Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study

Abstract Background Mortality prediction of pneumonia by severity scores in patients with multiple underlying health conditions has not fully been investigated. This prospective cohort study is to identify mortality-associated underlying health conditions and to analyse their influence on severity-based pneumonia mortality prediction. Methods Adult patients with community-acquired pneumonia or healthcare-associated pneumonia (HCAP) who visited four community hospitals between September 2011 and January 2013 were enrolled. Candidate underlying health conditions, including demographic and clinical characteristics, were incorporated into the logistic regression models, along with CURB (confusion, elevated urea nitrogen, tachypnoea, and hypotension) score as a measure of disease severity. The areas under the receiver operating characteristic curves (AUROC) of the predictive index based on significant underlying health conditions was compared to that of CURB65 (CURB and age ≥ 65) score or Pneumonia severity index (PSI). Mortality association between disease severity and the number of underlying health conditions was analysed. Results In total 1772 patients were eligible for analysis, of which 140 (7.9%) died within 30 days. Six underlying health conditions were independently associated: home care (adjusted odds ratio, 5.84; 95% confidence interval, CI, 2.28–14.99), recent hospitalization (2.21; 1.36–3.60), age ≥ 85 years (2.15; 1.08–4.28), low body mass index (1.99, 1.25–3.16), neoplastic disease (1.82; 1.17–2.85), and male gender (1.78; 1.16–2.75). The predictive index based on these conditions alone had a significantly or marginally higher AUROC than that based on CURB65 score (0.78 vs 0.66, p = 0.02) or PSI (0.78 vs 0.71, p = 0.05), respectively. Compared to this index, the AUROC of the total score consisting of six underlying health conditions and CURB score (range 0–10) did not improve mortality predictions (p = 0.3). In patients with one or less underlying health conditions, the mortality was discretely associated with severe pneumonia (CURB65 ≥ 3) (risk ratio: 7.24, 95%CI: 3.08–25.13), whereas in patients with 2 or more underlying health conditions, the mortality association with severe pneumonia was not detected (risk ratio: 1.53, 95% CI: 0.94–2.50). Conclusions Mortality prediction based on pneumonia severity scores is highly influenced by the accumulating number of underlying health conditions in an ageing society. The validation using a different cohort is necessary to generalise the conclusion

Additional file 2: of Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study

Figure S1. The AUROC of the total score consisting of six underlying health conditions and CURB score. The AUROC of the total score consisting of six underlying health conditions and CURB score (range 0–10) was 0.79 (95% CI 0.74–0.85) and did not significantly improve mortality predictions compared to the index using the underlying health conditions alone (p = 0.3). (TIF 65 kb

Additional file 1: of Six underlying health conditions strongly influence mortality based on pneumonia severity in an ageing population of Japan: a prospective cohort study

Table S1. Sensitivity analysis using a bootstrapped dataset. The sensitivity analysis using bootstrap method showed almost the identical result to the derived model except that age ≥ 85 years and recent hospitalisation were not statistically significant. AOR adjusted odds ratio, CI confidence interval, HCAP healthcare-associated pneumonia, CURB Confusion, blood Urea nitrogen > 7 mmol/L, Respiratory rate > 30 per minute, and Blood pressure < 90 mmHg in systole or ≤ 60 mmHg in diastole. a Home care: home infusion therapy or wound care. (DOCX 16 kb

Treatment of retinal diseases with VEGF antagonists

Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are the most prevalent causes of blindness in the Western world. The pathogenesis of neovascularization and vascular leakage, both hallmarks of these diseases, appears to have one common denominator: vascular endothelial growth factor (VEGF). Since the recent introduction of anti-VEGF therapy, intravitreal injections with these agents have become standard care in neovascular AMD, and have been found to be a valuable additional treatment strategy in several other vascular retinal diseases. This review provides an overview of the history of anti-VEGF treatment in the eye, its rationale, its efficacy, and its potential drawback