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Objective: This work aims to assess the effect of baricitinib in combination with methylprednisolone in patients with pneumonia in severe conditions and their impact on inflammation markers. Methods: From DECEMBER 2022 to AUGUST 2023, 182 patients diagnosed with severe pneumonia formed the sampling frame. These selected patients were then divided into two groups based on a random number table, with 91 patients in each group. Both groups underwent treatment under a traditional placebo. The control group received methylprednisolone, while the experimental group was treated with methylprednisolone in combination with baricitinib. They were treated similarly for seven days. The groups' peri-operative blood gas, inflammatory parameters, and drug safety were compared. Results: On the seventh day of the intervention, both the groups had improved with the blood gas parameters. Additionally, the results showed that the experimental group possessed significantly higher peripheral oxygen saturation (SpO2), partial pressure of arterial oxygen (PaO2), and oxygenation index (OI) as compared to the control group (P < 0.05). The experimental group also showed a higher level of carbon dioxide than the control group, P < 0. The experimental group had a mean partial pressure (PaCO2) lower as compared to that of the control group (P < 0). Further, the finding of the observation group, on average, had a significantly lower concentration of CRP, IL-6, and IL-10 during the seventh day compared to the control group (P<0). The result showed no statistically significant difference in the frequency of adverse reactions in the two groups when the medication was given (P > 0.05). Therefore, the utilization of baricitinib in combination with methylprednisolone can ameliorate blood gas parameters and indicate the levels of inflammatory markers in patients with severe pneumonia. Therefore, the medicine is considered safe and has the potential for wider clinical application. [ABSTRACT FROM AUTHOR]

Objective To observe the application effect of multi-dimensional nursing based on hazard analysis and critical control point (HACCP) and goal-oriented in patients with severe pneumonia with mechanical ventilation. Methods A total of 80 patients with severe pneumonia with mechanical ventilation who were treated in the Xinyi People′s Hospital from January 2020 to January 2023 were selected as the observation samples, and they were divided into 40 experimental group and 40 control group by random number table method. The control group followed the routine nursing method of mechanical ventilation of severe pneumonia. On this basis, HACCP and goal-oriented multidimensional nursing intervention were added to the experimental group, and Clinical Pulmonary Infection Score (CPIS),Nutritional Risk Screening (NRS) score, Acute Physiology and Chronic Health Evaluation (APACHEⅡ) score, mechanical ventilation time, hospitalization time and other observation indexes were compared between the two groups after intervention. Results After nursing, the CPIS score, NRS score and APACHEⅡ score [ (5. 43±0. 55), (3. 23±0. 58), (23. 85±1. 21) / (2. 90±0. 50) ] in the observation group were lower than those in the control group [ (6. 35±0. 48), (4. 33±0. 47), (25. 16±0. 60) / (3. 95±0. 60) ]. Mechanical ventilation time and hospitalization time [ (8. 25±0. 74), (23. 70±1. 32) d] were shorter than those in the control group [ (10. 85±0. 83), (32. 03±1. 27) d],and the differences were statistically significant (P＜0. 05). Conclusion The intervention of multi-dimensional nursing based on HACCP and goal-oriented on severe pneumonia patients with mechanical ventilation is conducive to the improvement of their lung infection and nutritional health status, and the realization of rapid rehabilitation goals. [ABSTRACT FROM AUTHOR]

Abstract Mycoplasma pneumoniae (MP) is one of the pathogens that cause community-acquired pneumonia in children. Atopic diseases are also common in children. However, the impact of atopy on Mycoplasma pneumoniae pneumonia (MPP) in children is still unclear. The purpose of this study is to analyze the impact of atopy on the clinical characteristics of MPP in children, and provide a diagnosis and treatment plan. A total of 489 children hospitalized for MPP in our hospital from June 2023 to December 2023 were selected. They were divided into an atopic group (n = 172) and a non-atopic group (n = 317) based on whether they had atopy or not. Clinical data, treatment regimens, and laboratory indicators were compared between the two groups. Eosinophil count, lactate dehydrogenase and IgE levels were higher in the atopic group than in the non-atopic group. Additionally, neutrophil percentage, procalcitonin levels were lower in the atopic group than in the non-atopic group (P

Abstract Background The aim of this study was to investigate the clinical characteristics of severe pneumonia caused by human bocavirus (HBoV) infection to explore the associated risk factors. Methods We conducted a retrospective review of data from children hospitalized with HBoV pneumonia. Based on the severity of pneumonia, patients were categorized into severe pneumonia and non-severe pneumonia groups. Clinical manifestations, laboratory examination results, chest imaging and pathogens were analyzed. Logistic regression was employed to identify the risk factors for severe HBoV pneumonia. Results A total of 334 patients were admitted, with 44 (13.17%) patients diagnosed with severe pneumonia and 290 (86.83%) with non-severe pneumonia. There were no significant differences in age distribution, presence of fever, lung moist rales, pleural effusion and reduced breath sounds between the two groups (all P > 0.05). 57.19% of the HBoV-positive children co-infected with other pathogens and HRV was the most common co-infected pathogens with HBoV. No significant differences were observed in the rate of co-infection between the two groups (χ 2 = 0.50, p = 0.48). The univariate analysis revealed significant differences between the severe pneumonia group and the non-severe group in terms of gender distribution, presence of underlying chronic diseases, wheezing, premature delivery, lung wheezing rales, pneumothorax, bronchoscopy procedures, length of hospital stay, duration of symptoms prior to admission, neutrophil count, CRP levels, CKMB levels, IgA levels, CD3+(%), CD3+CD4+(%), CD3+CD8+%, and CD3−CD19+% (all P

