Objective To verify the association between admission serum phosphate level and short-term (<30 days) mortality of severe pneumonia patients admitted to intensive care unit (ICU) / respiratory intensive care unit (RICU). Methods Severe pneumonia patients admitted to the ICU/RICU of Quanzhou First Hospital Affiliated to Fujian Medical University from November 2019 to September 2021 were included in the study. Serum phosphate was demonstrated as an independent risk factor for short-term mortality of severe pneumonia patients admitted to ICU/RICU by logical analysis and receiver operator characteristic (ROC) curve. The patients were further categorized by serum phosphate concentration to explore the relationship between serum phosphate level and short-term mortality. Results Comparison of baseline indicators at admission between the survival group (n=54) and the non survival group (n=46) revealed that there was significant difference in serum phosphate level [0.9 (0.8, 1.2) mmol/L vs. 1.2 (0.9, 1.5) mmol/L, P<0.05]. Logical analysis showed serum phosphate was an independent risk factor for short-term mortality. ROC curve showed that the prediction ability of serum phosphate was close to pneumonia severity index (PSI). After combining serum phosphate with PSI score, CURB65 score, and sequential organ failure score, the predictive ability of these scores for short-term mortality was improved. Compared with the normophosphatemia group, hyperphosphatemia was found be with significantly higher short-term mortality (85.7% vs. 47.3%, P<0.05), which is absent in hypophosphatemia (25.8%). Conclusions Serum phosphate at admission has a good predictive value on short-term mortality in severe pneumonia patients admitted to the ICU/RICU. Hyperphosphatemia at admission is associated with a higher risk of short-term death.
ObjectiveTo analyze the clinical features of Legionella-associated cavitary pneumonia, and to explore the diagnosis, treatment planning, and clinical management of patients.MethodsThe data of a patient with severe Legionella-associated cavitary pneumonia were collected and analyzed. Databases including PubMed, Ovid, Wanfang, VIP and Chinese National Knowledge Infrastructure were searched for pertinent literatures, using the keyword "Legionella, lung abscess or cavitary pneumonia" in Chinese and English from Jan. 1990 to Jun. 2019. The related literature was reviewed.ResultsA 60-year-old male patient was admitted to hospital because of fever, cough, and expectoration for five days. On presentation, his temperature was 38.3 °C, and pulmonary auscultation revealed rales on the left side of the lungs. Culture of lower airway secretions obtained by bronchoscopy revealed Legionella pneumophila infection, and serotype 6. Chest computerized tomography showed a consolidation in the left lung and an abscess in the left upper lobe. The patient was discharged from the hospital after three months of anti-Legionella treatment (Mosfloxacin, Azithromycin, etc.). Fifteen manuscripts, including 18 cases, were retrieved from databases. With the addition of our case, a total of 19 cases were analyzed in detail. There were 15 males and four females, aged from 4 months to 73 years old. Most of them (14/19, 73.7%) were accompanied by multiple underlying diseases. Initial empiric antimicrobial therapy failed in 15 (78.9%) cases, and 7 (36.8%) patients required combination therapy. The courses of antimicrobial treatment were from 3 to 49 weeks. All except one patient were fully recovered and discharged from hospital.ConclusionsLegionella pneumonia with pulmonary abscess or cavity is rare and often presents with fever. Pulmonary imaging shows infiltration in the initial, but can be free of cavities or abscesses. Most patients have basic diseases. Severe patients often need to be treated in combination with antibiotics for long periods of time.
