Objective To observe the gamma-glutamyltransferase ( GGT) activity and total antioxidant capacity ( T-AOC) in serum and platelet during the course of community-acquired pneumonia ( CAP) . Methods Ninety cases of hospitalized CAP were recruited from the respiratory wards in the Affiliated Hospital of XuzhouMedical College fromSeptember 2010 to September 2011, and 30 healthy cases who underwent physical examination in the same hospital were enrolled as control. GGT activity and T-AOC were compared between the CAP patients and the control subjects, and also between the CAP patients who developed reactive thrombocytosis ( platelet count gt;300 ×109 /L) and those without thrombocytosis ( platelet count ≤300 ×109 /L) . Results Compared with the control subjects, serumand platelet GGT activity of the CAP patients were significantly higher [ ( 45. 6 ±25. 4) U/L vs. ( 17. 9 ±3. 7 ) U/L, ( 179. 9 ±41. 3) mU/109plt vs. ( 49. 5 ±8. 0) mU/109plt, P lt; 0. 05] , serum T-AOC at admission was significantly lower [ ( 12. 6 ±1. 6) U/mL vs. ( 17. 7 ±2. 1) U/mL, P lt; 0. 05] , and platelet T-AOC at admission was significantly higher [ ( 61. 6 ±18. 3) mU/109plt vs. ( 48. 6 ±9. 9) mU/109 plt, P lt; 0. 05] . Platelet T-AOC of the CAP patients at discharge was significantly lower than that of the CAP patients at admission and the control subjects. Compared with the CAP patients without thrombocytosis, serum T-AOC and serum GGT activity of the CAP patients who developed reactive thrombocytosis were significantly higher( P lt;0. 05) , and platelet T-AOC and platelet GGT activity were both significantly lower ( P lt; 0. 05) . There were negative correlations of the platelet count with platelet T-AOC and GGT activity in the CAP patietns( r = - 0. 316,P =0.003; r = - 0. 318, P =0. 002) . Conclusions There is a correlation between the oxidative stress and the platelet function in the inflammatory process of CAP. There might be an indicative role of platelets in resolving the inflammatory process and in maintaining the oxidative-antioxidative balance.
Objective
To explore clinical characteristics and risk factors for mortality of community-acquired pneumonia due to Enterobacteriaceae (EnCAP) .
Methods
This was a single-center, retrospective study. Baseline demographic, clinic, radiologic characteristcs, treatment and outcomes were compared between patients hospilized with EnCAP and community-acquired pneumonia due to Streptoccocus pneumoniae (SpCAP) during January 1, 2010 to December 31, 2015. A univariate and multivariate logistic regression analysis was performed to determine factors independently associated with 30-day mortality for EnCAP.
Results
In comparison with SpCAP, cerebrovascular disease, chronic hepatopathy, chronic renal disease, aspiration risk, confusion, pleural effusion and higher PSI risk class/CURB-65 score, lower leukocyte, hemoglobin, albumin, longer length of stay in hospital were associated with EnCAP. Multivariate logistic regression analysis demonstrated sepsis shock (OR 1.700, P=0.018, 95%CI 0.781 to 38.326), hemoglobin (OR 0.087, P=0.011, 95%CI 0.857 to 0.981) and appropriate empirical antimicrobial therapy (OR 0.108, P=0.002, 95%CI 0.011 to 0.151) were risk factor for 30-day mortality of EnCAP.
Conclusions
The clinical characteristics of EnCAP are different with SpCAP. Clinic physicians should pay much attention to the risk factors for 30-day mortality of EnCAP.
Objective
To determine the role of serum cystatin C in evaluating the severity and predicting in-hospital mortality in patients with community-acquired pneumonia (CAP).
Methods
The clinical data of 176 patients with CAP treated between January 2015 and October 2016 were collected in a retrospective way. The CURB-65 score was used to assess the severity. The serum levels of cystatin C and C-reactive protein (CRP) on admission were measured. The correlations between cystatin C and CURB-65 score and between cystatin C and CRP were calculated. Receiver operating characteristic curve was used to determine the ability of cystatin C in predicting in-hospital mortality.
Results
The serum level of cystatin C increased with the increasing CURB-65 score (P<0.001). The serum level of cystatin C was correlated positively with CRP level (rs=0.190, P<0.011). There were 22 patients died in hospital, the mean serum cystatin C level of non-survivor was significantly higher than that of survivors [(1.51±0.56)vs. (1.02±0.29) mg/L, P<0.001]. At a cut-off 1.18 mg/L, the sensitivity and specificity of cystatin C in predicting in-hospital mortality were 68.18% and 81.17%, respectively. The area under the receiver operating characteristic curve was 0.793. The combination of cystatin C and CRP increased the predictive accuracy for in-hospital mortality.