Qiuyue Zhang,1,&ast; Yingchao Liu,1,&ast; Chuntang Tong,2 Lina Zhang,3 Rongchen Li,1 Wenbin Guo,4 Jianliang Li5 1Department of Clinical Laboratory, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, People’s Republic of China; 2Department of Respiratory Medicine, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, People’s Republic of China; 3Department of Scientific Research Management Division, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, People’s Republic of China; 4Department of Intensive Care Unit, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, People’s Republic of China; 5Department of Thoracic Surgery, The Second People’s Hospital of Liaocheng, Linqing, Shandong, 252600, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jianliang Li, Department of Thoracic Surgery The Second People’s Hospital of Liaocheng, 306 health Street, Linqing, Shandong, 252600, People’s Republic of China, Tel +86 15020622456, Email lijianliangl724@163.comObjective: This study aimed to investigate the levels of coagulation parameters in elderly patients with severe pneumonia and analyse their correlation with disease severity and prognosis.Methods: A retrospective study was conducted on 207 elderly patients (aged ≥ 60 years) with severe pneumonia admitted to our hospital between January 2022 and December 2023. Demographic data, clinical characteristics and coagulation parameters, including prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time and fibrinogen (FIB), were collected. Patients were divided into survivor and non-survivor groups based on 28-day mortality. The differences in coagulation parameters between groups and their correlation with disease severity and prognosis were analysed.Results: The 28-day mortality rate was 52.2%. Non-survivors had significantly higher PT, APTT and D-dimer levels and lower FIB levels than survivors (p < 0.05). Multivariate logistic regression analysis showed that elevated PT (odds ratio [OR] = 1.218, 95% confidence interval [CI]: 1.076– 1.379, p = 0.002) and D-dimer (OR = 1.109, 95% CI: 1.032– 1.192, p = 0.005) were independent risk factors for 28-day mortality. The combined model using PT and D-dimer showed the highest predictive value for 28-day mortality (area under the curve = 0.801, 95% CI: 0.739– 0.863, p < 0.001), with a sensitivity of 0.759 and specificity of 0.758.Conclusion: Coagulation dysfunction is common in elderly patients with severe pneumonia. Prothrombin time and D-dimer levels are closely associated with disease severity and can be valuable indicators for predicting prognosis in this population.Keywords: elderly, severe pneumonia, coagulation parameters, disease severity, prognosis

Peng Zhou,1 Dehua Zhang,2 Jianjian Fu,3 Dongling Zhu,4 Shixiao Li5 1Department of Pharmacy, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2Emergency Department, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou, Zhejiang, People’s Republic of China; 3Burn Department, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, People’s Republic of China; 4Nursing Department, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou, Zhejiang, People’s Republic of China; 5Department of Clinical Microbiology Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, Zhejiang, People’s Republic of ChinaCorrespondence: Shixiao Li, Email lsx0992@126.comObjective: To evaluate the value of respiratory specimens collected via different sampling methods combined with metagenomic next-generation sequencing (mNGS) in the etiological diagnosis of severe pneumonia.Methods: A total of 117 patients with severe pneumonia between 2019 and 2024 were included in this study, with 60 patients undergoing endotracheal aspiration (ETA) and 57 undergoing bronchoalveolar lavage (BAL), respectively. Patient records were retrospectively reviewed. Both ETA and BAL samples were tested using mNGS and conventional microbiological tests (CMT) to compare the detection rates, microbial profiles and their effects on clinical outcomes.Results: The positive rates of mNGS for ETA and BAL samples were 96.7% and 80.7%, respectively, which were higher than CMT. A total of 39 pathogenic microorganisms were detected, of which Klebsiella pneumoniae, Candida albicans and herpes simplex virus-4 (HSV-4), and cytomegalovirus (CMV) were the most commonly detected as bacteria, fungi and viruses, respectively. The percentages of Pseudomonas aeruginosa (30.0% vs 12.3%, p = 0.019) and Stenotrophomonas maltophilia (25.0% vs 8.8%, p = 0.020) were significantly higher in the ETA group compared to the BALF group. The detection rate of three or more microorganisms was notably higher in the ETA group. No significant differences existed in antibiotics adjustment between the groups. The ETA group experienced a higher frequency of continuous renal replacement therapy (CRRT), mechanical ventilation and complications. There was no significant difference in the hospital length of stay, duration of mechanical ventilation and mortality between both groups.Conclusion: Respiratory specimens collected by different sampling methods yield different microbial findings. ETA and BAL combined with mNGS play a role in guiding the pathogenetic diagnosis of patients with severe pneumonia. However, it is recommended that their sampling methods be determined by clinical symptoms and patient conditions.Keywords: metagenomic next-generation sequencing, sampling method, severe pneumonia, etiological diagnosis