ObjectiveTo investigate the condensate pollution in the pipeline of severe pneumonia patients undergoing mechanical ventilation.MethodsFrom January 2017 to January 2019, 120 patients with severe pneumonia treated by mechanical ventilation in our hospital were collected continuously. The lower respiratory tract secretions were collected for bacteriological examination. At the same time, the condensed water in the ventilator exhaust pipe was collected for bacteriological examination at 4, 8, 12, 16, 20 and 24 hours after tracheal intubation and mechanical ventilation. The bacterial contamination in the condensed water at different time points was analyzed and separated from the lower respiratory tract. The consistency of bacteria in secretion and drug resistance analysis of bacterial contamination in condensate water were carried out.ResultsOf the 120 patients with severe pneumonia after mechanical ventilation, isolates were cultured in the lower respiratory tract secretions of 102 patients. One strain was cultured in 88 cases, two strains were cultured in 10 cases, and three strains were cultured in 4 cases. The isolates were mainly Gram-negative bacteria (57.5%) and Gram-positive bacteria (42.5%). The most common isolates were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. The contamination rate of condensate water was 5.0% at 4 hours, 37.5% at 8 hours, 60.0% at 12 hours, 76.7% at 16 hours, 95.0% at 20 hours, and 100.0% at 24 hours, respectively. The bacterial contamination rate in condensate water at different time points was statistically significant (P=0.000). The pollution rate at 4 hours was significantly lower than that at 8 hours (P=0.000). Gram-negative bacteria accounted for 57.5% and Gram-positive bacteria accounted for 42.5%. The most common isolates were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The consistency of bacteria in lower respiratory tract and condensate water was 83.3% in severe pneumonia patients undergoing mechanical ventilation. The overall resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus was higher, but the resistance to imipenem/cilastatin was lower.ConclusionsThe bacterial contamination in the condensate of patients with severe pneumonia during mechanical ventilation is serious. The pollution rate is low within 4 hours. It is consistent with the bacterial contamination in lower respiratory tract and the bacterial resistance is high.
Objective To explore the clinical characteristics of Chlamydia psittaci pneumonia. Methods From January 2020 to March 2023, 21 cases of Psittacosis from the First Affiliated Hospital of Nanjing Medical University were diagnosed via metagenomic next-generation sequencing (mNGS). They were divided into a severe group (n=10) and a non-severe group (n=11) based on diagnostic criteria for severe pneumonia, and the clinical presentation, secondary examination, treatment, and prognosis of the two groups were analyzed retrospectively. Results Among the 21 patients, there were 11 males and 10 females, with a mean age of (51.7±11.6) years. All patients had an acute onset and 12 had a confirmed history of exposure to poultry. The onset of the disease occurred in the autumn and winter seasons in 18 patients. All the patients were suffering from high fevers. Other symptoms included coughing, phlegm, tightness in the chest and fatigue. Laboratory examinations showed that the levels of leukocytes, neutrophil counts, C-reactive protein, procalcitonin, aminotransferase, creatine kinase, lactic dehydrogenase, brain natriuretic peptide precursors and D-dimer were significantly higher in the severe group than those in the non-severe group. Chest CT scans revealed varying levels of consolidation and spot shadowing with peripheral exudate in all patients. The patients in the severe group were more likely to have bilateral lung involvement, bilateral pleural effusion, cavity and mediastinal lymph node enlargement. Eleven patients received tetracycline alone, three received laudanum alone, two received respiratory quinolones alone, and five received a combination of two drugs including tetracycline. Chest CT at clinical follow-up showed absorption of lung lesions. Conclusions Chlamydia psittaci pneumonia usually occurs in the fall and winter, and most patients have a history of contact with poultry. Clinical presentation and imaging are not specified. The technology of mNGS enables early diagnosis of the disease, and neutrophil lymphocyte ratio, neutrophil-lymphocyte ratio and lactic dehydrogenase levels help assess the risk of severe disease.
ObjectiveTo explore the correlation of serum neutrophil gelatinase-associated lipocalin (sNGAL) with inflammatory response in patients with community-acquired pneumonia (CAP) and assess the diagnostic value of sNGAL for severe CAP (SCAP).MethodsFrom January 2018 to June 2019, a total of 85 patients with CAP were enrolled in this study. Age, length of hospital stay, the levels of serum creatinine, blood urea nitrogen, white blood cell count,C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin, and CURB-65 score were compared between patients with SCAP (n=34) and patients without SCAP (n=51). The correlations of sNGAL with serum creatinine, blood urea nitrogen, white blood cell count, CRP, IL-6, procalcitonin, and CURB-65 score were assessed with Spearman’s correlation analysis. The area under the receiver operating characteristic (ROC) curve for sNGAL diagnosing SCAP was examined. ResultsCompared with patients without SCAP, SCAP patients demonstrated older age, longer hospital stay, higher serum CRP and IL-6 concentritions, and higher CURB-65 score (P<0.05). The Spearman’s correlation test showed that sNGAL was positively correlated with serum CRP, IL-6, PCT and CURB-65 score (rs=0.472, 0.504, 0.388, and 0.405, respectively; P<0.01). According to ROC analysis, the area under curve of sNGAL for diagnosing SCAP were 0.816, with a sensitivity of 76.56% and a specificity of 74.4% when the cut-off value was 171.0 ng/mL.ConclusionssNGAL concentration is positively correlated with the serverity of CAP. It can be regarded as a reliable indicator for diagnosis of SCAP in patients with CAP.
