Zakażenie układu oddechowego – Rokowania, prognozy i postęp choroby

Zakażenie układu oddechowego
Rokowania, prognozy i postęp choroby

Zakażenia układu oddechowego (RTI) stanowią istotne wyzwanie kliniczne, zwłaszcza w podstawowej opiece zdrowotnej, gdzie ocena ryzyka powikłań takich jak hospitalizacja czy śmiertelność jest kluczowa. U pacjentów z niepowikłanymi zakażeniami dolnych dróg oddechowych (LRTI) bez cech zapalenia płuc ryzyko niekorzystnych wyników wynosi poniżej 1%, a stosowanie antybiotyków nie wpływa znacząco na ich redukcję. Wysokie ryzyko obserwuje się natomiast w pozaszpitalnym zapaleniu płuc (CAP), szczególnie u pacjentów z chorobami układu sercowo-naczyniowego (CVD), które są powiązane z gorszym rokowaniem i zwiększonym ryzykiem powikłań po infekcji. Otyłość istotnie zwiększa ryzyko zarówno górnych, jak i dolnych RTI (skorygowane OR odpowiednio 1,55 i 2,02), a system oceny RTI-score, uwzględniający m.in. płeć, wiek, palenie i choroby współistniejące (astma, POChP), może efektywnie identyfikować osoby podatne na infekcje w populacji ogólnej. Biomarkery takie jak TIMP-1 i PDGF-BB wykazują potencjał prognostyczny w wykrywaniu wielokrotnych ostrych zakażeń dróg oddechowych (ARTI), co może mieć znaczenie w monitorowaniu pacjentów z przewlekłymi chorobami układu oddechowego.

Wirusowe zakażenia dróg oddechowych, zwłaszcza wywołane przez wirusa syncytialnego (RSV), charakteryzują się cięższym przebiegiem i wyższymi wartościami markerów zapalnych (WBC, CRP, NEWS) w porównaniu do innych wirusów, co podkreśla potrzebę dalszych badań nad leczeniem i profilaktyką RSV u dorosłych. Diagnostyka molekularna, w tym panele syndromiczne, umożliwia szybsze i bardziej precyzyjne wykrywanie patogenów, co jest kluczowe dla optymalizacji terapii i ograniczenia niewłaściwego stosowania antybiotyków. U dzieci z RTI identyfikacja ryzyka złego rokowania na podstawie objawów klinicznych jest ograniczona, choć objawy takie jak gorączka, tachykardia i odwodnienie korelują z ryzykiem hospitalizacji. W praktyce klinicznej konieczne jest rozwijanie i walidacja modeli prognostycznych integrujących czynniki kliniczne, biomarkery oraz profil mikrobiologiczny, co pozwoli na precyzyjną stratyfikację ryzyka, optymalizację leczenia i redukcję niepotrzebnych hospitalizacji oraz śmiertelności.

Prognoza zakażeń układu oddechowego (RTI)

Zakażenia układu oddechowego (RTI – Respiratory Tract Infections) stanowią istotną przyczynę zachorowalności w populacji ogólnej, przyczyniając się znacząco do kosztów opieki zdrowotnej oraz obniżenia jakości życia pacjentów.¹ Określenie ryzyka wystąpienia niekorzystnych wyników leczenia, hospitalizacji czy śmiertelności jest kluczowym elementem podejmowania decyzji klinicznych, szczególnie w podstawowej opiece zdrowotnej. Właściwa ocena ryzyka powikłań może przyczynić się do wczesnego wykrywania pogorszenia stanu pacjenta i wdrożenia odpowiedniego postępowania.²³

Czynniki prognostyczne u dorosłych

U pacjentów z niepowikłanymi zakażeniami dolnych dróg oddechowych (LRTI – Lower Respiratory Tract Infections), które nie sugerują zapalenia płuc, niekorzystne wyniki, takie jak hospitalizacja czy zgon, występują u mniej niż 1% przypadków. Stosowanie antybiotyków nie wydaje się zmniejszać częstości tych zdarzeń.⁴ Natomiast ryzyko powikłań jest znacznie wyższe u pacjentów z pozaszpitalnym zapaleniem płuc (CAP – Community-Acquired Pneumonia), jednak identyfikacja tych pacjentów w podstawowej opiece zdrowotnej może być trudna.⁵

Współistniejące choroby układu sercowo-naczyniowego (CVD) zostały powiązane z gorszym rokowaniem u pacjentów z LRTI, co potwierdza również najnowsza literatura dotycząca COVID-19.⁶⁷ Znaczenie CVD dla rokowania w LRTI wynika zarówno z jego związku z ogólnie złym rokowaniem, jak i z obserwowanego zwiększonego występowania CVD po początkowym zakażeniu.⁸

Otyłość jako czynnik ryzyka

Otyłość jest istotnym czynnikiem zwiększającym ryzyko zachorowania na RTI. W porównaniu z osobami o prawidłowej masie ciała, osoby otyłe zgłaszają konsekwentnie wyższą częstość występowania górnych i dolnych RTI.⁹ Otyłość była związana zarówno z zakażeniami dolnych dróg oddechowych (skorygowane OR=2,02, 95%CI=1,36-3,00), jak i zakażeniami górnych dróg oddechowych (skorygowane OR=1,55, 95%CI=1,22-1,96).¹⁰

Najsilniejszy związek zaobserwowano w przypadku zapalenia płuc i oskrzeli, a w związku z tym LRTI było silniej związane z otyłością niż zakażenia górnych dróg oddechowych (URTI). Długotrwałe RTI, częste RTI i wysokie wyniki w dziennikach pacjentów były również silniej związane z otyłością niż poszczególne objawy.¹¹ Związek między otyłością a RTI pozostał prawie niezmieniony po uwzględnieniu wieku, płci, statusu edukacyjnego, kontaktu z dziećmi, statusu palenia, aktywności sportowej i wyników żywieniowych.¹²