Abstract Background Ureaplasma urealyticum, Ureaplasma parvum, and Mycoplasma hominis were widely known as ammonia-producing microorganisms and can cause hyperammonemia, leading to cerebral edema and altered consciousness, which represent serious complications in lung transplant recipients. However, there is limited knowledge on the epidemiology and outcomes of infections caused by U. urealyticum, U. parvum, and M. hominis in non-transplant patients with severe pneumonia in the ICU. Methods Patients with severe pneumonia who underwent clinical metagenomics of bronchoalveolar lavage fluid (BALF) at the intensive care units (ICUs) of 17 medical centers from January 2019 to March 2023 were enrolled. All cases were divided into the positive group and the negative group based on whether U. urealyticum, U. parvum, or M. hominis was detected in lower respiratory tract. The clinical characteristics and outcomes were compared among the groups. The survival analysis after propensity score matching (PSM) was used to evaluate whether the mortality rate of U. urealyticum, U. parvum, and M. hominis positive patients were increased. Multivariate logistic regression was used to evaluate whether these microbials positivity were a risk factor for central nervous system dysfunction. Results In a total number of 1737 patients, 55 patients (3.17%) in the positive group and 1682 patients (96.83%) in the negative group. Patients in the positive group were younger, had a greater proportion of male patients, and had a longer time from ICU admission to clinical metagenomics testing. In contrast, the negative group had a higher proportion of patients with cerebrovascular disease. After PSM, there was no statistically significant difference in 28-day mortality following ICU admission between the two groups (hazard ratio [HR], 0.842; 95% confidence interval [CI], 0.489–1.451; p = 0.536). Multivariate logistic regression analysis showed an association between the detection of U. urealyticum, U. parvum, or M. hominis and neurological dysfunction (odds ratio [OR], 1.84; 95% CI 1.04–3.24; p = 0.035). Conclusion The detection of U. urealyticum, U. parvum, or M. hominis in the lungs of patients is associated with neurological dysfunction.

Abstract Reports on the application of metagenomic next-generation sequencing (mNGS) in adult patients with severe pneumonia after cardiac surgery remain limited. This study aimed to evaluate the clinical outcomes of mNGS analysis of bronchoalveolar lavage fluid (BALF) in such patients.A retrospective cohort study was conducted on adult patients with severe pneumonia after cardiac surgery. Samples were collected from patients in the surgical intensive care unit (SICU) of Sichuan Provincial People’s Hospital between January 2019 and March 2024. Upon diagnosis of severe pneumonia, bronchoalveolar lavage fluid was obtained via bronchoscopy within 24 h. The mNGS group was composed of patients tested using mNGS and conventional microbiological tests. BALF was detected only by the conventional microbiological test (CMT) method in the CMT group, which involved examining bacterial and fungal smears and cultures at least. We reviewed a total of 4,064 cardiac surgeries, and based on the inclusion criteria, a total of 113 adult patients with severe pneumonia after cardiac surgery were included in this study. The overall positive rate detected by mNGS was significantly higher than that of the culture method (98% vs. 58%, P

Abstract Patients with traumatic brain injury (TBI) frequently exhibit concomitant immunosuppression. In this study, we evaluated the predictive values of soluble programmed death-1 (sPD-1) and soluble programmed death ligand-1 (sPD-L1) in patients with severe TBI. Peripheral blood sPD-1 and sPD-L1 levels were measured within 48 h of patient admission. A total of 20 healthy volunteers and 82 patients were enrolled in this study. The levels of sPD-1 and sPD-L1 were upregulated in patients with severe TBI (P

Jun Song,1 Ning Li,1 Ruihua Li,1 Yuanyuan Xu2 1Department of Pediatrics, Taihe County People’s Hospital, Fuyang, Anhui, 236000, People’s Republic of China; 2Pediatric Intensive Care Unit, Anhui Children’s Hospital, Hefei, Anhui, 230051, People’s Republic of ChinaCorrespondence: Yuanyuan Xu, Pediat Intens Care Unit, Anhui Children’s Hospital, 39 Wangjiang East Road, Baohe District, Hefei, Anhui, 230051, People’s Republic of China, Tel +86-551-62237451, Email Xuyuanyuan7451@163.comObjective: This study aimed to probe the changes in coagulation function-related indicators (prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (D-D), and fibrinogen degradation product (FDP)) in severe pneumonia and their clinical significance.Methods: The levels of coagulation function indicators of all the children were measured within 24 hours of admission. Pearson correlation analysis was utilized to analyze the correlation between PT, APTT, FIB, D-D, FDP and PCIS in children with severe pneumonia. The ROC curve was drawn to assess the power of PT, APTT, FIB, D-D and FDP in diagnosing severe pneumonia and predicting the prognosis of severe pneumonia. A logistic regression analysis was implemented to analyze the factors influencing the prognosis of children with severe pneumonia.Results: PT, APTT, FIB, FDP, and D-D in the critically severe pneumonia and the extremely severe pneumonia groups were higher versus the common pneumonia group (P < 0.05). FDP and D-D levels in children with severe pneumonia were negatively correlated with PCIS. PT, APTT, FIB, FDP, and D-D of children in the poor prognosis group were higher compared with those in the good prognosis group (P < 0.05). Further logistic regression analysis unveiled that FDP and APTT were influential factors impacting the prognosis of severe pneumonia.Conclusion: The levels of D-D, FDP, FIB, APTT, and PT in severe pneumonia are increased. Detecting the contents of coagulation function indicators can help clinical judgment of the changes in the condition of severe pneumonia and evaluate prognosis.Keywords: severe pneumonia, prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, fibrinogen degradation product, pediatric critical illness score