Objective To investigate the pleural effusion lymphocyte subsets in patients with pneumonia complicated with pleural effusion and its relationship with the occurrence of critical illness. MethodsPatients with pneumonia complicated with pleural effusion (246 cases) admitted to our hospital from January 2020 to June 2022 were selected as the research subjects. According to the severity of pneumonia, they were divided into a critical group (n=150) and a non-critical group (n=96). After 1:1 matching by propensity score matching method, there were 60 cases in each group. The general data of the two groups were compared. CD3+, CD4+, CD8+, CD4+/CD8+ ratio were detected by flow cytometry. Multivariate logistic regression was used to analyze the risk factors of critical pneumonia, and a nomogram prediction model was constructed and evaluated. The relationship between PSI score and lymphocyte subsets in pleural effusion was analyzed by local weighted regression scatter smoothing (LOWESS). Results After matching, the differences between the two groups of patients in the course of disease, heat peak, heat course, atelectasis, peripheral white blood cell count (WBC), C-reactive protein (CRP), D-dimer (D-D), procalcitonin (PCT) and hemoglobin were statistically significant (P<0.05). Compared with the non-critical group, the proportion of CD3+, CD4+, CD4+/CD8+ cells in critical group was lower (P<0.05), and the proportion of CD8+ cells was higher (P<0.05). Combined atelectasis, increased course of disease, fever peak and fever course, increased WBC, CRP, D-D, CD8+ and PCT levels, and decreased CD3+, CD4+, CD4+/CD8+ and Hb levels were independent risk factors for the occurrence of critical pneumonia (P<0.05). The nomogram prediction model based on independent influencing factors had high discrimination, accuracy and clinical applicability. There was a certain nonlinear relationship between pneomonia severity index and CD3+, CD4+, CD8+ and CD4+/CD8+. Conclusions Lymphocyte subsets in pleural effusion are closely related to the severity of pneumonia complicated with pleural effusion. If CD3+, CD4+, CD8+ and CD4+/CD8+ are abnormal, attention should be paid to the occurrence of severe pneumonia.
ObjectiveTo summarize the clinical features of cytomegalovirus infection after severe pneumonia in immunocompetent subjects. MethodsTwo cases of cytomegalovirus infection after severe pneumonia in immunocompetent subjects were reported and the literatures were reviewed. ResultsTwo elderly patients were admitted to our Respiratory Intensive Care Unit for severe pneumonia and typeⅠrespiratory failure. After treatment of invasive mechanical ventilation, broad-spectrum antibiotics and steroids, their body temperature became normal with improvement of oxygenation and lung infiltrates on chest radiograph. After extubation, their oxygenation deteriorated, with extensive lung infiltrates on chest X ray. Coincidently, their blood cytomegalovirus DNA became positive and then they were treated with parenteral ganciclovir for more than 2 weeks. After that, their oxygenation and chest radiograph returned to normal. Combined with the results of the related literature, invasive mechanical ventilation and use of corticosteroids could be the risk factors of immunocompetent subjects to develop cytomegalovirus infection after severe pneumonia. The clinical characteristics include deterioration of oxygenation and extensive lung infiltrates without positive pathogenic findings of bacteria and fungi. Quantitive nucleic acid amplification tests for blood cytomegalovirus DNA, cytomegalovirus pp65 antigenemia test and histology/immunohistochemistry are recommended diagnostic tools. Valganciclovir or intravenous ganciclovir are recommended as first-line treatment for at least 2 weeks. ConclusionsCytomegalovirus infection occurs frequently in immunocompe-tent subjects with critical illness. Cytomegalovirus pneumonia should especially be considered in patients with severe pneumonia, receiving mechanical ventilation and steroids. Early diagnosis and treatment may help improve the prognosis of these patients.
