المؤلفون: Hong-lin Peng, Xia Chen, Hui Liu, Li-hua Liang, Wei-dong Song, Ming Li, Qing-zhou Zhao, Hai-yan Li, Mei Jiang, Hai-qiong Yu, Zhong-dong Lü, Yi-ping Zhou, Qi Guo, Nian Liu, Xiao-ke Chen

المصدر: International Journal of Infectious Diseases, Vol 38, Iss C, Pp 141-145 (2015)

مصطلحات موضوعية: Male, Microbiology (medical), medicine.medical_specialty, Severe community-acquired pneumonia, Hospital mortality, Severity of Illness Index, lcsh:Infectious and parasitic diseases, Cohort Studies, Community-acquired pneumonia, Internal medicine, Severity of illness, medicine, Humans, lcsh:RC109-216, Hospital Mortality, Prospective Studies, Mortality, Intensive care medicine, Prospective cohort study, Aged, Confusion, business.industry, Pneumonia, General Medicine, Middle Aged, medicine.disease, Community-Acquired Infections, Infectious Diseases, Minor criteria, Combination, Female, medicine.symptom, business, Cohort study

الوصف: Objectives: The individual 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is not clear whether the combinations of predictive findings might imply diverse severities or different mortalities. Methods: A prospective two centre cohort study was performed of 385 severe CAP patients fulfilling three or more IDSA/ATS minor criteria amongst 1430 patients. Results: Hospital mortality rose sharply from 5.7%, 9.9%, and 16.5%, respectively, for patients with none of three predictive findings most strongly associated to mortality (PaO2/FiO2 ≤ 250 mm Hg, confusion and uraemia), one of those, and two of those to 38.6% for patients with all those (p

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::35aee3e4719f1e0ba4ad204af967acabTest

المؤلفون: Wei-dong Song, Ming Li, Zhong-dong Lü, Li-hua Liang, Xiao-ke Chen, Qing-zhou Zhao, Qi Guo, Mei Jiang, Xia Chen, Hong-lin Peng, Hui Liu, Hai-qiong Yu, Nian Liu, Yi-ping Zhou, Hai-yan Li

المصدر: The American Journal of the Medical Sciences. 350:186-190

مصطلحات موضوعية: Male, medicine.medical_specialty, Sensitivity and Specificity, Severity of Illness Index, Cohort Studies, Respiratory Rate, Predictive Value of Tests, Internal medicine, Pneumonia, Bacterial, medicine, Humans, Urea, Hospital Mortality, Prospective Studies, Confusion, Intensive care medicine, Prospective cohort study, Retrospective Studies, Uremia, Receiver operating characteristic, business.industry, Mortality rate, Retrospective cohort study, General Medicine, Middle Aged, Prognosis, CURB-65, Community-Acquired Infections, ROC Curve, Predictive value of tests, Cohort, Female, Hypotension, business, Cohort study

الوصف: Background It is not clear whether low-blood pressure criterion could be removed from CURB-65 (confusion, urea >7 mmol/L, respiratory rate ≥30/min, low blood pressure and age ≥65 years) score to orchestrate an improvement in identifying patients with community-acquired pneumonia (CAP) in low–mortality rate settings. Methods A retrospective cohort study of 1,230 CAP patients was performed to simplify the CURB-65 scoring system by excluding low-blood pressure variable. The simplification was validated in a prospective 2-center cohort of 1,409 adults with CAP. Results The hospital mortalities were 1.3% and 3.8% in the retrospective and prospective cohorts, respectively. The mortality rates in the 2 cohorts increased directly with the increasing scores, showing significant increased odds ratios for mortality. The pattern of sensitivity, specificity, positive predictive value and Youden's index of a CUR-65 (Confusion, Urea >7 mmol/L, Respiratory rate ≥30/min and age ≥65 years) score of ≥2 for prediction of mortality was better than that of a CURB-65 score of ≥3 in the retrospective cohort. Higher values of corresponding indices were confirmed in the validation cohort. The higher accuracy of CUR-65 score for predicting mortality was illustrated by the area under the receiver operating characteristic curve of 0.937, compared with 0.915 for CURB-65 score in the retrospective cohort ( P = 0.0073). The validation cohort confirmed a similar paradigm (0.953 versus 0.907, P = 0.0002). Conclusions CURB-65 score could be simplified by removing low blood pressure to orchestrate an improvement in predicting mortality in CAP patients who have a low risk of death. A CUR-65 score of ≥2 might be a more valuable cutoff value for severe CAP.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::17d6d754c62e816315fc1f56b4778538Test
https://doi.org/10.1097/maj.0000000000000545Test

