The Neutrophil to Lymphocyte Ratio Is Superior to Other Inflammation-Based Prognostic Scores in Predicting the Mortality of Patients with Pneumonia

A neutrophil-to-lymphocyte ratio (NLR) > 7 is reportedly an independent marker of mortality in patients with bacteremia. However, no studies have shown an association between inflammation-based prognostic scores (including the Glasgow Prognostic Score, the NLR, the platelet-to-lymphocyte ratio, the Prognostic Nutritional Index, and the Prognostic Index) and mortality in patients with pneumonia. We retrospectively examined the cases of 33 patients diagnosed with pneumonia who were treated in the ICU of Osaka Medical College Hospital between January 2014 and June 2016. A multivariate analysis revealed that the NLR was a significant predictor of mortality in these pneumonia patients

Sudden, Sharp Turn in an AIDS Patient’s Course Following the Onset of Fulminant Type 1 Diabetes

A previously healthy 40-year-old Japanese male was urgently admitted with a 2-month history of dysphagia, 30-kg weight loss, and fever. Human immunodeficiency virus (HIV) antibodies and cytomegalovirus antigenemia were positive. Pneumocystis pneumonia and cytomegalovirus pneumonia were suspected. The patient was diagnosed with acquired immune deficiency syndrome (AIDS). Cytomegalovirus antigenemia became negative 20 days after the positive result. On hospital day 41, he experienced cardiopulmonary arrest. The clinical diagnosis was fulminant type 1 diabetes mellitus. He later developed hypoglycemia and was diagnosed with adrenal insufficiency accompanied by septic shock. He died of multiple organ failure 29 h post-admission to our ICU

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are superior to other inflammation-based prognostic scores in predicting the mortality of patients with gastrointestinal perforation

Abstract Background The neutrophil to lymphocyte ratio (NLR) is gaining interest as an independent predictor of survival in patients with various clinical conditions. No study to date has reported an association between inflammation-based prognostic scores, including the Glasgow Prognostic Score (GPS), NLR, platelet to lymphocyte ratio (PLR), Prognostic Nutritional Index (PNI), and Prognostic Index (PI), and mortality in patients with gastrointestinal perforation (GIP). We compared the prognostic value of these measures. Findings A total of 32 patients with GIP were retrospectively enrolled. Patients were assessed according to the GPS, NLR, PLR, PI, and PNI. Multivariate analyses were performed to identify variables associated with mortality. Receiver operating characteristic (ROC) analyses were also performed. Overall survival rates (in-hospital mortality) were calculated using the Kaplan–Meier method, and differences in survival rates between groups were compared by the log-rank test. Multivariate analysis of significant variables revealed NLR (HR 1.257, 95% CI 1.035–1.527, P = 0.021) and PLR (HR 1.004, 95% CI 1.001–1.007, P = 0.016) at the time of admission to the intensive care unit to be independently associated with in-hospital mortality. AUC analysis revealed Sequential Organ Failure Assessment-Glasgow Coma Scale (SOFA-GCS) (0.73) to be superior to NLR (0.57) and PLR (0.58) for predicting mortality, and a high SOFA-GCS score was associated with reduced overall survival (P < 0.05). Conclusions NLR and PLR were superior to other inflammation-based prognostic scores in predicting the mortality of patients with GIP

Bacillus cereus pneumonia in an immunocompetent patient: a case report

Abstract Background Bacillus cereus (B. cereus) rarely causes lower respiratory tract infections, although most reported cases of B. cereus pneumonia are fatal despite intensive antibiotic therapy. We present a case of B. cereus pneumonia in an immunocompetent patient. Case presentation An 81-year-old woman was transferred from a district general hospital to our hospital for treatment of congestive heart failure. The patient presented with a nonproductive cough, dyspnea, edema in both lower extremities, orthopnea, fever, and occult blood in the stool. A chest radiograph indicated bilateral pleural effusion and pulmonary congestion. After diuretic therapy and chest drainage, bilateral pleural effusion and pulmonary congestion improved. On day 2, she experienced severe respiratory distress. B. cereus was isolated from two blood sample cultures. On day 4, her condition had progressed to severe respiratory distress (PaO2/FiO2 ratio = 108). A chest radiograph and computed tomography indicated extensive bilateral infiltrates. She was transferred to the intensive care unit and was intubated. B. cereus was also isolated from five blood sample cultures at that time. After isolating B. cereus, we switched antibiotics to a combination of imipenem and levofloxacin, which were effective. She had no history of immunodeficiency, surgery, ill close contacts, risk factors for HIV or tuberculosis, recent central venous catheter insertion, or anthrax vaccination. She improved and was discharged from the intensive care unit after several days. Conclusion This is a rare case of B. cereus pneumonia in an immunocompetent patient, who subsequently recovered. Bacillus should be considered as a potential pathogen when immunocompetent patients develop severe pneumonia

Sudden onset of severe pulmonary edema after emergency cesarean section

Abstract Mitral valve stenosis (MS) associated with rheumatic disease no longer represents a major heart problem during the perinatal period in Japan. Here we present a case of acute heart failure due to MS after emergency cesarean section (CS). The patient was transferred due to the development of fetal distress at 36 weeks gestation and underwent an emergency CS under general anesthesia. She developed acute heart failure immediately postoperatively and was diagnosed with MS associated with pulmonary artery hypertension for the first time. She underwent percutaneous transvenous mitral commissurotomy and was discharged from our hospital in good condition