Materiały źródłowe

• #1 Prognostic factors and prediction models for hospitalisation and all-cause mortality in adults presenting to primary care with a lower respiratory tract infection: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10961536/

  To identify and synthesise relevant existing prognostic factors (PF) and prediction models (PM) for hospitalisation and all-cause mortality within 90 days in primary care patients with acute lower respiratory tract infections (LRTI). […] The risk of bias was judged high for all studies, mainly due to limitations in the analysis domain. […] Based on reported multivariable associations in PF studies, increasing age, sex, current smoking, diabetes, a history of stroke, cancer or heart failure, previous hospitalisation, influenza vaccination (negative association), current use of systemic corticosteroids, recent antibiotic use, respiratory rate 25/min and diagnosis of pneumonia were identified as most promising candidate predictors. […] Implementation of existing models for individualised risk prediction of 90-day hospitalisation or mortality in primary care LRTI patients in everyday practice is hampered by incomplete assessment of model performance.

• #2 Predicting in-hospital mortality in pneumonia-associated septic shock patients using a classification and regression tree: a nested cohort study | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0335-3

  Pneumonia complicated by septic shock is associated with significant morbidity and mortality. […] Overall mortality (51%) in patients with pneumonia complicated by septic shock is high. Increased time to administration of antimicrobial therapy, Acute Physiology and Chronic Health Evaluation II Score, serum lactate, and age were associated with increased in-hospital mortality. […] Time to administration of appropriate antimicrobial therapy remained the most important predictor of in-hospital mortality in this population. […] The CART model for predicting mortality in patients with pneumonia and septic shock is depicted in Fig. 1. Variables included within the model were the time to administration of appropriate antimicrobial therapy, APACHE II score, serum lactate, and age. The most important predictor of in-hospital mortality was the time to appropriate antimicrobial therapy.

• #2 Prognostic factors and prediction models for hospitalisation and all-cause mortality in adults presenting to primary care with a lower respiratory tract infection: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10961536/

  The identified candidate predictors provide useful information for clinicians and warrant consideration when developing or updating PMs using state-of-the-art development and validation techniques. […] The risk of bias in included studies was judged high, mainly due to issues in the analysis domains. […] Of all PFs analysed, 13 were identified as most promising; increasing age, sex, current smoking, diabetes, a history of stroke, cancer or heart failure, hospitalisation in the previous year, current use of systemic corticosteroids, antibiotic use in the previous month, a respiratory rate 25/min and diagnosis of pneumonia were associated with poor outcome whereas seasonal influenza vaccination was estimated to have a negative association. […] Most of these promising candidate predictors have also been incorporated into the identified PMs.

• #3 Predicting in-hospital mortality in pneumonia-associated septic shock patients using a classification and regression tree: a nested cohort study | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0335-3

  Pneumonia complicated by septic shock is associated with significant morbidity and mortality. […] Overall mortality (51%) in patients with pneumonia complicated by septic shock is high. Increased time to administration of antimicrobial therapy, Acute Physiology and Chronic Health Evaluation II Score, serum lactate, and age were associated with increased in-hospital mortality. […] Time to administration of appropriate antimicrobial therapy remained the most important predictor of in-hospital mortality in this population. […] The CART model for predicting mortality in patients with pneumonia and septic shock is depicted in Fig. 1. Variables included within the model were the time to administration of appropriate antimicrobial therapy, APACHE II score, serum lactate, and age. The most important predictor of in-hospital mortality was the time to appropriate antimicrobial therapy.

