Yuichiro Shindo1, Ryota Ito2, Daisuke Kobayashi3, Masahiko Ando4, Motoshi Ichikawa5, Yasuhiro Goto6, Yasutaka Fukui7, Mai Iwaki8, Junya Okumura9, Ikuo Yamaguchi10, Tetsuya Yagi11, Yoshimasa Tanikawa12, Yasuteru Sugino9, Joe Shindoh13, Tomohiko Ogasawara8, Fumio Nomura14, Hideo Saka15, Masashi Yamamoto16, Hiroyuki Taniguchi17, Ryujiro Suzuki7, Hiroshi Saito18, Takashi Kawamura19, Yoshinori Hasegawa20. 1. Institute for Advanced Research, Nagoya University, Nagoya, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: yshindo@med.nagoya-u.ac.jp. 2. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan. 3. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan. 4. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan. 5. Department of Respiratory Medicine and Allergy, Toyota Kosei Hospital, Toyota, Japan; Department of Respiratory Medicine, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. 6. Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan; Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan. 7. Department of Respiratory Medicine, Toyohashi Municipal Hospital, Toyohashi, Japan. 8. Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan. 9. Department of Respiratory Medicine, Toyota Memorial Hospital, Toyota, Japan. 10. Department of Central Laboratory, Toyohashi Municipal Hospital, Toyohashi, Japan. 11. Department of Infectious Diseases, Nagoya University Hospital, Nagoya, Japan. 12. Department of Respiratory Medicine and Allergy, Toyota Kosei Hospital, Toyota, Japan. 13. Department of Respiratory Medicine, Ogaki Municipal Hospital, Ogaki, Japan. 14. Department of Respiratory Medicine, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan. 15. Department of Respiratory Medicine, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan. 16. Department of Respiratory Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan. 17. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan. 18. Department of Respiratory Medicine, Aichi Cancer Center Aichi Hospital, Okazaki, Japan. 19. Kyoto University Health Service, Kyoto, Japan. 20. Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Abstract
BACKGROUND: Appropriate initial antibiotics are essential for the treatment of infectious diseases. However, some patients with pneumonia might develop adverse outcomes, despite receiving appropriate initial antibiotics. We aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotics and to identify potential candidates who would benefit from adjunctive therapy. METHODS: From March 15, to Dec 22, 2010, we did a prospective, observational study at ten medical institutions in hospitalised patients (aged ≥20 years) with pneumonia. We did a multivariable logistic regression analysis to calculate odds ratios (ORs) and 95% CI to assess the risk factors for 30-day mortality. This study was registered with the University Medical Information Network in Japan, number UMIN000003306. FINDINGS: The 30-day mortality was 11% (61 of 579 patients) in the appropriate initial antibiotic treatment group and 17% (29 of 168) in the inappropriate initial antibiotic treatment group. Albumin concentration of less than 30 mg/L (adjusted OR 3·39, 95% CI 1·83-6·28), non-ambulatory status (3·34, 1·84-6·05), pH of less than 7·35 (3·13, 1·52-6·42), respiration rate of at least 30 breaths per min (2·33, 1·28-4·24), and blood urea nitrogen of at least 7·14 mmol/L (2·20, 1·13-4·30) were independent risk factors in patients given appropriate initial antibiotic treatment. The 30-day mortality was 1% (one of 126 patients), 1% (two of 168), 17% (23 of 137), 22% (20 of 89), and 44% (14 of 32) for patients with no, one, two, three, and four or five risk factors, respectively. INTERPRETATION: Patients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors. FUNDING: Central Japan Lung Study Group.
BACKGROUND: Appropriate initial antibiotics are essential for the treatment of infectious diseases. However, some patients with pneumonia might develop adverse outcomes, despite receiving appropriate initial antibiotics. We aimed to clarify the risk factors for 30-day mortality in patients who received appropriate initial antibiotics and to identify potential candidates who would benefit from adjunctive therapy. METHODS: From March 15, to Dec 22, 2010, we did a prospective, observational study at ten medical institutions in hospitalised patients (aged ≥20 years) with pneumonia. We did a multivariable logistic regression analysis to calculate odds ratios (ORs) and 95% CI to assess the risk factors for 30-day mortality. This study was registered with the University Medical Information Network in Japan, number UMIN000003306. FINDINGS: The 30-day mortality was 11% (61 of 579 patients) in the appropriate initial antibiotic treatment group and 17% (29 of 168) in the inappropriate initial antibiotic treatment group. Albumin concentration of less than 30 mg/L (adjusted OR 3·39, 95% CI 1·83-6·28), non-ambulatory status (3·34, 1·84-6·05), pH of less than 7·35 (3·13, 1·52-6·42), respiration rate of at least 30 breaths per min (2·33, 1·28-4·24), and blood ureanitrogen of at least 7·14 mmol/L (2·20, 1·13-4·30) were independent risk factors in patients given appropriate initial antibiotic treatment. The 30-day mortality was 1% (one of 126 patients), 1% (two of 168), 17% (23 of 137), 22% (20 of 89), and 44% (14 of 32) for patients with no, one, two, three, and four or five risk factors, respectively. INTERPRETATION:Patients with two or more risk factors were at a higher risk of death during the 30 days assessed than were individuals with no or one risk factor, despite appropriate initial antibiotic treatment. Therefore, adjunctive therapy might be important for improving outcomes in patients with two or more risk factors. FUNDING: Central Japan Lung Study Group.
Authors: Yuichiro Shindo; Anja G Fuchs; Christopher G Davis; Tim Eitas; Jacqueline Unsinger; Carey-Ann D Burnham; Jonathan M Green; Michel Morre; Grant V Bochicchio; Richard S Hotchkiss Journal: J Leukoc Biol Date: 2016-09-14 Impact factor: 4.962
Authors: Christopher R Frei; Sylvie Rehani; Grace C Lee; Natalie K Boyd; Erene Attia; Ashley Pechal; Rachel S Britt; Eric M Mortensen Journal: Pharmacotherapy Date: 2017-02-03 Impact factor: 4.705
Authors: Larisa Pinte; Alexandr Ceasovschih; Cristian-Mihail Niculae; Laura Elena Stoichitoiu; Razvan Adrian Ionescu; Marius Ioan Balea; Roxana Carmen Cernat; Nicoleta Vlad; Vlad Padureanu; Adrian Purcarea; Camelia Badea; Adriana Hristea; Laurenţiu Sorodoc; Cristian Baicus Journal: J Pers Med Date: 2022-05-26