المؤلفون: Yi-ping Zhou, Xiao-ke Chen, Wei-dong Song, Qing-zhou Zhao, Zhong-dong Lü, Mei Jiang, Li-hua Liang, Hong-lin Peng, Xia Chen, Hai-yan Li, Nian Liu, Qi Guo, Hai-qiong Yu, Ming Li, Hui Liu

المصدر: The American journal of the medical sciences. 356(4)

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, China, Organ Dysfunction Scores, Pneumonia severity index, Severity of Illness Index, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Community-acquired pneumonia, Intensive care, Internal medicine, medicine, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Aged, Retrospective Studies, Aged, 80 and over, business.industry, Mortality rate, Retrospective cohort study, General Medicine, Pneumonia, Middle Aged, medicine.disease, Uremia, Community-Acquired Infections, Intensive Care Units, 030228 respiratory system, Cohort, Female, business

الوصف: Background The Infectious Disease Society of America/the American Thoracic Society (IDSA/ATS) minor criteria for severe community-acquired pneumonia (CAP) are of unequal weight in predicting mortality. It is unclear whether the patients with non-severe CAP meeting the minor criteria most strongly associated to mortality should have the priority for treatment and intensive care. It is warranted to explore this intriguing hypothesis. Methods A retrospective cohort study of 1230 patients with CAP was performed. This was tested against a prospective 2-center cohort of 1749 adults with CAP. Results The patients with CAP fulfilling the predictive findings most strongly associated to mortality, i.e. PaO2/FiO2 ≤ 250 mm Hg, confusion, and uremia, showed higher mortality rates than those not fulfilling the predictive findings in subgroup analyses of the retrospective cohort. The more the number of predictive findings present, the higher the mortality rates. The prospective cohort confirmed a similar pattern. Interestingly, the patients with non-severe CAP meeting the predictive findings demonstrated unexpectedly higher mortality rates compared with the patients with severe CAP not meeting the predictive findings in the prospective cohort (P = 0.003), although there only existed death of an uptrend in the retrospective cohort. Two similar and intriguing paradigms about sequential organ failure assessment (SOFA) scores and pneumonia severity index (PSI) scores were confirmed in the 2 cohorts. Conclusions The patients with non-severe CAP fulfilling the predictive findings most strongly associated to mortality demonstrated higher SOFA and PSI scores and mortality rates, and might have the priority for treatment and intensive care.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::1d6cc1cce30742708b0d53e92ca48281Test
https://pubmed.ncbi.nlm.nih.gov/31331456Test

المؤلفون: Nian Liu, Hai-yan Li, Ming Li, Qing-zhou Zhao, Hong-lin Peng, Hai-qiong Yu, Xia Chen, Hui Liu, Mei Jiang, Yi-ping Zhou, Xiao-ke Chen, Li-hua Liang, Qi Guo

المصدر: European Journal of Clinical Microbiology & Infectious Diseases. 31:3281-3286

مصطلحات موضوعية: Adult, Male, Microbiology (medical), medicine.medical_specialty, Scoring system, Pneumonia severity index, Sensitivity and Specificity, Severity of Illness Index, Community-acquired pneumonia, Predictive Value of Tests, Internal medicine, medicine, Humans, Intensive care medicine, Aged, Retrospective Studies, Receiver operating characteristic, business.industry, Mortality rate, Pneumonia, General Medicine, Odds ratio, Middle Aged, Prognosis, medicine.disease, Survival Analysis, CURB-65, Community-Acquired Infections, Infectious Diseases, ROC Curve, Female, Risk of death, business

