Massachusetts (95% CI 5562-7201 vs. 5050 COVID-19 deaths); New Jersey (95% CI 13 170-16 058 vs. 10 465 COVID-19 deaths); New York (95% CI 32 538-39 960 vs. 26 584 COVID-19 deaths); and Pennsylvania (95% CI 5125-6560 vs. 3793 COVID-19 deaths). Conventional model results were consistent with semiparametric results but less precise. Significant excess pneumonia deaths were also found for all locations and we estimated hundreds of excess influenza deaths in New York. We find that official COVID-19 mortality substantially understates actual mortality, excess deaths cannot be explained entirely by official COVID-19 death counts. Mortality reporting lags appeared to worsen during the pandemic, when timeliness in surveillance systems was most crucial for improving pandemic response.


Assuntos
Infecções por Coronavirus/epidemiologia , Mortalidade , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Influenza Humana/mortalidade , Pandemias , Pneumonia/mortalidade , Estados Unidos/epidemiologia
19.
J Stroke Cerebrovasc Dis ; 29(11): 105223, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066949

RESUMO

BACKGROUND AND PURPOSE: Stroke-associated pneumonia (SAP) often increases high hospital mortality, prolongs length of hospital stay, and has considerable economic impact on healthcare costs. We aimed to explore independent predictors of SAP in acute anterior large artery occlusion patients who treated with endovascular treatment (EVT). METHODS: Consecutive patients with acute anterior large artery occlusion stroke who underwent EVT from the Nanjing Stroke Registry from January 2019 to January 2020 were identified retrospectively. Patients were divided into SAP group and Non-SAP group. In the univariate analysis, variables including demographics, clinical factors, labs, and EVT features were compared between the two groups. Then a multivariable logistic regression analysis was conducted to determine independent predictors of SAP. RESULTS: One hundred and twelve patients were enrolled. Patients with SAP, compared to those without SAP, had lower modified treatment in cerebral infarction (mTICI) score 2b-3 rate (54.8% vs 85.2%; P = 0.001), higher asymptomatic intracerebral hemorrhage rate (48.4% vs 28.4%; P = 0.046), lower modified Rankin Scale (mRS) score 0-2 rate at 90days rate (9.7% vs 60.5%; P < 0.001), and higher mortality at 90days (38.7% vs 11.1%; P = 0.001). The independent predictors of SAP were dysphagia (Unadjusted Odds ratio[OR] 6.49, 95% Confidence interval[CI] 2.49-16.92; P = 0.02; Adjusted OR 3.59, 95% CI 1.19-10.83; P = 0.02), neutrophil-lymphocyte ratio (Unadjusted OR 1.19, 95% CI 1.1-1.3; P = 0.001; Adjusted OR 1.15, 95% CI 1.06-1.25; P = 0.001), and mTICI 2b-3 (Unadjusted OR 0.21, 95% CI 0.08-0.54; P = 0.001; Adjusted OR 0.3, 95% CI 0.1-0.92; P = 0.04). CONCLUSION: Dysphagia, higher neutrophil-lymphocyte ratio, and failed recanalization were associated with SAP in acute ischemic stroke patients underwent endovascular therapy. Identification and prevention of SAP was necessary and important.


Assuntos
Procedimentos Endovasculares , Pneumonia/epidemiologia , Acidente Vascular Cerebral/terapia , Trombectomia , Idoso , China/epidemiologia , Transtornos de Deglutição/epidemiologia , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/mortalidade , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
20.
Medicine (Baltimore) ; 99(39): e22012, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991404

RESUMO

BACKGROUND: Traditional Chinese medicine injections (TCMJ) used in the treatment of severe pneumonia have been widely implemented in clinical practice, but their overall efficacy and safety remain unclear. This paper aims to evaluate the efficacy and safety of TCMJ in the treatment of severe pneumonia. METHODS: PubMed, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang, and the Chongqing VIP Chinese Science and Technology Periodical Database were all searched for randomized controlled trials focusing on the administration of TCMJ for severe pneumonia. Two researchers independently screened titles, abstracts, full texts, and extracted relevant data. The RevMan 5.3 software (The Cochrane Collaboration, Software Update, Oxford, UK) and Stata 14 software (STATA Corporation, College Station, TX) were used for statistical analysis. RESULTS: This study summarizes the related randomized controlled trials to assess the effect and safety of TCMJ in the treatment of severe pneumonia. CONCLUSION: This article provides theoretical support for the clinical application of TCMJ in the treatment of severe pneumonia. PROSPERO REGISTRATION NUMBER: CRD42020185072.


Assuntos
Medicina Tradicional Chinesa/métodos , Pneumonia/terapia , Proteína C-Reativa/análise , Humanos , Injeções , Interleucina-6/sangue , Tempo de Internação , Contagem de Leucócitos , Medicina Tradicional Chinesa/efeitos adversos , Pneumonia/mortalidade , Pró-Calcitonina/biossíntese , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Respiração Artificial , Fator de Necrose Tumoral alfa/sangue
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