• #4 Predicting in-hospital mortality in pneumonia-associated septic shock patients using a classification and regression tree: a nested cohort study | Journal of Intensive Care | Full Text

  https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-018-0335-3

  In the training set (n=2111), a CART model using APACHE II score, lactate, age, and time to appropriate antimicrobial therapy yielded predictive accuracy of 73%, specificity 75%, sensitivity 71%, and AUROC 0.75. In the testing set (n=2111), the CART model offered predictive accuracy of 69%, specificity 72%, sensitivity 65%, and AUROC 0.72. […] The novelty of the study is the use of classification and regression tree (CART) methodology for the development of a simple, accurate prediction model for outcomes in pneumonia patients with septic shock. […] Overall mortality in patients with pneumonia and septic shock is high (51% in the CATSS dataset). Increasing time to appropriate antimicrobial therapy, APACHE II score, serum lactate, and age were significantly associated with in-hospital mortality. CART models offer simple prognostic models with good performance.

• #5 Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-018-0934-5

  Cirrhotic patients with pneumonia have a dramatically increased mortality. […] To recognize the risk factors of mortality and to optimize stratification are critical for improving survival rate. […] Patients with nosocomial acquired or community acquired pneumonia indicated similar prognosis after 30- and 90-day follow-up. […] However, patients triggered acute-on-chronic liver failure (ACLF) highly increased mortality (46.4% vs 4.5% for 30-day, 69.6% vs 11.2% for 90-day). […] Age, inappropriate empirical antibiotic therapy, bacteremia, white blood cell count (WBC) and total bilirubin were independent factors for mortality in current study. […] This study found age, bacteremia, WBC, total bilirubin and inappropriate empirical antibiotic therapy were independently associated with increased mortality.

• #6 Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-018-0934-5

  Pneumonia triggered ACLF remarkably increased mortality. […] CLIF-SOFA was more accurate in predicting mortality than other five prognostic models. […] The factors that associated with 30- and 90-day mortality were listed. […] Inappropriate empirical antibiotic therapy was critical for predicting 30-days and 90-days mortality. […] Bacteremia was also related to higher mortality. […] CLIF-SOFA in predicting 30-day and 90-day mortality at onset of pneumonia were higher than those of five other predicting models. […] Cirrhosis patients who complicated with pneumonia were at high risks of undesirable prognosis. […] Age, WBC, bacteremia and total bilirubin were significant in affecting outcomes, while appropriate empirical antibiotic therapy was important in improving survival. […] CLIF-SOFA model was superior to other scoring system in predicting 30-day and 90-day mortality.

• #7 The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study | BMJ Open

  https://bmjopen.bmj.com/content/6/9/e011021

  Objective To investigate the accuracy of the National Early Warning Score (NEWS) to predict mortality and adverse clinical outcomes for patients with community-acquired pneumonia (CAP) compared to standard risk scores such as the pneumonia severity index (PSI) and CURB-65. […] Our primary outcome was all-cause mortality within 6years of follow-up. Secondary outcomes were adverse clinical outcome defined as intensive care unit (ICU) admission, empyema and unplanned hospital readmission all occurring within 30days after admission. […] 6-year overall mortality was 45.1% (n=417) with a stepwise increase with higher NEWS categories. […] For prediction of ICU admission, NEWS showed moderate discrimination (AUC 0.73) and improved the prognostic accuracy of a regression model, including PSI (AUC from 0.66 to 0.74, p=0.001) and CURB-65 (AUC from 0.64 to 0.73, p=0.015).

• #8 Validation of a Prediction Rule for Prognosis of Severe Community- Acquired Pneumonia

  https://openrespiratorymedicinejournal.com/VOLUME/2/PAGE/67/FULLTEXT/

  In a previous study, we developed a prognostic prediction rule, based on nine prognostic variables, capable to estimate and to adjust the mortality rate of patients admitted in intensive care unit for severe community-acquired pneumonia. […] Our results demonstrate the performance and reproductibility of this prognostic prediction rule. […] On ICU admission, an initial risk score classified patients into three classes of increasing mortality. […] During the ICU stay, an adjustment risk score identified, in each initial risk class, subclasses associated with significantly different mortality rates. […] The goal of our prognostic prediction rule is quite different from the goal of these rules. […] Our prospective population included 511 patients admitted into ICU for severe CAP. The overall mortality rate was 29.0%. According to an initial risk score representing the first step of our prediction rule, we identified 3 groups of patients exhibiting significantly different mortality rates varying from 8.2% to 65%. […] In summary, the results of this prospective multicenter study demonstrate the performance and reproductibility of this prognostic prediction rule. Six predictors of mortality accurately predict the outcome, as early as ICU admission, for 50% of patients.