Objective To explore the application value of goal-directed strategy-based refined airway care in patients with severe pneumonia undergoing mechanical ventilation. Methods A total of 99 patients with severe pneumonia undergoing mechanical ventilation admitted to the Department of Infectious Diseases and Intensive Care Unit (ICU) of this hospital from January 2022 to August 2023 were selected. Based on the admission time, the first 49 patients admitted were assigned to the control group, and the subsequent 50 patients were assigned to the observation group. The control group received routine care, while the observation group received goal-directed strategy-based refined airway care. The interventions in both groups were compared and analyzed. Results Compared with the control group, patients in the observation group had lower airway resistance, peak airway pressure, and respiratory pressure after intervention; shorter durations of me-chanical ventilation, ICU treatment, and hospital stay; fewer airway-related complications; higher scores in all dimensions of quality of life and satisfaction after intervention, with statistically significant differences (P< 0.05). Conclusion Goal-directed strategy-based refined airway care for patients with severe pneumonia undergoing mechanical ventilation can improve lung function, accelerate recovery, reduce the incidence of airway-related complications, and enhance patients' quality of life and nursing satisfaction. [ABSTRACT FROM AUTHOR]

Background: Ureaplasma urealyticum, Ureaplasma parvum, and Mycoplasma hominis were widely known as ammonia-producing microorganisms and can cause hyperammonemia, leading to cerebral edema and altered consciousness, which represent serious complications in lung transplant recipients. However, there is limited knowledge on the epidemiology and outcomes of infections caused by U. urealyticum, U. parvum, and M. hominis in non-transplant patients with severe pneumonia in the ICU. Methods: Patients with severe pneumonia who underwent clinical metagenomics of bronchoalveolar lavage fluid (BALF) at the intensive care units (ICUs) of 17 medical centers from January 2019 to March 2023 were enrolled. All cases were divided into the positive group and the negative group based on whether U. urealyticum, U. parvum, or M. hominis was detected in lower respiratory tract. The clinical characteristics and outcomes were compared among the groups. The survival analysis after propensity score matching (PSM) was used to evaluate whether the mortality rate of U. urealyticum, U. parvum, and M. hominis positive patients were increased. Multivariate logistic regression was used to evaluate whether these microbials positivity were a risk factor for central nervous system dysfunction. Results: In a total number of 1737 patients, 55 patients (3.17%) in the positive group and 1682 patients (96.83%) in the negative group. Patients in the positive group were younger, had a greater proportion of male patients, and had a longer time from ICU admission to clinical metagenomics testing. In contrast, the negative group had a higher proportion of patients with cerebrovascular disease. After PSM, there was no statistically significant difference in 28-day mortality following ICU admission between the two groups (hazard ratio [HR], 0.842; 95% confidence interval [CI], 0.489–1.451; p = 0.536). Multivariate logistic regression analysis showed an association between the detection of U. urealyticum, U. parvum, or M. hominis and neurological dysfunction (odds ratio [OR], 1.84; 95% CI 1.04–3.24; p = 0.035). Conclusion: The detection of U. urealyticum, U. parvum, or M. hominis in the lungs of patients is associated with neurological dysfunction. [ABSTRACT FROM AUTHOR]

Objective: To investigate the expression of serum chemokine ligand 17 (CCL17), growth differentiation factor-15 (GDF-15) and angiopoietin 2 (ANG2) in children with severe pneumonia (SP) and their prognostic value. Methods: 344 SP children (SP group) and 150 healthy children (control group) were selected. The levels of serum CCL17, GDF-15, ANG2, inflammatory factors [interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT)] were detected and compared between two groups. Multivariate logistic regression was used to analyze the prognostic factors of children with SP. The prognostic value of serum GDF-15, ANG2 and CCL17 in children with SP was analyzed using receiver operating characteristic (ROC) curves. Results: Compared with control group, the levels of serum CCL17, GDF-15, ANG2, IL-6, CRP and PCT in SP group were significantly increased (P<0.05). The decrease of pediatric critical illness score (PCIS) and the increase of serum CCL17, GDF-15 and ANG2 levels were risk factors for poor prognosis in children with SP (P<0.05). The results of ROC curve analysis showed that, the areas under the curve (AUC) of CCL17, GDF-15 and ANG2 alone and in combination for predicting the prognosis of children with SP were 0.833, 0.801, 0.806 and 0.974, respectively, the value of combined prediction of poor prognosis in children with SP was higher than that of each index alone (P<0.05). Conclusion: The levels of serum CCL17, GDF-15 and ANG2 in children with SP are abnormally high, and are closely related to the poor prognosis, the combined detection of the three indexes has a high value in predicting the poor prognosis of children with SP. [ABSTRACT FROM AUTHOR]

Severe pneumonia is a crucial issue in the development of acute kidney injury (AKI). This study evaluated the efficacy of early goal-directed renal replacement therapy (GDRRT) for the treatment of severe pneumonia-associated AKI. In this real-world retrospective cohort study, we recruited 180 patients with severe pneumonia who were hospitalized and received GDRRT in a third-class general hospital in East China between January 1, 2017, and December 31, 2021. Clinical data on baseline characteristics, biochemical indicators, and renal replacement therapy were collected. Patients were divided into Early and Late RRT groups according to fluid status, inflammation progression, and pulmonary radiology. We investigated in-hospital all-cause mortality (primary endpoint) and renal recovery (secondary endpoint) between the two groups. Among the 154 recruited patients, 80 and 74 were in the early and late RRT groups, respectively. There were no significant differences in the demographic characteristics between the two groups. The duration of admission to RRT initiation was significantly shorter in Early RRT group [2.5(1.0, 8.7) d vs. 5.0(1.5,13.5) d, p = 0.027]. At RRT initiation, the patients in the Early RRT group displayed a lower percentage of fluid overload, lower doses of vasoactive agents, higher CRP levels, and higher rates of radiographic progression than those in the Late RRT group. The all-cause in-hospital mortality was significantly lower in the Early RRT group than in Late group (52.5% vs. 86.5%, p < 0.001). Patients in the Early RRT group displayed a significantly higher proportion of complete renal recovery at discharge (40.0% vs. 8.1%, p < 0.001). This study clarified that early GDRRT for the treatment of severe pneumonia-associated AKI based on fluid status and inflammation progression, was associated with reduced hospital mortality and better recovery of renal function. Our preliminary study suggests that early initiation of RRT may be an effective approach for severe pneumonia-associated AKI. [ABSTRACT FROM AUTHOR]

