Development and validation of a new scoring system for prognostic prediction of community-acquired pneumonia in older adults

The discriminative power of CURB-65 for mortality in community-acquired pneumonia (CAP) is suspected to decrease with age. However, a useful prognostic prediction model for older patients with CAP has not been established. This study aimed to develop and validate a new scoring system for predicting mortality in older patients with CAP. We recruited two prospective cohorts including patients aged ≥ 65 years and hospitalized with CAP. In the derivation (n = 872) and validation cohorts (n = 1, 158), the average age was 82.0 and 80.6 years and the 30-day mortality rate was 7.6% (n = 66) and 7.4% (n = 86), respectively. A new scoring system was developed based on factors associated with 30-day mortality, identified by multivariate analysis in the derivation cohort. This scoring system named CHUBA comprised five variables: confusion, hypoxemia (SpO2 ≤ 90% or PaO2 ≤ 60 mmHg), blood urea nitrogen ≥ 30 mg/dL, bedridden state, and serum albumin level ≤ 3.0 g/dL. With regard to 30-day mortality, the area under the receiver operating characteristic curve for CURB-65 and CHUBA was 0.672 (95% confidence interval, 0.607–0.732) and 0.809 (95% confidence interval, 0.751–0.856; P < 0.001), respectively. The effectiveness of CHUBA was statistically confirmed in the external validation cohort. In conclusion, a simpler novel scoring system, CHUBA, was established for predicting mortality in older patients with CAP

Cutaneous T-cell-attracting chemokine as a novel biomarker for predicting prognosis of idiopathic pulmonary fibrosis: a prospective observational study

[Background] Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disease that leads to respiratory failure and death. Although there is a greater understanding of the etiology of this disease, accurately predicting the disease course in individual patients is still not possible. This study aimed to evaluate serum cytokines/chemokines as potential biomarkers that can predict outcomes in IPF patients. [Methods] A multi-institutional prospective two-stage discovery and validation design using two independent cohorts was adopted. For the discovery analysis, serum samples from 100 IPF patients and 32 healthy controls were examined using an unbiased, multiplex immunoassay of 48 cytokines/chemokines. The serum cytokine/chemokine values were compared between IPF patients and controls; the association between multiplex measurements and survival time was evaluated in IPF patients. In the validation analysis, the cytokines/chemokines identified in the discovery analysis were examined in serum samples from another 81 IPF patients to verify the ability of these cytokines/chemokines to predict survival. Immunohistochemical assessment of IPF-derived lung samples was also performed to determine where this novel biomarker is expressed. [Results] In the discovery cohort, 18 cytokines/chemokines were significantly elevated in sera from IPF patients compared with those from controls. Interleukin-1 receptor alpha (IL-1Rα), interleukin-8 (IL-8), macrophage inflammatory protein 1 alpha (MIP-1α), and cutaneous T-cell-attracting chemokine (CTACK) were associated with survival: IL-1Rα, hazard ratio (HR) = 1.04 per 10 units, 95% confidence interval (95% CI) 1.01–1.07; IL-8, HR = 1.04, 95% CI 1.01–1.08; MIP-1α, HR = 1.19, 95% CI 1.00–1.36; and CTACK, HR = 1.12 per 100 units, 95% CI 1.02–1.21. A replication analysis was performed only for CTACK because others were previously reported to be potential biomarkers of interstitial lung diseases. In the validation cohort, CTACK was associated with survival: HR = 1.14 per 100 units, 95% CI 1.01–1.28. Immunohistochemistry revealed the expression of CTACK and CC chemokine receptor 10 (a ligand of CTACK) in airway and type II alveolar epithelial cells of IPF patients but not in those of controls. [Conclusions] CTACK is a novel prognostic biomarker of IPF

Pneumonia Caused by Severe Acute Respiratory Syndrome Coronavirus 2 and Influenza Virus: A Multicenter Comparative Study