Identyfikacja osób podatnych na zakażenia układu oddechowego

System oceny RTI (RTI-score) może pomóc w identyfikacji dorosłych w społeczności, którzy są podatni na RTI i mogą skorzystać ze środków zapobiegawczych.¹³ Wyniki RTI-score korelowały pozytywnie z płcią żeńską, młodszym wiekiem, częstym kontaktem z dziećmi, statusem palenia i otyłością, a także z szeregiem chorób współistniejących, najsilniej z astmą i przewlekłą obturacyjną chorobą płuc (POChP).¹⁴

Zastosowany system oceny RTI ułatwił identyfikację potencjalnie podatnych na infekcje osób w populacji ogólnej i okazał się predyktorem indywidualnego ryzyka RTI.¹⁵ Ten oparty wyłącznie na kwestionariuszu system oceny ma duży potencjał do zastosowania w praktyce ogólnej i w przewlekłym zarządzaniu pacjentem, gdzie wczesna wiedza o potencjalnej podatności na infekcje może mieć cenne znaczenie prognostyczne.¹⁶

Markery biologiczne w prognozowaniu RTI

Badania wykazały, że poziomy surowicze TIMP-1 (tkankowy inhibitor metaloproteinaz-1) i PDGF-BB (płytkopochodny czynnik wzrostu BB) są znacznie podwyższone u osób z wielokrotnymi ostrymi zakażeniami dróg oddechowych (ARTI) w porównaniu z kontrolami z pojedynczym ARTI i bez ARTI, co czyni te dwa cytokiny potencjalnymi predyktorami wielokrotnych ARTI.¹⁷ Analizy krzywej ROC (Receiver Operating Characteristic) pokazują, że kombinacja TIMP-1, PDGF-BB i fagów Propionibacterium może być silnym predyktorem wielokrotnych ARTI.¹⁸

Zarówno TIMP-1, jak i PDGF-BB były implikowane w astmie i POChP, w których dochodziło do charakterystycznego niszczenia macierzy pozakomórkowej (ECM) i przebudowy tkanki podpodścieliskowych komórek mezenchymalnych.¹⁹ Dane te wskazują, że poziomy surowicze tych dwóch cytokin mogą mieć wartość diagnostyczną dla wystąpienia wielokrotnych ARTI.²⁰

Wirusowe zakażenia układu oddechowego i ich rokowanie

Badania nad wirusowymi zakażeniami układu oddechowego, zwłaszcza tymi spowodowanymi przez wirusa syncytialnego układu oddechowego (RSV), wykazały, że pacjenci z RSV mieli częściej wysokie wartości markerów stanu zapalnego i podwyższony wynik NEWS (National Early Warning Score) w porównaniu z pacjentami hospitalizowanymi z powodu innych powszechnych wirusów oddechowych.²¹ Chorzy na RSV częściej cierpieli na choroby współistniejące, takie jak POChP, i wymagali pilniejszej hospitalizacji.²²

Dorośli pacjenci hospitalizowani z zakażeniem RSV znacznie częściej otrzymywali leczenie przeciwdrobnoustrojowe niż pacjenci z grypą A. Ponadto większa część pacjentów z RSV miała wysokie wartości leukocytów (WBC), białka C-reaktywnego (CRP) i wyniki NEWS, co wskazuje na cięższy stan zapalny.²³ Te odkrycia podkreślają potrzebę dalszych badań klinicznych nad chorobą RSV u dorosłych i osób starszych.²⁴

Znaczenie mikrobiomu górnych dróg oddechowych

Wykrycie wirusów dróg oddechowych z górnych dróg oddechowych ma wpływ na rokowanie u dzieci rekrutowanych z podstawowej opieki zdrowotnej.²⁵ Ustalenie, że niektóre mikroby górnych dróg oddechowych mogą wpływać na rokowanie choroby, sugeruje, że mogą one odgrywać rolę etiologiczną.²⁶ Te nowe dowody, pokazujące, że wykrycie wirusów górnych dróg oddechowych, a w mniejszym stopniu bakterii, wpływa na rokowanie infekcji u dzieci, sugerują, że istnieje rola dla wirusowych testów diagnostycznych typu point-of-care (POCT) górnych dróg oddechowych.²⁷

Modele predykcyjne dla niekorzystnych wyników

Obecnie istniejące modele predykcyjne dla niekorzystnych wyników koncentrują się jedynie na hospitalizacji i śmiertelności i cierpią z powodu niepełnej walidacji modelu, co utrudnia wdrożenie w praktyce klinicznej.²⁸²⁹ Rozważając wzajemne oddziaływanie między LRTI a CVD, należy opracować i zewnętrznie zwalidować dwa modele predykcyjne, które przewidują klinicznie istotne wyniki, takie jak zdarzenia sercowo-naczyniowe, hospitalizacja i śmiertelność.³⁰³¹

Modele te mogą pomóc lekarzom podstawowej opieki zdrowotnej w stratyfikacji ryzyka złego rokowania u pacjentów z LRTI w podstawowej opiece zdrowotnej, co może ostatecznie pozwolić na wczesne wykrycie i zapobieganie pogorszeniu.³²³³

Znaczenie diagnostyki w rokowaniu

Szybka i szybka diagnostyka laboratoryjna RTI jest wymagana, aby wspierać i kierować decyzjami klinicznymi na korzyść odpowiedniego zarządzania pacjentem, jednocześnie unikając niewłaściwego stosowania środków przeciwdrobnoustrojowych.³⁴ Opóźnienie w identyfikacji czynnika przyczynowego RTI może prowadzić do pojawienia się i rozprzestrzeniania się patogenów opornych na środki przeciwdrobnoustrojowe z powodu niewłaściwego stosowania szerokospektralnej terapii empirycznej, co skutkuje złymi wynikami klinicznymi, zwiększonymi wskaźnikami śmiertelności i długością pobytu w szpitalu.³⁵