الوصف: The CURB-65 scoring system performs well at identifying patients with pneumonia who have a low risk of death. Whether it predicts mortality in community-acquired pneumonia (CAP) better than the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) minor criteria in low-mortality-rate settings is not clear. The purpose of this study was to determine the hypothesis.A total of 1,230 adult inpatients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively.The hospital mortality was 1.3 %. Percentage mortality increased significantly with CURB-65 score and the increasing number of IDSA/ATS minor criteria present. The number of CURB-65 criteria or IDSA/ATS minor criteria present had significant increased odds ratios for mortality of 7.547 and 2.711, respectively. The sensitivities of a CURB-65 score of ≥ 3 and the presence of ≥ 3 minor criteria in predicting mortality was 25 % and 37.5 %, which increased to 75 % and 62.5 %, while the cut-off values reduced to ≥ 2 criteria, respectively. The area under the receiver operating characteristic curve for CURB-65 was greater than the corresponding area for IDSA/ATS minor criteria in predicting hospital mortality (0.915 vs. 0.805, p = 0.0091).CURB-65 score predicted hospital mortality better than IDSA/ATS minor criteria, and a CURB-65 score of ≥ 2 or the presence of ≥ 2 minor criteria might be more valuable cut-off values for "severe" CAP in a low-mortality-rate setting.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5cf438785fdd16c2d9e7c48994866c91Test
https://doi.org/10.1007/s10096-012-1693-8Test

المؤلفون: Hai-yan Li, Mei Jiang, Qing-zhou Zhao, Xia Chen, Hui Liu, Hong-lin Peng, Ming Li, Yi-ping Zhou, Li-hua Liang, Nian Liu, Hai-qiong Yu, Qi Guo, Xiao-ke Chen

المصدر: Internal Medicine. 51:2521-2527

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Length of hospitalization, Severity of Illness Index, Community-acquired pneumonia, Internal medicine, Internal Medicine, medicine, Humans, Hospital Mortality, Confusion, Aged, Retrospective Studies, Rank correlation, Inpatients, business.industry, Incidence, Mortality rate, Age Factors, Health Care Costs, Pneumonia, General Medicine, Odds ratio, Length of Stay, Middle Aged, medicine.disease, CURB-65, Community-Acquired Infections, Survival Rate, Blood pressure, Physical therapy, Female, business

الوصف: The CURB-65 score is a simple well validated tool for the assessment of severity in community-acquired pneumonia (CAP). The weight of each criterion in very low-mortality-rate settings is unclear. The purpose of this study was to determine the weight in such setting.This study retrospectively reviewed 1,230 adult patients admitted for CAP from 2005 to 2009.The 30-day mortality rose sharply from 0%, 1.0%, 8.2% and 16.7%, respectively, for patients with CURB-65 scores of 0, 1, 2 and 3 to 100.0% for patients with the scores of 4 (x(2) = 219.494, p0.001). Confusion had the strongest association with mortality (odds ratio, 22.148). The presence of low blood pressure was not associated with mortality. Confusion, urea7 mmol.L(-1) and age ≥ 65 yrs showed independent relationships with mortality (Odds ratio, 11.537, 5.988 and 10.462; respectively). Urea7 mmol.L(-1) was most strongly associated with the sequential organ failure assessment (SOFA) scores [rank correlation coefficient (r(s)), 0.352]. Confusion had the closest relationship with hospital length of stay (r(s), 0.114). Age ≥ 65 yrs had the strongest association with costs (r(s), 0.223). Conclusion The individual CURB-65 criteria were of unequal weight for predicting the 30-day mortality, SOFA scores, hospital length of stay and costs in a very low-mortality-rate setting, and a low blood pressure was not associated with mortality.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a9e4717721b788eeb8676c18f70e18aaTest
https://doi.org/10.2169/internalmedicine.51.8159Test

المؤلفون: Qing-zhou Zhao, Hai-yan Li, Hong-lin Peng, Mei Jiang, Qi Guo, Hai-qiong Yu, Yi-ping Zhou, Li-hua Liang, Xia Chen, Ming Li, Hui Liu, Xiao-ke Chen, Zhong-dong Lü, Nian Liu, Wei-dong Song

المصدر: Medicine

مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, China, Youden's J statistic, Observational Study, Hypothermia, Notification, Severity of Illness Index, Cohort Studies, Patient Admission, Community-acquired pneumonia, Respiratory Rate, Predictive Value of Tests, Internal medicine, Severity of illness, medicine, Humans, Mortality prediction, Lung, Aged, Retrospective Studies, Receiver operating characteristic, business.industry, Age Factors, Retrospective cohort study, General Medicine, Odds ratio, Pneumonia, medicine.disease, Prognosis, Predictive value, Thrombocytopenia, Surgery, Community-Acquired Infections, Radiography, Research Design, Predictive value of tests, Female, Hypotension, business, Validation cohort, Research Article, Cohort study