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Objective To analyze the influence of delirium on the prognosis of elderly patients with severe pneumonia (SP) undergoing mechanical ventilation, and to construct a prediction model for the occurrence of delirium. Methods Three hundred and ninety-seven cases of SP patients undergoing mechanical ventilation were selected and were classified into the delirium group (80 cases) and non-delirium group (317 cases) according to the occurrence of delirium during the hospitalization period. The patients were followed up for 28 days starting from their admission to the intensive care unit (ICU). The 28-d cumulative survival rates of the two groups were compared, and the clinical data of the two groups were collected. Multivariate Logistic regression was used to analyze the risk factors for the occurrence of delirium during the hospitalization period in elderly SP patients undergoing mechanical ventilation and we constructed a risk prediction model. The value of the risk prediction model in predicting the occurrence of delirium in elderly SP patients was analyzed by the receiver operating characteristic (ROC) curve. Results The 28-day cumulative survival rate of the delirium group was 45. 00% (36/80), which was lower than that [14. 20% (45/317)] of the non-delirium group, with statistically significant difference (P<0. 05). Univariate analysis showed that the severity of disease, the proportion of diabetes mellitus, the proportion of cerebrovascular disease, blood lactate, C-reactive protein (CRP), and procalcitonin (PCT) levels were higher in the delirium group than in the non-delirium group, and the ICU time, mechanical ventilation time, and time to arousal after discontinuation of medication were longer than those in the non-delirium group, and the hemoglobin level was lower than that in the non-delirium group (all P<0. 05). Multifactorial Logistic regression analysis showed that high-risk condition, cerebrovascular disease, diabetes mellitus, prolonged mechanical ventilation, prolonged arousal time after discontinuation of medication, elevated blood lactate, elevated CRP, and elevated PCT were the independent risk factors for delirium in elderly patients with SP undergoing mechanical ventilation (all P<0. 05). The risk prediction model for the occurrence of delirium in elderly patients with SP undergoing mechanical ventilation: Ln (P/1-P) = -15. 475+1. 165×severity of illness + 1. 019×diabetes mellitus + 1. 476×cerebrovascular disease + 0. 008×duration of mechanical ventilation + 0. 103× time of arousal after discontinuation of medication + 0. 751×blood lactate + 0. 011×CRP + 0. 362×PCT (χ² =7. 996, P= 0. 434). The ROC curve showed that the area under the curve of the risk prediction model in predicting the occurrence of delirium in elderly SP patients undergoing mechanical ventilation was 0. 929 (95% CI：0. 899-0. 952), with a optimal cutoff value of 0. 217, a sensitivity of 83. 75%, a specificity of 86. 44%, and the maximum Youden index of 0. 702, respectively. Conclusions Delirium will increase the risk of death in elderly SP patients. A prediction model is successfully constructed based on the risk factors for delirium in elderly SP patients undergoing mechanical ventilation, and this model has a high predictive value. [ABSTRACT FROM AUTHOR]

AIM: To establish a severe pneumonia mouse model induced by bacterial infection. METHODS: A total of 102 male SPF C57BL/6J mice were randomly divided into a control group and a model group. Klebsiella pneumoniae was administered via tracheal instillation at a concentration of 5×109 CFU. Mice were euthanized on days 1, 2, 4, 8, and 14 post-infection to assess general condition, body weight, mortality, white blood cell and neutrophil counts, inflammatory markers, and pathological changes in lung, heart, liver, spleen, kidney, and intestinal tissues. RESULTS: Mice in the model group exhibited symptoms such as dyspnea and huddling from 6 hours to 4 days post-infection, which progressively worsened, accompanied by continuous weight loss （P<0. 01）. These symptoms gradually resolved between days 5 and 14. Arterial oxygen saturation in the model group dropped to 80. 7% from days 1 to 8（ P<0. 01） but returned to normal from days 9 to 14. A total of 23 model mice died between days 1 and 9, with no deaths thereafter, resulting in a mortality rate of 31. 9%（ P<0. 01）. Pathological examination revealed inflammatory cell infiltration, congestion, and edema in lung tissue from days 1 to 2, with continued inflammatory cell infiltration, alveolar structural disorganization from days 4 to 8, and alveolar rupture and fusion by day 14（ P<0. 05 or P<0. 01）. Additionally, model mice showed significant increases in neutrophil count, white blood cell count, protein content in bronchoalveolar lavage fluid, total cell count, neutrophil ratio, and levels of inflammatory factors tumor necrosis factor-α（ TNF-α）, interleukin-1β（ IL-1β） and IL-6 in peripheral blood from days 1 to 8 （P<0. 05 or P<0. 01）. No significant pathological changes were observed in heart and liver tissues, while spleen, kidney, and intestinal tissues exhibited notable pathological changes: indistinct boundaries between red and white pulp in the spleen, significant congestion and edema around renal glomeruli, renal tubules, and collecting ducts, and extensive inflammatory cell infiltration in the colonic mucosa. CONCLUSION: Tracheal instillation of 5×109 CFU Klebsiella pneumoniae induces severe pathological changes in the lungs of mice, offering a robust model for studying the pathogenesis and treatment of severe pneumonia. [ABSTRACT FROM AUTHOR]