Wdrożenie paneli syndromicznych w algorytmie diagnostycznym zakażeń układu oddechowego ma potencjał, aby być potężnym narzędziem decyzyjnym w zarządzaniu pacjentem, szczególnie na oddziałach ratunkowych, pomimo wymagania odpowiedniego stosowania testu w różnych populacjach pacjentów.³⁶ Zastosowanie paneli syndromicznych do wykrywania patogenów oddechowych jest związane z radykalnie skróconym czasem do uzyskania wyników i, równolegle, ze zwiększonym wykrywaniem klinicznie istotnych patogenów w porównaniu do standardowych metod.³⁷

Prognozowanie wyników u dzieci

U dzieci zakażenia układu oddechowego są najczęstszym powodem konsultacji w podstawowej opiece zdrowotnej.³⁸³⁹ Istnieje niepewność zarówno ze strony rodziców, jak i lekarzy co do tego, jak zidentyfikować dzieci z RTI, które są zagrożone złym rokowaniem.⁴⁰

Objawy oddechowe, wymioty, gorączka, odwodnienie i tachykardia przy pierwszym kontakcie były związane z przyszłą hospitalizacją.⁴¹ Obecne dowody są niewystarczające, aby umożliwić lekarzom identyfikację dzieci zagrożonych śmiercią, ponowną konsultacją, przepisaniem antybiotyków lub przedłużającymi się lub pogarszającymi się objawami na podstawie badania i historii podczas jednej konsultacji.⁴² Jest to spowodowane słabą jakością badań, a także bardzo niewielką liczbą wyników wskazujących, że jest to możliwe.⁴³

Niektóre dowody są dostępne dla lekarzy, aby stratyfikować ryzyko przyszłej hospitalizacji, ale nie innych wyników prognostycznych.⁴⁴⁴⁵⁴⁶ Istnieją niewielkie dowody dostępne dla rodziców, aby zidentyfikować dzieci zagrożone złym rokowaniem.⁴⁷⁴⁸⁴⁹ Potrzebne są badania nad tym, czy złe rokowanie może być przewidziane przez rodziców w domu.⁵⁰⁵¹⁵²⁵³

Podsumowanie prognostyki RTI

Dokładne przewidywanie ryzyka niekorzystnych wyników u pacjentów z RTI jest kluczowe dla podejmowania decyzji klinicznych, właściwego zarządzania antybiotykami i optymalizacji wyników leczenia pacjentów. Badania wskazują na potrzebę rozwoju i walidacji kompleksowych modeli prognostycznych, które uwzględniają nie tylko tradycyjne czynniki ryzyka, ale także markery biologiczne, profil mikrobiologiczny i choroby współistniejące, szczególnie choroby układu sercowo-naczyniowego i POChP. Wczesna identyfikacja pacjentów zagrożonych ciężkim przebiegiem RTI może przyczynić się do zmniejszenia śmiertelności, ograniczenia niepotrzebnych hospitalizacji i lepszego wykorzystania zasobów opieki zdrowotnej.⁵⁴⁵⁵⁵⁶