Background: Detailed differences in clinical information between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia (CP), which is the main phenotype of SARS-CoV-2 disease, and influenza pneumonia (IP) are still unclear. Methods: A prospective, multicenter cohort study was conducted by including patients with CP who were hospitalized between January and June 2020 and a retrospective cohort of patients with IP hospitalized from 2009 to 2020. We compared the clinical presentations and studied the prognostic factors of CP and IP. Results: Compared with the IP group (n = 66), in the multivariate analysis, the CP group (n = 362) had a lower percentage of patients with underlying asthma or chronic obstructive pulmonary disease (P < .01), lower neutrophil-to-lymphocyte ratio (P < .01), lower systolic blood pressure (P < .01), higher diastolic blood pressure (P < .01), lower aspartate aminotransferase level (P < .05), higher serum sodium level (P < .05), and more frequent multilobar infiltrates (P < .05). The diagnostic scoring system based on these findings showed excellent differentiation between CP and IP (area under the receiver operating characteristic curve, 0.889). Moreover, the prognostic predictors were different between CP and IP. Conclusions: Comprehensive differences between CP and IP were revealed, highlighting the need for early differentiation between these 2 pneumonias in clinical settings

トクハツセイ ハイ センイショウ ノ リンショウ ケイカ シンチリョウ ニ ツイテ ノ ケントウ

京都大学0048新制・論文博士博士(医学)乙第12244号論医博第1960号新制||医||970(附属図書館)UT51-2008-L169(主査)教授 稲垣 暢也, 教授 宮地 良樹, 教授 中村 孝志学位規則第4条第2項該当Doctor of Medical ScienceKyoto UniversityDA

A case of pulmonary nocardiosis with Nocardia brasiliensis spread from a post‐traumatic cutaneous infection in an immunocompetent patient

Abstract Nocardia is an aerobic Gram‐positive bacterium found in the environment, including soil and water. Nocardia brasiliensis is reportedly associated with cutaneous infections, and disseminated disease is typically detected in immunocompromised individuals. We present a rare case of disseminated nocardiosis with N. brasiliensis in an immunocompetent patient. An 82‐year‐old male, who had a left elbow injury 2 months prior to the first visit, presented with bilateral multiple lung nodules. N. brasiliensis was identified in both sputum and pus specimens, we concluded that the N. brasiliensis had spread from the primary cutaneous lesion. The patient was treated with antibiotics and had a favourable clinical course. As the present case report demonstrates, disseminated nocardiosis caused by this species can progress from a primary cutaneous lesion even in immunocompetent individuals, if the initiation of appropriate treatment is delayed. Therefore, careful evaluation is warranted when Nocardia species are detected