Background Obinutuzumab is a humanized and glycoengineered anti-CD20 monoclonal antibody that has been shown to induce more profound B-cell depletion than rituximab. The effectiveness and safety of obinutuzumab in the treatment of membranous nephropathy remain unclear. Methods This was a retrospective study conducted in Huashan Hospital, Fudan University between 1 December 2021 and 30 November 2023. Patients with membranous nephropathy were included to assess the effectiveness and safety of obinutuzumab and prevalence of severe pneumonia during the outbreak of COVID-19 in China. Results Eighteen patients were included in the study assessing the effectiveness of obinutuzumab. After a 12-month follow-up, 14 patients (78%) achieved remission, with six (33%) achieving complete remission and eight (44%) achieving partial remission. Among the 18 obinutuzumab-treated patients contracting COVID-19 for the first time, six (33%) developed severe pneumonia, and one died. By contrast, two of the 37 patients receiving glucocorticoids combined with cyclophosphamide, and none of the 44 patients on calcineurin inhibitors or the 46 patients on rituximab developed severe pneumonia. However, compared to patients receiving rituximab or glucocorticoids plus cyclophosphamide, the obinutuzumab-treated patients had a longer duration of membranous nephropathy and immunosuppressive therapy. Therefore, cardinal matching was employed to balance these baseline characteristics. Owing to small sample size for each regimen, patients receiving all the three non-obinutuzumab immunosuppressive regimens were grouped as a control cohort. After matching for age, gender, remission status, duration of membranous nephropathy, duration of immunosuppressive therapy, and ongoing immunosuppression, the obinutuzumab-treated patients still had a significantly higher incidence of severe pneumonia compared to those on other regimens (P  = .019). Conclusion Obinutuzumab was an effective treatment option for patients with membranous nephropathy. On the other hand, it was associated with a higher incidence of severe pneumonia following COVID-19 infection compared to other immunosuppressive regimens. [ABSTRACT FROM AUTHOR]

Objective Severe pneumonia is a common pediatric disease, often complicated by respiratory failure (RF). The expression changes of long non-coding RNA zinc finger antisense 1 (ZFAS1) were examined in children with severe pneumonia, as well as their predictive value in the occurrence of RF and poor outcomes. Methods A total of 120 children with severe pneumonia were included, 60 of whom had RF. RT-qPCR was used to detect mRNA levels. Deaths during the follow-up period were recorded through a 28-day follow-up survey. Receiver operating characteristic (ROC) curve and Kaplan Meier (K-M) plot were drawn to display diagnostic and predictive values, with the help of multiple logistic and Cox regression analysis. Results A sharp rise of serum ZFAS1 was tested in severe pneumonia children, providing a area under the receiver operator characteristic curve (AUC-ROC) of 0.920, with a sensitivity of 81.67% and a specificity of 90.00%. Serum ZFAS1 (OR = 5.832, 95% CI = 2.283–14.899) was found to be associated with the occurrence of RF after adjusting other clinical indexes, with an AUC-ROC of 0.843. ZFAS1 (HR = 4.624, 95% CI = 1.318–16.217, P < 0.05) was an independent influence factor for the poor prognosis. Cases with high ZFAS1 levels had worse clinical outcomes. Conclusion Monitoring serum ZFAS1 levels is helpful in assessing severe pneumonia in children, especially for early identification of cases with RF. High serum ZFAS1 levels have a certain predictive value for poor prognosis in patients. [ABSTRACT FROM AUTHOR]

Pneumonia often causes myocardial damage. This study sought to understand how early myocardial injury affects severe pneumonia patients' prognoses. This multi-center prospective cohort study from March 2020 to October 2023 comprised severe pneumonia patients. Binary logistic regression analysis examined how myocardial damage affects cardiac complications and acute renal injury (AKI). We used Spearman correlation analysis to examine the relationship between troponin I levels and the vasoactive inotropic score (VIS) in shock patients with myocardial injury. We used the Kaplan–Meier survival curve to evaluate the impact of myocardial injury on 30-day and 1-year survival rates. Mediation investigations examined how AKI and cardiac complications mediate myocardial injury and death. This study included 363 severe pneumonia patients, of whom 204 (56.2%) developed myocardial damage, 132 (36.4%) had cardiac problems, and 146 (40.2%) had AKI. Myocardial damage independently elevated the incidence of cardiac complications (OR = 2.548, 95% CI = 1.404–4.303, P = 0.002) and AKI (OR = 1.946, 95% CI = 1.177–3.219, P = 0.009). There was a positive link between troponin I and VIS in myocardial injury and shock patients (r = 0.43, P < 0.001). COX regression found myocardial injury to be a death risk (HR = 1.472, 95% CI = 1.043–2.077, P = 0.028). Adjusted Kaplan–Meier survival analysis showed significantly decreased short-term and long-term survival rates with myocardial injury (log-rank test P < 0.05). The mediation study showed that cardiac complications and AKI mediated myocardial injury and death by 19.30% and 17.18%, respectively. Early myocardial injury in severe pneumonia patients raises the likelihood of cardiac problems, AKI, and refractory shock, reducing short- and long-term survival. [ABSTRACT FROM AUTHOR]