• #8 The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study | BMJ Open

  https://bmjopen.bmj.com/content/6/9/e011021

  NEWS provides additional prognostic information with regard to risk of ICU admission and complications and thereby improves traditional clinical-risk scores in the management of patients with CAP in the ED setting. […] This first study evaluating NEWS in a large population with CAP from a multicentre study with a 6-year follow-up has three key findings. First, NEWS is a moderate predictor for adverse clinical outcomes, particularly ICU admission, and to a lesser degree for empyema in patients presenting with CAP to the ED. Second, NEWS improves the PSI and CURB-65 for prediction of ICU admission. Third, although NEWS is associated with mortality, this score has a lower prognostic performance compared to standard CAP scores and did not improve their performance. […] We found NEWS to provide additional prognostic information with regard to risk of ICU admission and empyema, thereby improving traditional clinical CAP risk scores in the management of patients in the ED setting.

• #9 Prognostic factors and prediction models for hospitalisation and all-cause mortality in adults presenting to primary care with a lower respiratory tract infection: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10961536/

  The secondary care-derived CRB-65, predicting mortality in patients with CAP and a newly developed PM by Bont et al predicting hospitalisation and mortality in elderly LRTI patients both showed promising results after external validation. However, none assessed model calibration, leaving the precision of predicted risks unknown.

• #10 Utility of the New Early Warning Score (NEWS) in combination with the neutrophil–lymphocyte ratio for the prediction of prognosis in older patients with pneumonia | Family Medicine and Community Health

  https://fmch.bmj.com/content/11/2/e002239

  A combination of the NEWS and NLR (NEWSNLR or NEWS+NLR) may be superior to the NEWS alone for the prediction of 30-day mortality in older patients with pneumonia. […] In the present study, we have shown that the NEWS is a predictor of 30-day mortality in older patients with pneumonia in a general hospital in Japan. Interestingly, we have also shown that the NEWS in combination with the neutrophil/lymphocyte ratio (NLR) (NEWSNLR or NEWS+NLR) is superior in its prognostic ability to the NEWS alone. […] The assessment of disease severity and risk stratification are essential for physicians to determine the appropriate location for a patient to be treated, whether as an outpatient, on a ward or in the intensive care unit. […] Thus, for the management of pneumonia in older patients, the NEWS and combinations of NEWS and NLR represent promising predictors of prognosis that can be rapidly calculated, not only in the emergency setting but also in the primary care and general medicine settings.

• #11 Utility of the New Early Warning Score (NEWS) in combination with the neutrophil–lymphocyte ratio for the prediction of prognosis in older patients with pneumonia | Family Medicine and Community Health

  https://fmch.bmj.com/content/11/2/e002239

  We have shown that the NEWS is a predictor of 30-day mortality in older patients with pneumonia, and also the superiority of combinations of the NEWS and NLR (NEWSNLR and NEWS+NLR) to the NEWS score alone for the prediction of 30-day mortality in older patients with pneumonia. However, further studies should be performed to validate the use of these indices for the prediction of prognosis in such patients.

• #12 Development of a new prognostic model to predict pneumonia outcome using artificial intelligence-based chest radiograph results | Scientific Reports

  https://www.nature.com/articles/s41598-024-65488-1

  This study aimed to develop a new simple and effective prognostic model using artificial intelligence (AI)-based chest radiograph (CXR) results to predict the outcomes of pneumonia. […] Therefore, a new prognostic model incorporating AI-based CXR results along with traditional pneumonia severity score could be a simple and useful tool for predicting pneumonia outcomes in clinical practice. […] In the present study, we showed that a new prognostic score composed of AI-based CXR results improved the prediction of pneumonia prognosis when combined with the previously known pneumonia severity score. […] Our findings showed that the power of predicting the patients prognosis and mortality increased when the consolidation score on CXRs presented by AI was combined with the patients clinical characteristics.

