Role of Comorbid Diseases and Some Biochemical Markers in Determination of Severity and Prognosis of Community Acquired Pneumonia // Роля на коморбидните заболявания и някои биохимични маркери в определяне тежестта и прогнозата на пневмония придобита в обществото

[EN] Community-acquired pneumonia (CAP) is a disease with a high incidence, hospitalization and still high mortality rate. Despite the success of antibiotic treatment, the mortality rate ranged between 5-15%, and in intensive care units it is up to 50%. The presence of comorbid diseases affects the course and outcome of the disease. There is no single opinion regarding their significance as the concomitant diseases vary in their nature and severity and their impact in the course of pneumonia is difficult to define. In this paper we evaluate not only the significance of particular diseases to the course of pneumonia, but also evaluate the cumulative risk in polimorbid patients assessed through Charlson Comorbidity Index (ССI). Adding of ССI to the basic severity scales can improve the stratification of risk in patients with pneumonia. Some of the severity scales for CAP such as PSI and IDSA/ATS criteria include a relatively large number of indices and require time to complete them making them difficult to be used in routine practice. Therefore, the interest in markers that are quickly achievable, objective and reliable severity predictors is growing. Some biochemical markers meet these conditions. Their role in diagnosing pneumonia is expressed in several directions – establishing of diagnosis, referring to etiological agent, severity prediction, treatment failure and mortality from pneumonia, referring to an appropriate choice of antibiotic and determining the duration of treatment. Some of the biomarkers such as leucocytes and CRP are routinely used in clinical practice. Other, such as procalcitonin (PCT) and D-dimer are yet to enter in diagnosis and determination of prognosis in CAP. Adding biomarkers to pneumonia severity scales and even their individual use will improve the detection of high-risk patients and reduce the mortality from the disease. For that reasons the topic has not only great scientific but also practical application. The aim of this paper is to investigate the role of comorbid diseases and some biomarkers on the community-acquired pneumonia severity and outcome. In conclusion: CAP is a common disease with heterogeneous clinical picture – from mild and well amenable outpatient treatment, to severe life-threatening infection. Comorbid diseases have significant impact on the course and prognosis of CAP. There cumulative burden can be well assessed through CCI, which must be incorporated in risk assessment models. It is also appropriate to add biomarkers to other factors included in the main scales in order to improve risk stratification in CAP patients. Proper risk assessment will help to identify high-risk patients who require active monitoring and more aggressive treatment to improve the prognosis of the disease.[BG] Дисертационният труд оценява значението на коморбидните заболявания и някои биомаркери в определяне тежестта и изхода от заболяването при хоспитализирани болни с пневмония придобита в обществото (ППО). Определена е честотата на придружаващите заболявания. Особено внимание е обърнато на влиянието на социално значими заболявания като сърдечно-съдови заболявания, захарен диабет и ХОББ върху хода на пневмонията. Изследвана е и кумулативната тежест на коморбидните заболявания, оценена чрез Индекса на коморбидностите на Чарлсон (CCI) , върху хода и изхода от заболяването. Разгледана е ролята на биомаркерите – левкоцити, С-реактивен протеин, Д-димер и прокалцитонин в определяне тежестта и прогнозата на ППО. Сравнена е предиктивната стойност за вътреболнична смъртност на CCI и изследваните биомаркери с тази на основните скали за тежест - PSI, CURB-65, IDSA/ATS критерии. Направен е цялостен анализ на вътреболничната смъртност. Разработен е рисков профил на пациентите с ППОс включване в него на коморбидности и биомаркери. Изработен е алгоритъм за избор на място на лечение и проследяване на пациентите с ППО

Role of some biomarkers in determining the risk of mortality of hospitalized patients with community- acquired pneumonia

Introduction: Various biomarkers are used to determine the severity and risk of mortality in community-acquired pneumonia (CAP). The aim of this article is to evaluate the prognostic value for in-hospital mortality of leukocyte count (Leuk), C-reactive protein (CRP), procalcitonin (PCT), and mid-regional proadrenomedullin (MR-proADM) in CAP patients.Materials and Methods: This was a prospective study including a total of 92 CAP patients hospitalized in the Clinic of Pneumology and Phthisiatry at St. Marina University Hospital of Varna. Biomarkers were determined at hospitalization, Leuk - by automated methodology, CRP - by latex-enhanced immuno-turbidimetric method, and both MR-proADM and PCT - by standard ELISA. CAP severity was estimated by Pneumonia Severity Index (PSI) and CURB-65.Results: The patients were at a mean age of 59.2±16.8 years, 68.5% were men. In-hospital mortality was 7.6%. The optimal cut-off value of MR-proADM for in-hospital mortality was 0.88 ng/mL (sensitivity 85.7% and specificity 85.8%). The positive predictive value was 33.3% and the negative predictive value was 98.6%. The optimal cut-off value of PCT was 1.84 ng/mL (sensitivity 71.4% and specificity 81.1%). The positive predictive value was 23.8% and the negative predictive value was 97.1%. Cut-off values for CRP and Leuk could not be established. By performing ROC curves, MR-proADM, PSI, PCT and CURB-65 were good predictors for in-hospital mortality (AUC 0.91, 0.90, 0.89, and 0.86, respectively).Conclusion: MR-proADM and PCT are promising markers in predicting CAP prognosis. Their predictive value for mortality is similar to that of PSI and CURB-65. CRP and Leuk cannot serve as predictors

Second Black Sea Symposium For Young Scientists In Biomedicine March 27-30, 2014, Varna, Bulgaria

Варненски медицински форум (Varna Medical Forum) V. 3, Suppl 1(2014

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.info:eu-repo/semantics/publishedVersio

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

BACKGROUND: The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. METHODS: We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. RESULTS: At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P &lt; .001). CONCLUSIONS: Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

International prevalence and risk factors evaluation for drug-resistant Streptococcus pneumoniae pneumonia

Objective: Streptococcus pneumoniae is the most frequent bacterial pathogen isolated in subjects with Community-acquired pneumonia (CAP) worldwide. Limited data are available regarding the current global burden and risk factors associated with drug-resistant Streptococcus pneumoniae (DRSP) in CAP subjects. We assessed the multinational prevalence and risk factors for DRSP-CAP in a multinational point-prevalence study. Design: The prevalence of DRSP-CAP was assessed by identification of DRSP in blood or respiratory samples among adults hospitalized with CAP in 54 countries. Prevalence and risk factors were compared among subjects that had microbiological testing and antibiotic susceptibility data. Multivariate logistic regressions were used to identify risk factors independently associated with DRSP-CAP. Results: 3,193 subjects were included in the study. The global prevalence of DRSP-CAP was 1.3% and continental prevalence rates were 7.0% in Africa, 1.2% in Asia, and 1.0% in South America, Europe, and North America, respectively. Macrolide resistance was most frequently identified in subjects with DRSP-CAP (0.6%) followed by penicillin resistance (0.5%). Subjects in Africa were more likely to have DRSP-CAP (OR: 7.6; 95% CI: 3.34-15.35, p < 0.001) when compared to centres representing other continents. Conclusions: This multinational point-prevalence study found a low global prevalence of DRSP-CAP that may impact guideline development and antimicrobial policies. Published by Elsevier Ltd on behalf of The British Infection Association