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Patients with traumatic brain injury (TBI) frequently exhibit concomitant immunosuppression. In this study, we evaluated the predictive values of soluble programmed death-1 (sPD-1) and soluble programmed death ligand-1 (sPD-L1) in patients with severe TBI. Peripheral blood sPD-1 and sPD-L1 levels were measured within 48 h of patient admission. A total of 20 healthy volunteers and 82 patients were enrolled in this study. The levels of sPD-1 and sPD-L1 were upregulated in patients with severe TBI (P < 0.001). They were significantly increased in the post-TBI severe pneumonia group and among non-survivors (P < 0.001). The area under the curves (AUCs) for sPD-1 and sPD-L1 levels to predict severe pneumonia were 0.714 and 0.696, respectively, and the AUCs to predict mortality were 0.758 and 0.735. The levels of sPD-1 and sPD-L1 are correlated with the GCS scores at admission, APACHE II scores, length of MV, and time elapsed to mortality. The levels of sPD-1 and sPD-L1 emerged as independent predictive factors for severe pneumonia and mortality. This study demonstrates that upregulation of sPD-1 and sPD-L1 in severe TBI patients is significantly associated with severe pneumonia and mortality, suggesting their potential as predictive biomarkers for these outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the clinical significance of serum al-antitrypsin (al-AT), soluble interleukin-2 receptor (sIL-2R) and galectin-3 (Gal-3) in elderly patients with severe pneumonia (SP) combine with respiratory failure (RF). Methods: 200 elderly patients with SP combine with RF who were admitted to our hospital were selected, patients were divided into low risk group, medium risk group and high risk group, patients were divided into death group and survival group according to the 30 days prognosis. Serum α1-AT, SIL-2R and Gal-3 levels were detected. The factors of death in elderly patients with SP combine with RF were analyzed by multivariate Logistic regression. Results: Serum α1-AT, SIL-2R and Gal-3 levels in low risk group, middle risk group and high risk group increased in turn (P<0.05). The 30 day mortality rate of 200 elderly patients with SP combine with RF was 30.50% (61/200). The increase of age, severity of disease and the increase of αl-AT, SIL-2R and Gal-3 were independent risk factors for death in elderly patients with SP combine with RF, and the increase of oxygenation index was an independent protective factor (P<0.05). Conclusion: The increase of serum αl-AT, SIL-2R and Gal-3 levels in elderly patients with SP combine with RF are closely relate to the aggravation of the disease and poor prognosis. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the prognostic significance of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), creatinine, and lactic acid in patients diagnosed with severe pneumonia (SP). We conducted a retrospective analysis of patient data from our hospital who were diagnosed with severe pneumonia between June 2020 and June 2023. The patients were divided into two groups: survivors (363 cases) and non-survivors (346 cases). We collected demographic, clinical and laboratory data and used multifactorial logistic regression to identify prognostic risk factors. We also evaluated the predictive accuracy of each parameter using Receiver Operating Characteristic (ROC) curve analysis. Statistical analysis was performed using SPSS 26.0. In the study, it was found that patients who died had higher levels of certain markers in their blood, including NLR, PLR, procalcitonin (PCT), C-reactionprotein (CRP), Brain natriuretic peptide (BNP), blood creatinine, lactic acid and age Shock Index (SI) (p < 0.001). They also had lower levels of partial pressure of oxygen (PO2) and partial pressure carbon dioxide (PCO2) (p < 0.05). On the other hand, patients who survived had lower levels of these markers and higher levels of PO2 and PCO2. After analyzing the data, it was determined that NLR, PLR, creatinine and lactic acid were significant risk factors for poor prognosis in patients with SP. The Area Under ROC Curve (AUCs) for these factors ranged from 0.577 to 0.725, and they had sensitivities ranging from 67.9% to 77.7% and specificities ranging from 61.2% to 80.7%. When these factors were combined, they provided a more accurate evaluation of prognosis, with an AUC of 0.789 and a sensitivity of 67.1% and specificity of 77.4% at the optimal threshold. NLR, PLR, creatinine and lactic acid are significant prognostic indicators in SP patients. A combined assessment of these parameters enhances prognostic accuracy, aiding in better management. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the characteristics that increase the likelihood of acute kidney injury (AKI) in patients with severe community-acquired pneumonia (SCAP) and to create a predictive nomogram for AKI. Methods: This study comprised individuals who received a diagnosis of SCAP over the period from January 01, 2019, to December 31, 2023. The patients were categorized into two groups: AKI and non-AKI. The clinical and demographic characteristics of the patients were extracted from their medical records. An analysis was conducted to compare the rates of survival at 30 and 90 days among various groups. A multivariate analysis was performed to discover the autonomous risk factors linked to SCAP. The nomogram was built based on these parameters. A receiver operating characteristics (ROC) curve study was performed to assess the predictive accuracy of the nomogram, namely by measuring the area under the curve (AUC). Results: Initial screening was conducted on a total of 1218 patients. After excluding 744 individuals who did not meet the exclusion criteria, a total of 474 patients, with an average age of 7 4. 2 2 ± 1 5. 1 6 years and a female representation of 33.3%, were selected for inclusion in this study. The prevalence of AKI in the subjects with SCAP was 47.7%. Out of these instances, 39.8% were categorized as AKI stage 1, 31.0% as AKI stage 2, and 29.2% as AKI stage 3. Those diagnosed with AKI exhibited a significantly higher mortality rate at both the 30-day and 90-day marks in comparison to those who did not have AKI. The independent risk factors for AKI were determined to include age, male gender, chronic renal disease, diabetes, and the utilization of nonsteroidal anti-inflammatory medicines (NSAIDs). In addition, higher levels of baseline serum creatinine and uric acid were identified as risk factors for AKI. The final predictive nomogram achieved an AUC of 0.811, with a 95% confidence interval (CI) ranging from 0.773 to 0.849. Conclusion: Our nomogram can serve as a valuable tool for evaluating the progression of AKI in patients with SCAP. [ABSTRACT FROM AUTHOR]