Conclusion
Cystatin C level increases with the increaseing severity of CAP, and it may be a clinical biomarker to evaluate the severity and prognosis of patients with CAP.
ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
Objective
To investigate the value of procalcitonin (PCT) at admission for severity stratificaton and prognosis prediction of community-acquired pneumonia (CAP), and assess the ability of the combination of PCT and the validated pneumonia risk scores (PSI and CURB-65) for predicting 30-day mortality.
Methods
A retrospective study was performed in 150 hospitalized CAP patients admitted in the Department of Respiratory Medicine of General Hospital of Tianjin Medical University between March 2015 and March 2016. The primary end point for this study was mortality within 30 days. Sensitivity (SEN), specificity (SPE), positive and negative predictive value (PPV, NPV) of PCT for assessing mortality was calculated and compared to validated pneumonia risk scores.
Results
In the 150 CAP patients enrolled, there were 77 males and 73 females with an average age of 58.4±16.3 years. Twelve (8%) patients died within 30 days. The non-survivors had significantly higher median PCT level (4.25 ng/mlvs. 0.24 ng/ml) and C-reactive protein (CRP) level (14.60 mg/dlvs. 5.10 mg/dl) compared with the survivors. The median PCT level was significantly higher in the patients with more severe disease assessed by two risk scoring systems. Combination of PCT with risk scores can improve prognostic value for predicting 30-day mortality of CAP.
Conclusions
The level of PCT at admission is more useful than the traditional biomarkers for the severity stratification and prognosis prediction of CAP. It can well determine patients at low risk of mortality from CAP. There is no advantage of PCT compared to PSI or CURB-65, so we recommend combination of PCT to risk sores to predict 30-day mortality of CAP.
Objective
To investigate the clinical efficacy of nutritional support with different proportion of fat on the prognosis of patients with severe community-acquired pneumonia (SCAP).
Methods
Ninety SCAP patients with nutritional risk treated between January 2014 and July 2015 were randomized into high, normal, and low-proportion fat groups with 30 patients in each. The patients in different groups underwent nutritional support with different fat proportion besides the same medication. Data of albumin, pre-albumin and transferrin were collected and analyzed before treatment and 10 days after treatment. The mortality rates were compared between groups.
Results
Albumin, pre-albumin and transferrin were similar in all groups before intervention (P>0.05); albumin, pre-albumin and transferrin increased significantly 10 days after treatment in each group (P<0.05). Patients in the normal-fat group acquired significantly more obvious improvements on each index (P<0.05). A shorter length of stay in hospital was observed in the normal-proportion fat group compared with the high and low-proportion fat groups, but there was no significant differences among groups (P>0.05). On the 10th day, the normal -proportion fat proportion group had a significantly higher cure rate and a significantly lower mortality rate than the other two groups (P<0.05). The improvement rate was similar in all groups (P>0.05).
Conclusion
Supportive treatment with normal fat proportion has a promising value in the improvement of albumin, pre-albumin and transferrin for SCAP patients with a shorter length of stay in hospital, which is worthy of clinical promotion.
ObjectiveTo explore the correlation of serum neutrophil gelatinase-associated lipocalin (sNGAL) with inflammatory response in patients with community-acquired pneumonia (CAP) and assess the diagnostic value of sNGAL for severe CAP (SCAP).MethodsFrom January 2018 to June 2019, a total of 85 patients with CAP were enrolled in this study. Age, length of hospital stay, the levels of serum creatinine, blood urea nitrogen, white blood cell count,C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin, and CURB-65 score were compared between patients with SCAP (n=34) and patients without SCAP (n=51). The correlations of sNGAL with serum creatinine, blood urea nitrogen, white blood cell count, CRP, IL-6, procalcitonin, and CURB-65 score were assessed with Spearman’s correlation analysis. The area under the receiver operating characteristic (ROC) curve for sNGAL diagnosing SCAP was examined. ResultsCompared with patients without SCAP, SCAP patients demonstrated older age, longer hospital stay, higher serum CRP and IL-6 concentritions, and higher CURB-65 score (P<0.05). The Spearman’s correlation test showed that sNGAL was positively correlated with serum CRP, IL-6, PCT and CURB-65 score (rs=0.472, 0.504, 0.388, and 0.405, respectively; P<0.01). According to ROC analysis, the area under curve of sNGAL for diagnosing SCAP were 0.816, with a sensitivity of 76.56% and a specificity of 74.4% when the cut-off value was 171.0 ng/mL.ConclusionssNGAL concentration is positively correlated with the serverity of CAP. It can be regarded as a reliable indicator for diagnosis of SCAP in patients with CAP.
ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP).
MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission.
ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05).
ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
Objective
To investigate the relationship between the red blood cell distribution width (RDW) and the severity of community-acquired pneumonia (CAP).
Methods
The clinical data of 285 adult patients with CAP admitted from November 2014 to August of 2017 were analyzed retrospectively. The severity of CAP was evaluated by pneumonia severity index (PSI) score. Meanwhile, 60 cases with qualified medical examination were collected as a healthy control group. The distributions of PSI score, RDW, procalcitonin (PCT), C-reactive protein (CRP) and neutrophil percentage (NEU%) were described in the patients with different risk degree. The correlation analysis of various indicators were analyzed by Spearman correlation. The threshold of RDW(%) was calculated through the construction of the general linear regression equation. The risk factors of PSI score were analyzed with multiple linear regression.
Results
The higher the risk stratification, the higher the distribution of PSI scores, RDW, PCT, CRP and NEU% were. RDW was positively correlated with PCT, CRP, and NEU% (r values were 0.417, 0.252, 0.318, respectively, P<0.05). PSI score was positively correlated with RDW, PCT, CRP, and NEU% (r values were 0.537,0.598, 0.557, 0.482, respectively, P<0.05). RDW was positively correlated with PSI score (r=0.537, P<0.05). The thresholds of RDW(%) were 14.514 and 19.041. Multiple linear regression showed that RDW, PCT, CRP and NEU% were all influential factors of PSI scores and explained 46.9% of the total mutation rate.
Conclusion
RDW is correlated with the severity of CAP, and can predict the severity of CAP.
Objective To evaluate the predictive value of CURB-65 score combined with blood urea nitrogen to albumin ratio (B/A) for intensive care unit (ICU) admission and death in adults with community-acquired pneumonia (CAP). Methods A retrospective analysis was performed on 523 patients with CAP hospitalized in the Second Affiliated Hospital of Kunming Medical University from January 2018 to January 2022. According to whether the patients were admitted to ICU, they were divided into an ICU group (n=36) and a general ward group (n=487). The patients were divided into a death group (n=45) and a non-death group (n=478) according to the death situation during hospitalization. Basic data (age, gender, history of underlying diseases, etc.), hospital stay, antibiotic use days, CURB-65 score, white blood cell count (WBC), neutrophil count (NEUT), procalcitonin (PCT), C-reactive protein (CRP), serum albumin (Alb), blood urea nitrogen (BUN), and BUN to Alb ratio (B/A) of the two groups were compared respectively. Receiver operating characteristic (ROC) curve were plotted to evaluate the predictive value of CURB-65 score, B/A, and their combination for death during ICU admission and hospitalization in patients with CAP. Logistic regression was used to analyze risk factors for in-hospital death in the patients with CAP. Results The number of days in hospital, the number of days of antibiotic use, the number of deaths during hospitalization, the proportion of hypertension, diabetes, CURB-65 score, WBC, NEUT, PCT, CRP, BUN and B/A in the ICU group were significantly higher than those in the general ward group. Age, male, combined hypertension, diabetes, coronary heart disease, ICU admission, CURB-65 score, WBC, NEUT, PCT, CRP, BUN and B/A in the death group were significantly higher than those in the non-death group, and Alb in the ICU group and the death group were significantly lower (all P<0.05). Correlation analysis showed that B/A was positively correlated with PCT, CRP, WBC, NEUT and CURB-65 scores (correlation coefficient r values were 0.486, 0.291, 0.260, 0.310, 0.666, all P<0.001). The area under ROC curve of CURB-65 combined with B/A to predict ICU admission and death of CAP patients was 0.862 (95%CI 0.807 - 0.918, sensitivity 91.7%, specificity 66.4%) and 0.908 (95%CI 0.864 - 0.952, sensitivity 93.3%, specificity 75.7%), respectively. Multivariate logistic regression analysis showed that diabetes, high CURB-65 score, low Alb level and B/A≥4.755 mg/g were independent risk factors for death of CAP patients during hospitalization (P<0.05). Conclusions There is a significant correlation between elevated B/A and ICU demand and mortality in CAP patients. Combined use can improve the predictive value of CURB-65 score for ICU admission and mortality in CAP patients.