ObjectiveTo systematically review the effectiveness of Xuebijing injection combined with routine therapy versus routine therapy alone in treating severe pneumonia. MethodsDatabases including PubMed (1990-2013.4), EMbase (1990-2013.4), The Cochran Library (Issue 4, 2013), CNKI (1982-2013.4), WangFang Data (1990-2013.4), VIP (1989-2013.4) and CBM (1978-2013.4) were searched from inception to April, 2013, for randomized controlled trials (RCTs) on Xuebijing injection for severe pneumonia. Studies were screened according to the inclusion and exclusion criteria, data were extracted, and methodological quality was evaluated. Meta-analysis was then performed using RevMan 5.2 software. ResultsA total of 12 studies involving 860 patients were included. The results of meta-analysis showed that, routine therapy plus Xuebijing injection had higher total effective and excellent rates, and the combined therapy reduced the average hospitalization days, and they had better improvement in WBC, CRP, CPIS, IL-6, IL-8, TNF-α. ConclusionThis current evidence shows that Xuebijing injection has a better clinical efficacy in treating severe pneumonia. Traditional Chinese herbs with the function of "promoting blood circulation to remove blood stasis" may exert their pharmacological effects via a multi-target way in treating severe pneumonia, which have a great potential for both clinical work and scientific research. Due to the limited quality and quantity of the included studies, better designed RCTs are needed to support Xuebijing's clinical efficacy in the treatment of severe pneumonia.
目的:探讨胸腺肽α1(Tα1)对重症肺炎细胞因子及免疫功能的影响,观察Tα1在重症肺炎中的治疗作用。方法:将2005年3月至2007年12月在成都市第三人民医院呼吸科(包括RICU)收治的重症肺炎患者随机分为对照组(40例)及用药组(45例),在控制感染的基础上加用胸腺肽α1,观察细胞因子水平的变化及T细胞亚群的改变,同时观察临床症状、体征、X线改变,进行疗效评价。结果:两组患者肿瘤坏死因子(TNF-α),白细胞介素6(L-6)水平均呈升高趋势,但对照组升高更加明显,而白介素10(L-10)在用药组患者中呈升高趋势,治疗第4,第8天,用药组CD4+、CD4+/CD8+较用药前升高,明显高于对照组;治疗组临床疗效及住院时间也优于对照组。结论:Tα1可以调节重症肺炎患者的TNF-α,L-6,L-10等细胞因子的水平,减轻炎症反应,改善患者的免疫功能。
Objective Since the first case of avian influenza A (H7N9) virus infection in humans identified in Suining, Sichuan province on January 25th, 2017, there were other five severely ill patients confirmed in the following 3 weeks. It is urgent to find out the common clinical characters of these patients, so that to make sure the optimal ways for early diagnosis and treatment for H7N9 virus infection in community hospitals or primary hospitals as soon as possible. Methods The early symptoms, the data of early laboratory findings, the early imaging study, the early process of diagnosis and treatment of these six patients were collected and analyzed. Results All six patients had high fever, dry cough, hypocalcemia, and hypophosphatemia, with advanced CT image lesions manifested as consolidation and ground-grass opacity in bilateral lower lung lobes. Some patients had typically leukopenia, lymphopenia, thrombocytopenia. And most of them had a history of direct exposure to live poultry before complaining of flu-like syndromes. However, the flu can not be effectively controlled by routine anti-infection. Conclusion The human infection with H7N9 virus can be early identified by combining the epidemiology of live poultry exposure, the symptoms of high fever, dry cough, dramatical leukopenia, lymphopenia, thrombocytopenia, the typical CT image, and the rapidly worsen clinical condition.