Advances in respiratory medicine最新文献

Background: There is a paucity of data on biomarkers for the early deterioration and clinical instability of patients in community-acquired pneumonia (CAP), as treatment failure occurs in the first seven days in 90% of patients. Aim: To evaluate serum albumin and copeptin with CURB-65, PSI scoring and ATS/IDSA minor criteria for the prediction of early mortality or ICU-admission (7 days) and clinical instability after 72 h. Methods: In 100 consecutive hospitalized adult CAP patients, PSI-scores, CURB-65 scores, ATS/IDSA 2007 minor criteria, copeptin and albumin on admission were evaluated. Univariate and multivariate Cox regression analysis was performed to assess independent risk factors for early combined mortality or ICU admission. Predictive powers of albumin and copeptin were tested with ROC curves and ICU-free survival probability was tested using Kaplan−Meier analysis. Results: Albumin was lower and copeptin higher in patients with short-term adverse outcomes (p < 0.05). Cox regression analysis showed that albumin [HR (95% CI): 0.41 (0.18−0.94, p = 0.034)] and copeptin [HR (95% CI): 1.94 (1.03−3.67, p = 0.042)] were independent risk factors for early combined mortality or ICU admission (7 days). The Kaplan−Meier analysis observed that high copeptin (>27.12 ng/mL) and low albumin levels (<2.85 g/dL) had a lower (p < 0.001) survival probability. The diagnostic accuracy of albumin was better than copeptin. The inclusion of albumin and copeptin into ATS/IDSA minor criteria significantly improved their predictive power. Conclusions: Both biomarkers serum albumin and copeptin can predict early deterioration and clinical instability in hospitalized CAP patients and increase the prognostic power of the traditional clinical scoring systems.

Background: The diagnostic value for chest CT has been widely established in patients with COVID-19. However, there is a lack of satisfactory data about the prognostic value of chest CTs. This study investigated the prognostic value of chest CTs in COVID-19 patients. Materials and Methods: A total of 521 symptomatic patients hospitalized with COVID-19 were included retrospectively. Clinical, laboratory, and chest CT characteristics were compared between survivors and non-survivors. Concerning chest CT, for each subject, a semi-quantitative CT severity scoring system was applied. Results: Most patients showed typical CT features based on the likelihood of COVID-19. The global CT score was significantly higher in non-survivors (median (IQR), 1 (0−6) vs. 10 (5−13), p < 0.001). A cut-off value of 5.5 for the global CT score predicted in-hospital mortality with 74% sensitivity and 73% specificity. Global CT score, age, C-reactive protein, and diabetes were independent predictors of in-hospital mortality. The global CT score was significantly correlated with the C-reactive protein, D-dimer, pro-brain natriuretic peptide, and procalcitonin levels. Conclusion: The global CT score could provide valuable prognostic data in symptomatic patients with COVID-19.

Advances in Respiratory Medicine (ARM) is the journal of the Polish Respiratory Society [...].

Background: Diagnostic work-up of pulmonary embolism (PE) remains a challenge. Methods: We retrospectively studied all patients referred for computed tomography pulmonary angiography (CTPA) with suspicion of PE during a 12-month period (2018). The diagnostic accuracy of different D-dimer (Dd) cutoff thresholds for ruling out PE was evaluated. Furthermore, the association of Dd and red cell distribution width (RDW) with embolus location, CTPA findings, and patient outcome was recorded. Results: One thousand seventeen (n = 1017) patients were finally analyzed (mean age: 64.6 years (SD = 11.8), males: 549 (54%)). PE incidence was 18.7%. Central and bilateral embolism was present in 44.7% and 59.5%, respectively. Sensitivity and specificity for conventional and age-adjusted Dd cutoff was 98.2%, 7.9%, and 98.2%, 13.1%, respectively. A cutoff threshold (2.1 mg/L) with the best (64.4%) specificity was identified based on Receiver Operating Characteristics analysis. Moreover, a novel proposed Dd cutoff (0.74 mg/L) emerged with increased specificity (20.5%) and equal sensitivity (97%) compared to 0.5 mg/L, characterized by concurrent reduction (17.2%) in the number of performed CTPAs. Consolidation/atelectasis and unilateral pleural effusion were significantly associated with PE (p < 0.05, respectively). Patients with consolidation/atelectasis or intrapulmonary nodule(s)/mass on CTPA exhibited significantly greater median Dd values compared to patients without the aforementioned findings (2.34, (IQR 1.29−4.22) vs. 1.59, (IQR 0.81−2.96), and 2.39, (IQR 1.45−4.45) vs. 1.66, (IQR 0.84−3.12), p < 0.001, respectively). RDW was significantly greater in patients who died during hospitalization (p = 0.012). Conclusions: Age-adjusted Dd increased diagnostic accuracy of Dd testing without significantly decreasing the need for imaging. The proposed Dd value (0.74 mg/L) showed promise towards reducing considerably the need of CTPA. Multiple radiographic findings have been associated with increased Dd values in our study.