الوصف: It is not clear whether the IDSA/ATS minor criteria for severe community-acquired pneumonia (CAP) could be simplified or even be modified to orchestrate improvements in predicting mortality. A retrospective cohort study of 1230 CAP patients was performed to simplify and to modify the scoring system by excluding 4 noncontributory or infrequent variables (leukopenia, hypothermia, hypotension, and thrombocytopenia) and by excluding these variables and then adding age ≥65 years, respectively. The simplification and modification were tested against a prospective 2-center validation cohort of 1409 adults with CAP. The increasing numbers of IDSA/ATS, simplified, and modified minor criteria present in the retrospective cohort were positively associated with the mortality, showing significant increased odds ratios for mortality of 2.711, 4.095, and 3.755, respectively. The validation cohort confirmed a similar pattern. The sensitivity, specificity, positive predictive value, and Youden index of modified minor criteria for mortality prediction were the best pattern in the retrospective cohort. High values of corresponding indices were confirmed in the validation cohort. The highest accuracy of the modified version for predicting mortality in the retrospective cohort was illustrated by the highest area under the receiver operating characteristic curve of 0.925 (descending order: modified, simplified, and IDSA/ATS minor criteria). The validation cohort confirmed a similar paradigm. The IDSA/ATS minor criteria could be simplified to 5 variables and then be modified to orchestrate improvements in predicting mortality in CAP patients. The modified version best predicted mortality. These were more suitable for clinic and emergency department.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::90c7f51b065f88de2718963480b6ad53Test
https://pubmed.ncbi.nlm.nih.gov/31415439Test

المؤلفون: Ming Li, Li-hua Liang, Hong-lin Peng, Xiao-ke Chen, Xia Chen, Hui Liu, Qi Guo, Qing-zhou Zhao, Nian Liu, Hai-yan Li, Yi-ping Zhou, Hai-qiong Yu, Mei Jiang

المصدر: Respiratory Medicine. (10):1543-1549

مصطلحات موضوعية: Pulmonary and Respiratory Medicine, Male, medicine.medical_specialty, Community-acquired pneumonia, Arterial oxygen, Guidelines as Topic, Hospital mortality, Severity of Illness Index, Severity, Association, Patient Admission, Predictive Value of Tests, Internal medicine, medicine, Humans, Hospital Mortality, Rank correlation, Retrospective Studies, Leukopenia, Sequential organ failure assessment, business.industry, Odds ratio, Pneumonia, Middle Aged, medicine.disease, Prognosis, Weight, Uremia, United States, Surgery, respiratory tract diseases, Community-Acquired Infections, Minor criteria, Female, medicine.symptom, business

الوصف: Summary Background The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) when patients fulfilled three out of nine minor criteria. Whether each of the criteria is of equal weight is not clear. The purpose of this study was to determine the weight of the minor criteria. Methods 1230 adult patients admitted to our hospital from 2005 to 2009 for CAP were reviewed retrospectively. Results Hospital mortality rose sharply from 0.3%, 1.0% and 3.3%, respectively, for patients with none, one and two minor criteria to 10.5% for patients with three minor criteria. Arterial oxygen pressure/fraction inspired oxygen (PaO 2 /FiO 2 ) ≤ 250 mm Hg, confusion, and uremia had the strongest association with mortality (Odds ratio, 22.162, 22.148, 16.343; respectively). Leukopenia, hypothermia, and hypotension were not associated with mortality. Confusion and uremia showed independent relationships with mortality (Odds ratio, 9.296, 8.493; respectively). Sequential organ failure assessment (SOFA) scores and costs increased significantly with the number of minor criteria present. Uremia and PaO 2 /FiO 2 ≤ 250 mm Hg were most strongly associated with SOFA scores [rank correlation coefficient ( r s ), 0.352, 0.336; respectively]. PaO 2 /FiO 2 ≤ 250 mm Hg and confusion were in closest relation to hospital length of stay (LOS) ( r s , 0.114, 0.114; respectively). PaO 2 /FiO 2 ≤ 250 mm Hg and multilobar infiltrates were most strongly associated with costs ( r s , 0.257, 0.196; respectively). Conclusions The individual 2007 IDSA/ATS minor criteria for severe CAP were of unequal weight in predicting hospital mortality, SOFA scores, hospital LOS, and costs.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::29076aa59a8ccac72c3b17bd1354735dTest