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Materiały źródłowe

#1 Obesity and risk of respiratory tract infections: results of an infection-diary based cohort study | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5172-8
Respiratory tract infections (RTIs) are a major morbidity factor contributing largely to health care costs and individual quality of life. […] Compared to individuals with normal weight, obese individuals reported a consistently higher frequency of upper and lower RTIs and predominantly fell in the upper 10% group of a diary sumscore adding-up 10 different RTI symptoms over time. Obesity was associated both with lower RTIs (adjustedOR=2.02, 95%CI=1.363.00) and upper RTIs (adjustedOR=1.55, 95%CI=1.221.96). […] We confirm the association of obesity with infection burden and present evidence for putative interaction with sports activity and dietary patterns. […] The overall aim of our study targeting the adult population in South Baden, Germany, is to identify risk factors for the susceptibility to RTIs.
#2 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
Community-acquired lower respiratory tract infections (LRTI) are common in primary care and patients at particular risk of adverse outcomes, e.g., hospitalisation and mortality, are challenging to identify. […] Accurate risk prediction of adverse outcomes in LRTI patients, while considering the interplay with CVD, can aid general practitioners (GP) in the clinical decision-making process, and may allow for early detection of deterioration. […] This paper therefore presents the design of the development and external validation of two models for predicting individual risk of all-cause hospitalisation or mortality (model 1) and short-term incidence of CVD (model 2) in adults presenting to primary care with LRTI. […] Adverse outcomes such as hospitalisation or mortality occur in less than 1% of patients with uncomplicated LRTI, i.e. not suggestive of pneumonia, and antibiotics seem not to reduce the occurrence of these outcomes.
#3 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Community-acquired lower respiratory tract infections (LRTI) are common in primary care and patients at particular risk of adverse outcomes, e.g., hospitalisation and mortality, are challenging to identify. […] Accurate risk prediction of adverse outcomes in LRTI patients, while considering the interplay with CVD, can aid general practitioners (GP) in the clinical decision-making process, and may allow for early detection of deterioration. […] Adverse outcomes such as hospitalisation or mortality occur in less than 1% of patients with uncomplicated LRTI, i.e. not suggestive of pneumonia, and antibiotics seem not to reduce the occurrence of these outcomes. […] Concurrent cardiovascular diseases (CVD) have also been linked to poor prognosis in patients with LRTI, which is supported by recent literature on coronavirus disease 2019 (COVID-19).
#4 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
Community-acquired lower respiratory tract infections (LRTI) are common in primary care and patients at particular risk of adverse outcomes, e.g., hospitalisation and mortality, are challenging to identify. […] Accurate risk prediction of adverse outcomes in LRTI patients, while considering the interplay with CVD, can aid general practitioners (GP) in the clinical decision-making process, and may allow for early detection of deterioration. […] This paper therefore presents the design of the development and external validation of two models for predicting individual risk of all-cause hospitalisation or mortality (model 1) and short-term incidence of CVD (model 2) in adults presenting to primary care with LRTI. […] Adverse outcomes such as hospitalisation or mortality occur in less than 1% of patients with uncomplicated LRTI, i.e. not suggestive of pneumonia, and antibiotics seem not to reduce the occurrence of these outcomes.
#5 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
The risk of complications is far more pronounced in patients with community-acquired pneumonia (CAP), but identifying these patients in primary care can be challenging. […] In addition, concurrent cardiovascular diseases (CVD) have also been linked to poor prognosis in patients with LRTI, which is supported by recent literature on coronavirus disease 2019 (COVID-19). […] Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection.
#6 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
The risk of complications is far more pronounced in patients with community-acquired pneumonia (CAP), but identifying these patients in primary care can be challenging. […] In addition, concurrent cardiovascular diseases (CVD) have also been linked to poor prognosis in patients with LRTI, which is supported by recent literature on coronavirus disease 2019 (COVID-19). […] Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection.
#7 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Community-acquired lower respiratory tract infections (LRTI) are common in primary care and patients at particular risk of adverse outcomes, e.g., hospitalisation and mortality, are challenging to identify. […] Accurate risk prediction of adverse outcomes in LRTI patients, while considering the interplay with CVD, can aid general practitioners (GP) in the clinical decision-making process, and may allow for early detection of deterioration. […] Adverse outcomes such as hospitalisation or mortality occur in less than 1% of patients with uncomplicated LRTI, i.e. not suggestive of pneumonia, and antibiotics seem not to reduce the occurrence of these outcomes. […] Concurrent cardiovascular diseases (CVD) have also been linked to poor prognosis in patients with LRTI, which is supported by recent literature on coronavirus disease 2019 (COVID-19).
#8 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection. […] While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#9 Obesity and risk of respiratory tract infections: results of an infection-diary based cohort study | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5172-8
Respiratory tract infections (RTIs) are a major morbidity factor contributing largely to health care costs and individual quality of life. […] Compared to individuals with normal weight, obese individuals reported a consistently higher frequency of upper and lower RTIs and predominantly fell in the upper 10% group of a diary sumscore adding-up 10 different RTI symptoms over time. Obesity was associated both with lower RTIs (adjustedOR=2.02, 95%CI=1.363.00) and upper RTIs (adjustedOR=1.55, 95%CI=1.221.96). […] We confirm the association of obesity with infection burden and present evidence for putative interaction with sports activity and dietary patterns. […] The overall aim of our study targeting the adult population in South Baden, Germany, is to identify risk factors for the susceptibility to RTIs.
#10 Obesity and risk of respiratory tract infections: results of an infection-diary based cohort study | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5172-8
Respiratory tract infections (RTIs) are a major morbidity factor contributing largely to health care costs and individual quality of life. […] Compared to individuals with normal weight, obese individuals reported a consistently higher frequency of upper and lower RTIs and predominantly fell in the upper 10% group of a diary sumscore adding-up 10 different RTI symptoms over time. Obesity was associated both with lower RTIs (adjustedOR=2.02, 95%CI=1.363.00) and upper RTIs (adjustedOR=1.55, 95%CI=1.221.96). […] We confirm the association of obesity with infection burden and present evidence for putative interaction with sports activity and dietary patterns. […] The overall aim of our study targeting the adult population in South Baden, Germany, is to identify risk factors for the susceptibility to RTIs.
#11 Obesity and risk of respiratory tract infections: results of an infection-diary based cohort study | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5172-8