• #13 Development of a new prognostic model to predict pneumonia outcome using artificial intelligence-based chest radiograph results | Scientific Reports

  https://www.nature.com/articles/s41598-024-65488-1

  Therefore, combining AI-based CXR results to the simple CURB-65 had additive and practical value in clinical use for predicting pneumonia outcomes and had the potential to be widely utilized clinically. […] In conclusion, our study demonstrates that a new prognostic model incorporating AI-based CXR result, along with traditional pneumonia severity scores, could provide a simple and effective method for predicting pneumonia outcomes.

• #14 Validation of a Prediction Rule for Prognosis of Severe Community- Acquired Pneumonia

  https://openrespiratorymedicinejournal.com/VOLUME/2/PAGE/67/ABSTRACT/

  In a previous study, we developed a prognostic prediction rule, based on nine prognostic variables, capable to estimate and to adjust the mortality rate of patients admitted in intensive care unit for severe community-acquired pneumonia. […] The ICU mortality rate was 29.0%. In the 3 initial risk classes, we observed significantly increasing mortality rates (8.2% in class I, 22.8% in class II and 65.0% in class III) (p0.001). […] Our results demonstrate the performance and reproductibility of this prognostic prediction rule.

• #15

  https://link.springer.com/article/10.1007/s10140-021-02008-y

  Infection with SARS-CoV-2 has dominated discussion and caused global healthcare and economic crisis over the past 18 months. […] However, rapid deterioration to severe disease with or without acute respiratory distress syndrome (ARDS) can occur within 12 weeks from the onset of symptoms in a proportion of patients. Early identification by risk stratifying such patients who are at risk of severe complications of COVID-19 is of great clinical importance. […] There is growing interest in the prognostic value of baseline chest CT since an early risk stratification of patients with COVID-19 would allow for better resource allocation and could help improve outcomes. Recent studies have demonstrated the utility of baseline chest CT to predict intensive care unit (ICU) admission in patients with COVID-19.

• #16

  https://link.springer.com/article/10.1007/s10140-021-02008-y

  Understanding the prognostic value of a baseline CT to assess the outcome of the disease in the earliest phases of onset could help lead to improved resource distribution. […] Higher CT scores from such grading systems are associated with worse outcomes, including a higher mortality risk, showing the importance of imaging when managing patients and evaluating their prognosis. […] The type and the extent of initial pulmonary lesions in intensive care unit (ICU) patients have been observed to differ from those seen in less severely ill patients. […] More severe disease is associated with the scattered bilateral distribution of lesions either in the subpleural and centro-parenchymal areas, a higher number of involved lobes, a higher percentage of the involved lung parenchyma, and exhibit the features typical of the progressive stage of the disease.

• #17

  https://link.springer.com/article/10.1007/s10140-021-02008-y

  Different patterns from chest CT portray different prognostic roles, as demonstrated by Liang et al. […] The extent of lesions has been used by Aydemir et al. to classify patients into 4 groups and study the relationship with adverse events. […] They found a positive correlation between pulmonary involvement and rate of ICU transfer with significant differences among the different groups: 2.2% for group 0 (no lesions), 5.6% for group 1 (unilateral and few lesions in one segment or lobe), 13.5% for group 2 (3 lesions in multiple lobes or segments), and 17.7% for group 3 (diffuse and bilateral lesions). […] The prognostic role of pulmonary findings has been further investigated by Hegazu et al. in a cohort of 168 ICU patients with COVID-19. […] The majority of patients had multifocal and bilateral GGOs, significantly correlated with SOFA score on admission and with specific comorbidities, mainly cardiovascular disease and obesity.