We thank Salama S et al [...].

Clinical rationale for study: Despite advancements in critical care, the mortality rate of sepsis remains high, with an overall poor prognosis. There is a complex pathophysiology of a lethal cascade of cytokines and inflammatory proteins underlying sepsis. The use of vitamin C can theoretically suppress the inflammatory cascade but remains a questionable practice due to a lack of conclusive evidence. Aims of the study: To appraise the therapeutic role of vitamin C in sepsis. Materials and methods: A systematic review was conducted on PubMed, Embase, and the Central Cochrane Registry. The study included randomized clinical trials (RCTs) with vitamin C as an intervention arm in the septic patient population. For continuous variables, the difference in means (MD) and for discrete variables, the odds ratio (OR) was used. For effect sizes, a confidence interval of 95% was used. A p-value of less than 0.05 was used for statistical significance. The analysis was performed using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: 23 studies were included with the total sample size of 2712 patients. In patients treated with vitamin C, there was a statistically significant reduction in the mortality: OR = 0.778 (0.635 to 0.954), p = 0.016; the sequential organ failure assessment score (SOFA): MD = −0.749 (−1.115 to −0.383), p < 0.001; and the duration of vasopressor requirement: MD = −1.034 days (−1.622 to −0.445), p = 0.001. No significant difference was found in the hospital or ICU length of stay. Conclusions and clinical implications: Vitamin C treatment regimens were associated with reduced mortality, SOFA score, and vasopressor requirement compared to the control in sepsis. Given its low cost and minimal adverse effects, we strongly encourage further large, randomized trials to establish vitamin C as a standard of care in sepsis management.

Background: Limited epidemiological data are available on changes in management, benefits, complications, and outcomes after open lung biopsy in patients with ARDS.

Methods: We performed a literature search of PubMed, Ovid, and Cochrane databases for articles from the inception of each database till November 2020 that provided outcomes of lung biopsy in ARDS patients. The primary outcome was the proportion of patients that had a change in management with alteration of treatment plan, after lung biopsy. Secondary outcomes included pathological diagnoses and complications related to the lung biopsy. Pooled proportions with a 95% confidence interval (CI) were calculated for the prevalence of outcomes.

Results: After analysis of 22 articles from 1994 to 2018, a total of 851 ARDS patients (mean age 59.28 ± 7.41, males 56.4%) that were admitted to the ICU who underwent surgical lung biopsy for ARDS were included. Biopsy changed the management in 539 patients (pooled proportion 75%: 95% CI 64-84%). There were 394 deaths (pooled proportion 49%: 95% CI 41-58%). The most common pathologic diagnosis was diffuse alveolar damage that occurred in 30% (95% CI 19-41%), followed by interstitial lung disease in 10% (95% CI 3-19%), and viral infection in 9% (95% CI 4-16%). Complications occurred among 201 patients (pooled proportion 24%, 95% CI 17-31%). The most common type of complication was persistent air-leak among 115 patients (pooled estimate 13%, 95% CI 9-17%).

Conclusion: Despite the high mortality risk associated with ARDS, lung biopsy changed management in about 3/4 of the patients. However, 1/4 of the patients had a complication due to lung biopsy. The risks from the procedure should be carefully weighed before proceeding with lung biopsy.