The strongest association was seen for pneumonia and bronchitis, and accordingly, any LRTI was more strongly associated with obesity than any URTI. Long-lasting RTIs, frequent RTIs and high diary scores were also more strongly associated with obesity than the individual symptoms. […] The association between obesity and RTIs remained nearly unchanged after adjustment for age, gender, educational status, contact to children, smoking status, sports activity and nutrition scores, suggesting that the association is not markedly confounded by the effects of these factors on both BMI and the risk of infections. […] In conclusion, in this prospective cohort of adults we found obese overrepresented among those reporting frequent and long-lasting RTIs.
#12 Obesity and risk of respiratory tract infections: results of an infection-diary based cohort study | BMC Public Health | Full Text
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5172-8
The strongest association was seen for pneumonia and bronchitis, and accordingly, any LRTI was more strongly associated with obesity than any URTI. Long-lasting RTIs, frequent RTIs and high diary scores were also more strongly associated with obesity than the individual symptoms. […] The association between obesity and RTIs remained nearly unchanged after adjustment for age, gender, educational status, contact to children, smoking status, sports activity and nutrition scores, suggesting that the association is not markedly confounded by the effects of these factors on both BMI and the risk of infections. […] In conclusion, in this prospective cohort of adults we found obese overrepresented among those reporting frequent and long-lasting RTIs.
#13
https://www.alliedacademies.org/articles/screening-score-to-identify-people-prone-to-respiratory-tract-infections-in-the-community-7924.html
Respiratory tract infections (RTIs) are a major cause of morbidity in society. A proportion of the general population suffers more often from recurrent and severe RTI compared to the vast majority. […] The RTI-score correlated positively with female sex, younger age, and frequent contact to children, smoking status, and obesity as well as a number of co-morbidities, most strongly asthma and chronic obstructive pulmonary disease. […] The RTI-score applied in this study helps to identify adults in the community prone to RTI who might benefit from preventive measures. […] Here we ask whether a questionnaire-based score, the RTI score, can predict individuals who suffer more frequent and severe RTIs in an adult community cohort. […] The associations of the RTI score with chronic obstructive pulmonary disease (COPD) and asthma were more pronounced than associations with all other individual co-morbidities, whereas a history of diabetes or cancer showed the least marked associations.
#14
https://www.alliedacademies.org/articles/screening-score-to-identify-people-prone-to-respiratory-tract-infections-in-the-community-7924.html
Respiratory tract infections (RTIs) are a major cause of morbidity in society. A proportion of the general population suffers more often from recurrent and severe RTI compared to the vast majority. […] The RTI-score correlated positively with female sex, younger age, and frequent contact to children, smoking status, and obesity as well as a number of co-morbidities, most strongly asthma and chronic obstructive pulmonary disease. […] The RTI-score applied in this study helps to identify adults in the community prone to RTI who might benefit from preventive measures. […] Here we ask whether a questionnaire-based score, the RTI score, can predict individuals who suffer more frequent and severe RTIs in an adult community cohort. […] The associations of the RTI score with chronic obstructive pulmonary disease (COPD) and asthma were more pronounced than associations with all other individual co-morbidities, whereas a history of diabetes or cancer showed the least marked associations.
#15
https://www.alliedacademies.org/articles/screening-score-to-identify-people-prone-to-respiratory-tract-infections-in-the-community-7924.html
This analysis supports the ability of the RTI score to identify individuals at greater risk of RTI and RTI-related health impairment. […] The RTI score we propose aims to identify the range of susceptibility in adults and via its questionnaire-only based approach promises great potential for application in general practice and in chronic patient management, where early knowledge of a putative proneness to infections could have a valuable prognostic impact. […] The RTI score employed facilitated identification of putatively infection-prone individuals in the general population and proved predictive of the individual RTI risk.
#16
https://www.alliedacademies.org/articles/screening-score-to-identify-people-prone-to-respiratory-tract-infections-in-the-community-7924.html
This analysis supports the ability of the RTI score to identify individuals at greater risk of RTI and RTI-related health impairment. […] The RTI score we propose aims to identify the range of susceptibility in adults and via its questionnaire-only based approach promises great potential for application in general practice and in chronic patient management, where early knowledge of a putative proneness to infections could have a valuable prognostic impact. […] The RTI score employed facilitated identification of putatively infection-prone individuals in the general population and proved predictive of the individual RTI risk.
#17 Altered respiratory virome and serum cytokine profile associated with recurrent respiratory tract infections in children | Nature Communications
https://www.nature.com/articles/s41467-019-10294-x
Recurrent acute respiratory tract infections (ARTIs) affect a large population, yet the specific decisive factors are largely unknown. […] Serum levels of TIMP-1 and PDGF-BB are markedly increased in multiple ARTIs compared to single-ARTI and non-ARTI controls, making these two cytokines potential predictors for multiple ARTIs. […] Receiver operating characteristic (ROC) curve analyses show that the combination of TIMP-1, PDGF-BB and Propionibacterium phages could be a strong predictor for multiple ARTIs. […] These findings indicate that respiratory microbe homeostasis and specific cytokines are associated with the onset of multiple ARTIs over time. […] To better understand the role of cytokines in ARTI, we measured 48 common cytokines and chemokines in sera obtained from the single-ARTI and multiple-ARTIs children using the Proteomic Chip-based Cytokine Antibody Assay.
#18 Altered respiratory virome and serum cytokine profile associated with recurrent respiratory tract infections in children | Nature Communications
https://www.nature.com/articles/s41467-019-10294-x
Recurrent acute respiratory tract infections (ARTIs) affect a large population, yet the specific decisive factors are largely unknown. […] Serum levels of TIMP-1 and PDGF-BB are markedly increased in multiple ARTIs compared to single-ARTI and non-ARTI controls, making these two cytokines potential predictors for multiple ARTIs. […] Receiver operating characteristic (ROC) curve analyses show that the combination of TIMP-1, PDGF-BB and Propionibacterium phages could be a strong predictor for multiple ARTIs. […] These findings indicate that respiratory microbe homeostasis and specific cytokines are associated with the onset of multiple ARTIs over time. […] To better understand the role of cytokines in ARTI, we measured 48 common cytokines and chemokines in sera obtained from the single-ARTI and multiple-ARTIs children using the Proteomic Chip-based Cytokine Antibody Assay.
#19 Altered respiratory virome and serum cytokine profile associated with recurrent respiratory tract infections in children | Nature Communications
https://www.nature.com/articles/s41467-019-10294-x
Both TIMP-1 and PDGF-BB have been implicated in asthma and chronic obstructive pulmonary disease (COPD), in which there was characteristic destruction of the extracellular matrix (ECM) and tissue remodeling of sub-epithelial mesenchymal cells. […] These data indicate that the serum levels of these two cytokines may have diagnostic values for the occurrence of multiple ARTIs. […] The combination of these three factors might have important diagnostic potential for predicting frequent ARTIs in children, and such prediction may be used as a guidance for initiating early intervention.