Bentall術後の大動脈基部再置換術症例の検討と術式の工夫

大動脈基部再置換術は手技的にも複雑であり困難である.今回我々は弁付き人工血管置換術後における大動脈基部再置換術の手術成績と手技的工夫について検討した.対象は1997年1月～2007年7月までに当院で施行した大動脈基部再置換術10例である.平均年齢は38.7±15.5歳で7例が男性であった.初回手術で使用した人工弁は全て機械弁であった.初回手術時の冠動脈再建法は,Inclusion法が7例(70.0%),Graft Interposition法が2例(20.0%),Button法が1例(10.0%)であった.再手術の原因は仮性動脈瘤形成が8例(80.0%),人工弁感染が2例(20.0%)であった.また初回手術時に使用した機械弁を再手術時に5例温存可能であった.再手術の成績については,手術死亡を認めなかった.平均観察期間は28.4(6～77)ヵ月で,遠隔期死亡を2例に認め,原因は敗血症と胸腹部大動脈瘤破裂であった.観察期間中に血栓塞栓症,再手術,冠動脈イベント,冠動脈吻合部瘤は認めなかった.再手術後の5年生存率は75.0±15.8%であった.大動脈基部再置換術の早期遠隔成績は満足のいくものであった.冠動脈吻合部瘤で再手術となったものに関しては初回手術時の人工弁を温存することが可能であった.また,大動脈基部再置換術に関して,Button法が施行できない場合,Separate Interposition法は選択肢の一つとなりえると考えられた.Redo aortic root replacement is technically challenging. We review our redo aortic root surgical results following composite valve graft replacement. Between January 1997 and July 2007,10 patients (mean age 38.7 ± 15.5 years, 70.0% men) underwent redo aortic root replacement. The coronary reconstruction techniques in the previous operation were the inclusion technique in 7 (70.0%), graft interposition in 2 (20.0%), and the coronary button technique in one (10.0%). The indications for reoperation were pseudoaneurysm formation in 8 patients (80.0%) and prosthetic valve endocarditis in 2 (20.0%). We could preserve the previous mechanical valve in 5 patients. There were no operative deaths. The mean follow-up was 28.4 months. There were 2 late deaths, one due to sepsis and the other due to thoracoabdominal aortic aneurysm rupture. During follow-up period, there were no thromboembolic events, reoperations, coronary events, or coronary pseudoaneurysms. The actuarial survival rate at 5 years was 75.0 ± 15.8%. Redo aortic root replacement can be performed with good early and late results. In cases of redo aortic root replacement, we consider coronary reconstruction using the separately interposition technique to be feasible as one of many modifications when the button technique is not able to performed

Bentall術後の大動脈基部再置換術症例の検討と術式の工夫

大動脈基部再置換術は手技的にも複雑であり困難である.今回我々は弁付き人工血管置換術後における大動脈基部再置換術の手術成績と手技的工夫について検討した.対象は1997年1月～2007年7月までに当院で施行した大動脈基部再置換術10例である.平均年齢は38.7±15.5歳で7例が男性であった.初回手術で使用した人工弁は全て機械弁であった.初回手術時の冠動脈再建法は,Inclusion法が7例(70.0%),Graft Interposition法が2例(20.0%),Button法が1例(10.0%)であった.再手術の原因は仮性動脈瘤形成が8例(80.0%),人工弁感染が2例(20.0%)であった.また初回手術時に使用した機械弁を再手術時に5例温存可能であった.再手術の成績については,手術死亡を認めなかった.平均観察期間は28.4(6～77)ヵ月で,遠隔期死亡を2例に認め,原因は敗血症と胸腹部大動脈瘤破裂であった.観察期間中に血栓塞栓症,再手術,冠動脈イベント,冠動脈吻合部瘤は認めなかった.再手術後の5年生存率は75.0±15.8%であった.大動脈基部再置換術の早期遠隔成績は満足のいくものであった.冠動脈吻合部瘤で再手術となったものに関しては初回手術時の人工弁を温存することが可能であった.また,大動脈基部再置換術に関して,Button法が施行できない場合,Separate Interposition法は選択肢の一つとなりえると考えられた.Redo aortic root replacement is technically challenging. We review our redo aortic root surgical results following composite valve graft replacement. Between January 1997 and July 2007,10 patients (mean age 38.7 ± 15.5 years, 70.0% men) underwent redo aortic root replacement. The coronary reconstruction techniques in the previous operation were the inclusion technique in 7 (70.0%), graft interposition in 2 (20.0%), and the coronary button technique in one (10.0%). The indications for reoperation were pseudoaneurysm formation in 8 patients (80.0%) and prosthetic valve endocarditis in 2 (20.0%). We could preserve the previous mechanical valve in 5 patients. There were no operative deaths. The mean follow-up was 28.4 months. There were 2 late deaths, one due to sepsis and the other due to thoracoabdominal aortic aneurysm rupture. During follow-up period, there were no thromboembolic events, reoperations, coronary events, or coronary pseudoaneurysms. The actuarial survival rate at 5 years was 75.0 ± 15.8%. Redo aortic root replacement can be performed with good early and late results. In cases of redo aortic root replacement, we consider coronary reconstruction using the separately interposition technique to be feasible as one of many modifications when the button technique is not able to performed