Aim: To evaluate and describe lymphocyte populations' and B cell subsets' frequencies in patients presenting with Predominantly antibody deficiencies (PAD) and diagnosed with bronchiectasis or recurrent pneumonia seen in Cali (Colombian Southwest region).

Materials and methods: 16 subjects with PAD, 20 subjects with pulmonary complications (bronchiectasis or recurrent pneumonia) and 20 healthy donors (HD). Controls and probands between 14 and 64 years old, regardless of gender were included. Lymphocyte populations (T, B and NK cells) and B cell subsets were evaluated in peripheral blood mononuclear cells using flow cytometry, T/B/NK reagent and the pre-germinal center antibody panel proposed by the EUROflow consortium were used. EUROclass and the classification proposed by Driessen et al. were implemented.

Results: CVID patients exhibited increase absolute numbers of CD8+ T cells and reduce NK cells as compare with HD, other PAD cases or pulmonary complications. PAD B cell subsets were disturbed when compared to the age range-matched healthy donors. Among B cell subsets, the memory B cell compartment was the most affected, especially switched memory B cells. Four participants were classified as B- and two CVID as smB-Trnorm and smB-21low groups according to EUROclass classification. The most frequent patterns proposed by Driessen et al. were B cell production and germinal center defect.

Conclusions: B cell subsets, especially memory B cells, are disturbed in PAD patients from Southwestern Colombia. To the best of our knowledge this is the most comprehensive study of B cell subsets in Colombian adults.

Introduction: Lower respiratory tract infections (LRTIs) have been reported to possibly initiate the development of asthma in children. However, the role of LRTIs in infantile asthma remains controversial. The goal of this study is to investigate whether LRTIs in hospitalized infants are involved in the development of asthma.

Materials and methods: The subjects were 251 infants under 2 years of age who were admitted to our hospital with an RTI (59 cases of upper RTI (URTIs) with upper respiratory tract inflammation and pharyngeal tonsillitis; 192 cases of LRTIs with bronchitis, pneumonia, and bronchiolitis). Pathogens of viral infections were examined at admission using viral antigen test kits that could be used in ordinary clinical practice in Japan. When the children reached the age of 3 years, a survey was conducted by mailing a questionnaire to determine the symptoms, diagnosis, and treatment of asthma.

Results: The mailed questionnaires were returned by 116 of the 251 subjects. On the questionnaire, the diagnosis of asthma and treatment for asthma were significantly higher in hospitalized infants with LRTIs than in those with URTIs. By diagnosis of LRTIs, infants with pneumonia and bronchiolitis were significantly more likely to develop asthma. However, on pathogen-specific examination, there was no difference in the development of asthma among infants with LRTIs.

Conclusion: LRTI in infancy may be involved in the development of asthma. The severity of LRTI in hospitalized infants, but not the particular viral pathogen causing infection, may be associated with later asthma onset.

Fractional exhaled nitric oxide (FeNO) is a non-invasive biomarker of eosinophilic airway inflammation and therapeutic response to corticosteroid treatment of respiratory diseases. Atopic dermatitis (AD), one of the most common allergic conditions of the skin, is a factor influencing the increase of FeNO. The main aim of this study was to determine differences between levels of FeNO in patients with AD and healthy controls as measured by an electrochemical analyzer. In total, 54 teenagers and adults with AD were recruited and compared with 34 healthy volunteers. The measurements of FeNO were taken using the Hyp’Air FeNO in participants. FeNO was statistically significantly higher in patients with AD than in healthy controls (60.5 ± 35.1 vs. 14.8 ± 5.1 ppb, p < 0.001). We found a strong positive significant correlation between FeNO and the number of positive skin prick tests among AD patients (R = 0.754, p < 0.001). There was no correlation between FeNO and duration of disease as well as SCORAD index among patients. Moreover, we also found no FeNO difference between the mild and moderate forms of AD. The presence of AD and the increasing number of positive skin prick tests increase FeNO, so the results of this measurement should be interpreted with caution in patients with respiratory diseases suffering from AD.