#20 Altered respiratory virome and serum cytokine profile associated with recurrent respiratory tract infections in children | Nature Communications
https://www.nature.com/articles/s41467-019-10294-x
Both TIMP-1 and PDGF-BB have been implicated in asthma and chronic obstructive pulmonary disease (COPD), in which there was characteristic destruction of the extracellular matrix (ECM) and tissue remodeling of sub-epithelial mesenchymal cells. […] These data indicate that the serum levels of these two cytokines may have diagnostic values for the occurrence of multiple ARTIs. […] The combination of these three factors might have important diagnostic potential for predicting frequent ARTIs in children, and such prediction may be used as a guidance for initiating early intervention.
#21 Frontiers | Clinical Outcome of Viral Respiratory Tract Infections in Hospitalized Adults in Norway: High Degree of Inflammation and Need of Emergency Care for Cases With Respiratory Syncytial Virus
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.866494/full
Background: The clinical features and outcomes of viral respiratory tract infections (RTIs) in adults have not been thoroughly studied, especially the respiratory syncytial virus (RSV) disease burden. It has become apparent that outbreaks of RSV in the elderly are associated with increased hospitalization rates. However, little data exists on the severity of such viral RTIs in adults, particularly the need for hospitalization, respiratory support and intensive care. […] Conclusion: Patients with RSV had more often high values for markers of inflammation and elevated NEWS score when compared to patients hospitalized with other common respiratory viruses. Taken into account that they suffered more frequently from comorbidities like COPD, these patients needed hospitalization more urgently. These findings highlight the need for further investigations on RSV disease in adults and the elderly.
#22 Frontiers | Clinical Outcome of Viral Respiratory Tract Infections in Hospitalized Adults in Norway: High Degree of Inflammation and Need of Emergency Care for Cases With Respiratory Syncytial Virus
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.866494/full
Background: The clinical features and outcomes of viral respiratory tract infections (RTIs) in adults have not been thoroughly studied, especially the respiratory syncytial virus (RSV) disease burden. It has become apparent that outbreaks of RSV in the elderly are associated with increased hospitalization rates. However, little data exists on the severity of such viral RTIs in adults, particularly the need for hospitalization, respiratory support and intensive care. […] Conclusion: Patients with RSV had more often high values for markers of inflammation and elevated NEWS score when compared to patients hospitalized with other common respiratory viruses. Taken into account that they suffered more frequently from comorbidities like COPD, these patients needed hospitalization more urgently. These findings highlight the need for further investigations on RSV disease in adults and the elderly.
#23 Frontiers | Clinical Outcome of Viral Respiratory Tract Infections in Hospitalized Adults in Norway: High Degree of Inflammation and Need of Emergency Care for Cases With Respiratory Syncytial Virus
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.866494/full
To our knowledge, this study is the first of its kind in Scandinavia, aiming to compare clinical outcome and mortality rates of hospitalized adults with viral RTIs. By investigating clinical outcome in viral RTIs, we discovered that patients suffering from RSV had significantly higher NEWS indicating more severe illness compared with influenza A patients. Comorbidities such as COPD and congestive heart failure were more often found in cases with RSV. The RSV patients also had higher WBC and CRP levels when compared to influenza A, indicating more severe inflammation. […] Adult patients hospitalized with RSV infection were significantly more often prescribed an antimicrobial treatment than patients with influenza A. Moreover, a larger proportion of the RSV patients had high WBC, CRP and NEWS scores. These findings highlight the need for further clinical investigations on RSV disease in adults and the elderly.
#24 Frontiers | Clinical Outcome of Viral Respiratory Tract Infections in Hospitalized Adults in Norway: High Degree of Inflammation and Need of Emergency Care for Cases With Respiratory Syncytial Virus
https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.866494/full
To our knowledge, this study is the first of its kind in Scandinavia, aiming to compare clinical outcome and mortality rates of hospitalized adults with viral RTIs. By investigating clinical outcome in viral RTIs, we discovered that patients suffering from RSV had significantly higher NEWS indicating more severe illness compared with influenza A patients. Comorbidities such as COPD and congestive heart failure were more often found in cases with RSV. The RSV patients also had higher WBC and CRP levels when compared to influenza A, indicating more severe inflammation. […] Adult patients hospitalized with RSV infection were significantly more often prescribed an antimicrobial treatment than patients with influenza A. Moreover, a larger proportion of the RSV patients had high WBC, CRP and NEWS scores. These findings highlight the need for further clinical investigations on RSV disease in adults and the elderly.
#25 Prognostic value of upper respiratory tract microbes in children presenting to primary care with respiratory infections: A prospective cohort study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268131
The association between upper respiratory tract microbial positivity and illness prognosis in children is unclear. This impedes clinical decision-making and means the utility of upper respiratory tract microbial point-of-care tests remains unknown. […] There is a potential role for upper respiratory tract microbiological point-of-care tests in determining the prognosis of childhood RTIs. […] This exploratory analysis is one of the first to demonstrate associations between the detection of respiratory viruses from the upper respiratory tract and prognosis in children recruited from primary care. […] Establishing that some upper respiratory tract microbes may influence disease prognosis suggests that they could be playing an aetiological role. […] This novel evidence, demonstrating that the detection of upper respiratory tract viruses, and less so bacteria, influences infection prognosis in children, suggests that there is a role for upper respiratory tract viral POCTs.
#26 Prognostic value of upper respiratory tract microbes in children presenting to primary care with respiratory infections: A prospective cohort study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268131
The association between upper respiratory tract microbial positivity and illness prognosis in children is unclear. This impedes clinical decision-making and means the utility of upper respiratory tract microbial point-of-care tests remains unknown. […] There is a potential role for upper respiratory tract microbiological point-of-care tests in determining the prognosis of childhood RTIs. […] This exploratory analysis is one of the first to demonstrate associations between the detection of respiratory viruses from the upper respiratory tract and prognosis in children recruited from primary care. […] Establishing that some upper respiratory tract microbes may influence disease prognosis suggests that they could be playing an aetiological role. […] This novel evidence, demonstrating that the detection of upper respiratory tract viruses, and less so bacteria, influences infection prognosis in children, suggests that there is a role for upper respiratory tract viral POCTs.
#27 Prognostic value of upper respiratory tract microbes in children presenting to primary care with respiratory infections: A prospective cohort study | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268131