• #18

  https://link.springer.com/article/10.1007/s10140-021-02008-y

  The prognostic value of CT scans can be improved when integrated into AI systems. Indeed, the combination of imaging and machine learning can provide tools for fast, accurate, and precise disease extent quantification as well as the identification of patients at risk for severe adverse events from COVID-19.

• #19 Frontiers | Risk factors analysis and prediction model construction for severe pneumonia in older adult patients

  https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2024.1399470/full

  Objective: Pneumonia is a common and serious infectious disease that affects the older adult population. Severe pneumonia can lead to high mortality and morbidity in this group. Therefore, it is important to identify the risk factors and develop a prediction model for severe pneumonia in older adult patients. […] The prediction model can help clinicians to stratify the risk of severe pneumonia in older adult patients and provide timely and appropriate interventions. […] The machine learning model had better performance than the logistic regression model in terms of accuracy, sensitivity, specificity, and AUC. […] Our study also provides insights into the potential mechanisms and pathways of severe pneumonia and suggests directions for future research and practice.

• #20 Cryptococcosis in Non-HIV Immunocompromised Hosts: Epidemiology, Pathogenesis, and Management | IntechOpen

  https://www.intechopen.com/online-first/1213803

  In cryptococcosis, serum CrAg is now a well-accepted diagnostic biomarker for detecting or confirming cryptococcal infection; like in HIV patients with cryptococcus infection, high titers herald a poor prognosis. […] Regarding cryptococcus meningitis in non-HIV patients, over the years there have been described significant prognostic factors, including low CSF glucose, high CSF lactate, high CSF cryptococcal antigen titer ( or = 1:1024), initial level of consciousness, the presence of seizure, hydrocephalus, and central nervous system vasculitis. […] Non-HIV immunosuppressed hosts have been noted to have a poorer prognosis. […] In a retrospective study that included 302 patients diagnosed with cryptococcosis between 1996 and 2010, mortality was highest in the NHNT group (27%) vs. SOT (14%) and HIV (20%).

• #21 Cryptococcosis in Non-HIV Immunocompromised Hosts: Epidemiology, Pathogenesis, and Management | IntechOpen

  https://www.intechopen.com/online-first/1213803

  On univariate analyses, prognostic factors positively associated with 90-day mortality included cancer (P = 0.018), fever (P = 0.031), altered mental status (P = 0.001), positive blood cultures (P 0.001), and high (1:512) serum CrAg (P = 0.021). […] In multivariable logistic regression analyses, cryptococcemia [odds ratio (OR) 5.09, 95% confidence interval (CI) 2.5410.22; P 0.001], baseline opening pressure of 25 cm H2O (OR 2.93, 95% CI 1.256.88; P = 0.013), and altered mental status (OR 1.96, 95% CI 0.983.91; P = 0.057) were associated with increased odds of mortality. […] Another retrospective study included 28 confirmed cryptococcal infections between 2005 and 2017. […] The case fatality rate was highest among patients with underlying hematologic malignancies (63%), followed by SOT (50%) and HIV patients (20%).

• #22 Cryptococcosis in Non-HIV Immunocompromised Hosts: Epidemiology, Pathogenesis, and Management | IntechOpen

  https://www.intechopen.com/online-first/1213803

  A 12-year review at a tertiary care center (University of Kentucky HealthCare system) included 114 patients with cryptococcosis; 23 (20.2%) had HIV infection, 11 (9.6%) had transplants (nine patients had SOT and two had stem cell transplants), and 80 (70.2%) were NHNT patients. […] Overall, mortality was 28.1% (32/114), and relapse occurred in 10.5% (12/114) of patients. […] The mortality trend was higher (OR = 2.346, p = 0.287) in the transplant group (45.5%, 5/11) than in the HIV (26.1%, 6/23) and NHNT groups (26.3%, 21/80). […] Chronic liver disease had a large and statistically significant association with mortality on multivariate analysis (OR = 3.583, p = 0.013), which was more pronounced than the HIV or transplant groups.

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