The association between upper respiratory tract microbial positivity and illness prognosis in children is unclear. This impedes clinical decision-making and means the utility of upper respiratory tract microbial point-of-care tests remains unknown. […] There is a potential role for upper respiratory tract microbiological point-of-care tests in determining the prognosis of childhood RTIs. […] This exploratory analysis is one of the first to demonstrate associations between the detection of respiratory viruses from the upper respiratory tract and prognosis in children recruited from primary care. […] Establishing that some upper respiratory tract microbes may influence disease prognosis suggests that they could be playing an aetiological role. […] This novel evidence, demonstrating that the detection of upper respiratory tract viruses, and less so bacteria, influences infection prognosis in children, suggests that there is a role for upper respiratory tract viral POCTs.
#28 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
The risk of complications is far more pronounced in patients with community-acquired pneumonia (CAP), but identifying these patients in primary care can be challenging. […] In addition, concurrent cardiovascular diseases (CVD) have also been linked to poor prognosis in patients with LRTI, which is supported by recent literature on coronavirus disease 2019 (COVID-19). […] Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection.
#29 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection. […] While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#30 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#31 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection. […] While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#32 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#33 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection. […] While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#34 Respiratory Tract Infections and Laboratory Diagnostic Methods: A Review with A Focus on Syndromic Panel-Based Assays
https://www.mdpi.com/2076-2607/10/9/1856
Respiratory tract infections (RTIs) are the focus of developments in public health, given their widespread distribution and the high morbidity and mortality rates reported worldwide. […] The clinical spectrum ranges from asymptomatic or mild infection to severe or fatal disease. […] A prompt and rapid laboratory diagnosis of RTIs is required to support and to guide clinical decisions in favor of appropriate patient management, while also avoiding the inappropriate use of antimicrobials. […] The delay in identifying the causative agent of RTIs could lead to the emergence and spread of antimicrobial-resistant pathogens due to the misuse of broad-spectrum empirical therapy, thus resulting in poor clinical outcomes, increased mortality rates and length of hospital stay. […] The implementation of syndromic panels in the respiratory infection diagnostic algorithm has the potential to be a powerful decision-making tool for patient management, especially in emergency departments, despite requiring the appropriate use of the test in different patient populations.
#35 Respiratory Tract Infections and Laboratory Diagnostic Methods: A Review with A Focus on Syndromic Panel-Based Assays
https://www.mdpi.com/2076-2607/10/9/1856
Respiratory tract infections (RTIs) are the focus of developments in public health, given their widespread distribution and the high morbidity and mortality rates reported worldwide. […] The clinical spectrum ranges from asymptomatic or mild infection to severe or fatal disease. […] A prompt and rapid laboratory diagnosis of RTIs is required to support and to guide clinical decisions in favor of appropriate patient management, while also avoiding the inappropriate use of antimicrobials. […] The delay in identifying the causative agent of RTIs could lead to the emergence and spread of antimicrobial-resistant pathogens due to the misuse of broad-spectrum empirical therapy, thus resulting in poor clinical outcomes, increased mortality rates and length of hospital stay. […] The implementation of syndromic panels in the respiratory infection diagnostic algorithm has the potential to be a powerful decision-making tool for patient management, especially in emergency departments, despite requiring the appropriate use of the test in different patient populations.
#36 Respiratory Tract Infections and Laboratory Diagnostic Methods: A Review with A Focus on Syndromic Panel-Based Assays
https://www.mdpi.com/2076-2607/10/9/1856
Respiratory tract infections (RTIs) are the focus of developments in public health, given their widespread distribution and the high morbidity and mortality rates reported worldwide. […] The clinical spectrum ranges from asymptomatic or mild infection to severe or fatal disease. […] A prompt and rapid laboratory diagnosis of RTIs is required to support and to guide clinical decisions in favor of appropriate patient management, while also avoiding the inappropriate use of antimicrobials. […] The delay in identifying the causative agent of RTIs could lead to the emergence and spread of antimicrobial-resistant pathogens due to the misuse of broad-spectrum empirical therapy, thus resulting in poor clinical outcomes, increased mortality rates and length of hospital stay. […] The implementation of syndromic panels in the respiratory infection diagnostic algorithm has the potential to be a powerful decision-making tool for patient management, especially in emergency departments, despite requiring the appropriate use of the test in different patient populations.
#37 Respiratory Tract Infections and Laboratory Diagnostic Methods: A Review with A Focus on Syndromic Panel-Based Assays
https://www.mdpi.com/2076-2607/10/9/1856
In conclusion, the use of syndromic panels for the detection of respiratory pathogens is associated with a radically reduced time-to-results and, in parallel, to increased detection of clinically relevant pathogens compared to the standard methods. […] Syndromic panels, if implemented wisely and interpreted cautiously, can improve antimicrobial use and patient outcomes through improved clinical decision, optimized laboratory workflow, and enhanced antimicrobial and laboratory stewardship.
#38 Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review – PubMed
https://pubmed.ncbi.nlm.nih.gov/33872323/
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
#39 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] There is uncertainty from both parents and clinicians about how to identify children with RTIs who are at risk of poor prognosis. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home. […] We found nine studies exploring associations between symptoms, signs, and investigations and prognostic outcomes in children presenting with RTIs to primary care.
#40 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] There is uncertainty from both parents and clinicians about how to identify children with RTIs who are at risk of poor prognosis. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home. […] We found nine studies exploring associations between symptoms, signs, and investigations and prognostic outcomes in children presenting with RTIs to primary care.
#41 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review â Nuffield Department of Primary Care Health Sciences, University of Oxford
https://www.phc.ox.ac.uk/@@disable-cookies?came_from=https://www.phc.ox.ac.uk/publications/1172598
Predicting poor outcomes in children aged 112 with respiratory tract infections: A systematic review […] Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. […] Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. […] There is little evidence available to parents to identify children at risk of poor prognosis. […] Research is needed into whether poor prognosis can be predicted by parents in the home.
#42 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Current evidence is insufficient to enable clinicians to identify children at risk of death, re-consultation, antibiotic prescription, or prolonged or deteriorating symptoms from examination and history at one consultation. This is due to poor quality studies, as well as very few results indicating that this is possible. There were no studies in a home setting, and no studies explicitly aiming to identify clinical features which mean it is safe to continue caring for children in the home. Research asking whether parents can identify children at risk of poor prognosis in the home is needed.
#43 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Current evidence is insufficient to enable clinicians to identify children at risk of death, re-consultation, antibiotic prescription, or prolonged or deteriorating symptoms from examination and history at one consultation. This is due to poor quality studies, as well as very few results indicating that this is possible. There were no studies in a home setting, and no studies explicitly aiming to identify clinical features which mean it is safe to continue caring for children in the home. Research asking whether parents can identify children at risk of poor prognosis in the home is needed.
#44 Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review – PubMed
https://pubmed.ncbi.nlm.nih.gov/33872323/
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
#45 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] There is uncertainty from both parents and clinicians about how to identify children with RTIs who are at risk of poor prognosis. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home. […] We found nine studies exploring associations between symptoms, signs, and investigations and prognostic outcomes in children presenting with RTIs to primary care.
#46 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review â Nuffield Department of Primary Care Health Sciences, University of Oxford
https://www.phc.ox.ac.uk/@@disable-cookies?came_from=https://www.phc.ox.ac.uk/publications/1172598
Predicting poor outcomes in children aged 112 with respiratory tract infections: A systematic review […] Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. […] Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. […] There is little evidence available to parents to identify children at risk of poor prognosis. […] Research is needed into whether poor prognosis can be predicted by parents in the home.
#47 Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review – PubMed
https://pubmed.ncbi.nlm.nih.gov/33872323/
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
#48 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] There is uncertainty from both parents and clinicians about how to identify children with RTIs who are at risk of poor prognosis. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home. […] We found nine studies exploring associations between symptoms, signs, and investigations and prognostic outcomes in children presenting with RTIs to primary care.
#49 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review â Nuffield Department of Primary Care Health Sciences, University of Oxford
https://www.phc.ox.ac.uk/@@disable-cookies?came_from=https://www.phc.ox.ac.uk/publications/1172598
Predicting poor outcomes in children aged 112 with respiratory tract infections: A systematic review […] Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. […] Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. […] There is little evidence available to parents to identify children at risk of poor prognosis. […] Research is needed into whether poor prognosis can be predicted by parents in the home.
#50 Predicting poor outcomes in children aged 1-12 with respiratory tract infections: A systematic review – PubMed
https://pubmed.ncbi.nlm.nih.gov/33872323/
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home.
#51 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Demand for NHS services is high and rising. In children respiratory tract infections (RTI) are the most common reason for consultation with primary care. Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] There is uncertainty from both parents and clinicians about how to identify children with RTIs who are at risk of poor prognosis. […] Some evidence is available to clinicians to stratify risk of future hospitalisation, but not of other prognostic outcomes. There is little evidence available to parents to identify children at risk of poor prognosis. Research is needed into whether poor prognosis can be predicted by parents in the home. […] We found nine studies exploring associations between symptoms, signs, and investigations and prognostic outcomes in children presenting with RTIs to primary care.
#52 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249533
Current evidence is insufficient to enable clinicians to identify children at risk of death, re-consultation, antibiotic prescription, or prolonged or deteriorating symptoms from examination and history at one consultation. This is due to poor quality studies, as well as very few results indicating that this is possible. There were no studies in a home setting, and no studies explicitly aiming to identify clinical features which mean it is safe to continue caring for children in the home. Research asking whether parents can identify children at risk of poor prognosis in the home is needed.
#53 Predicting poor outcomes in children aged 1â12 with respiratory tract infections: A systematic review â Nuffield Department of Primary Care Health Sciences, University of Oxford
https://www.phc.ox.ac.uk/@@disable-cookies?came_from=https://www.phc.ox.ac.uk/publications/1172598
Predicting poor outcomes in children aged 112 with respiratory tract infections: A systematic review […] Understanding which features are associated with good and poor prognosis with RTI will help develop interventions to support parents manage illness. […] Respiratory signs, vomiting, fever, dehydration and tachycardia at the initial contact were associated with future hospitalisation. […] Some evidence is available to clinicians to stratify risk of, future hospitalisation, but not of other prognostic outcomes. […] There is little evidence available to parents to identify children at risk of poor prognosis. […] Research is needed into whether poor prognosis can be predicted by parents in the home.
#54 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC10702048/
While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#55 Predicting adverse outcomes in adults with a community-acquired lower respiratory tract infection: a protocol for the development and validation of two prediction models for (i) all-cause hospitalisation and mortality and (ii) cardiovascular outcomes | Di
https://diagnprognres.biomedcentral.com/articles/10.1186/s41512-023-00161-1
Accurate prediction of the risk of adverse outcomes can aid general practitioners (GP) in identifying LRTI patients in whom close follow-up or (antibiotic) treatment is warranted. […] Currently, existing prediction models for adverse outcomes only focus on hospitalisation and mortality and suffer from incomplete model validation, hampering implementation in clinical practice. […] The importance of CVD for the prognosis of LRTIs is proposed by both its association with overall poor prognosis and the observed increased incidence of CVD following the initial infection. […] While considering the interplay between LRTI and CVD, we aim to develop and externally validate two prediction models that predict clinically relevant outcomes such as cardiovascular events, hospitalisation, and mortality. […] These models can aid GPs in stratifying the risk of poor prognosis in primary care LRTI patients, which may ultimately allow for early detection and prevention of deterioration.
#56 Respiratory Tract Infections and Laboratory Diagnostic Methods: A Review with A Focus on Syndromic Panel-Based Assays
https://www.mdpi.com/2076-2607/10/9/1856
In conclusion, the use of syndromic panels for the detection of respiratory pathogens is associated with a radically reduced time-to-results and, in parallel, to increased detection of clinically relevant pathogens compared to the standard methods. […] Syndromic panels, if implemented wisely and interpreted cautiously, can improve antimicrobial use and patient outcomes through improved clinical decision, optimized laboratory workflow, and enhanced antimicrobial and laboratory stewardship.