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ABSTRACT Severe pneumonia remains the leading infectious cause of death worldwide. The time-consuming nature and suboptimal sensitivity of sputum cultures hamper prompt pathogen detection for tailored treatments. Advanced techniques such as polymerase chain reaction (PCR) and next-generation sequencing (NGS) offer rapid genetic pathogen detection and identification of antimicrobial resistance (AMR) genes. However, the performance of hybrid capture-based target enrichment NGS, e.g., Respiratory Pathogen ID/AMR Enrichment Panel (RPIP), for pathogen detection in patients with severe pneumonia remains uncertain. A prospective study involving adults with severe pneumonia was conducted. Respiratory samples from the lower respiratory tract were collected via bronchoalveolar lavage, bronchial washing, or endotracheal tube suction. The performance of RPIP in pathogen and AMR-associated gene detection was compared to that of conventional culture methods and the multiplex PCR-based FilmArray Pneumonia Panel (FilmArray-PN). A total of 83 subjects were enrolled. The most prevalent pathogens detected by RPIP were Rothia mucilaginosa, Stenotrophomonas maltophilia, Pseudomonas aeruginosa; herpes simplex virus-1, cytomegalovirus, and Epstein-Barr virus, and Pneumocystis jirovecii. Overall, the positive and negative agreement rates for bacterial detection were 63.6% and 97.5% between RPIP and culture methods, respectively, and 55.8% and 99.4% between FilmArray-PN and culture methods, respectively. Compared to FilmArray-PN, RPIP exhibited significantly better detection rates for bacteria (P = 0.029), viruses (P < 0.001), and fungi (P < 0.001) and identified additional blaOXA, blaCMY as extended-spectrum β-lactamase genes and blaOXA, blaSHV as carbapenemase genes. In conclusion, RPIP can sensitively profile respiratory pathogens and is a promising tool for detecting multiple microorganisms and AMR-associated genes in patients with severe pneumonia.IMPORTANCESensitive pathogen detection is pivotal for timely treatment by tailoring adequate antimicrobial agents. Unlike conventional phenotypic approach, novel measures using molecular interrogation appear promising. This study aimed to elucidate the efficacy of a hybrid capture-based target enrichment next-generation sequencing technique (Respiratory Pathogen ID/AMR Enrichment Panel, RPIP) as exemplified in a cohort with severe pneumonia. Pathogen landscape in the population was illustrated by these three methodologies. As compared with multiplex polymerase chain reaction-based FilmArray Pneumonia Panel and conventional culture, RPIP demonstrated significantly improved sensitivity in identifying bacteria, viruses, and fungi. The RPIP also exhibited better performance in identifying different pathogens in patients co-infected with multiple microorganisms. Additionally, the genotypes contributing to antimicrobial resistance were determined by RPIP. The study facilitated the implementation of molecular diagnosis by presenting real-world data, whereas future studies are mandated to generalize such an approach toward different clinical settings.

Objective To investigate the molecular mechanism of polysaccharides from Atractylodes macrocephala koidz.(PAM) to treat severe pneumonia. Methods Sixty male SD rats were randomly divided into control group, model group (inoculation of Klebsiella pneumonia by tracheal puncture), positive control group (levofloxacin, 18 mg/kg), PAM low-dose group (50 mg/kg) and PAM high-dose group (200 mg/kg) with 12 in each. After occurrence of severe pneumonia, the rats were orally administered the medicine once daily for 7 day. The lung tissue underwent histopathological examination using HE staining microscopy to find the pathological alterations and evaluate the extent of injury. Wet/dry ratio of lung tissue was measured by weighing method. The leukocytes and neutrophils counts in peripheral blood were determined by hematology analyzer. The level of tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β) and IL-6 in serum and bronchoalveolar lavage fluid (BALF) was detected by enzyme-linked immunosorbent assay. The expression of proteins related to the Toll-like receptor 4 (TLR4) / myeloid differentiation factor 88 (MyD88)/nuclear factor-κB(NF-κB) signaling pathway in lung tissues was detected using Western blot analysis. Results Compared with the control group, lung injury score and wet/dry ratio, the number of leukocytes and neutrophils in peripheral blood, the level of TNF-α, IL-1β and IL-6 in serum and in BALF,protein expression of TLR4 and MyD88 and the phosphorylation level of NF-κB p56 in lung tissues from model group were all significantly increased(P＜0.05). The lung injury of rats in each levofloxacin treatment group exhibited significant improvement compared to the model group. Among them, the number of leukocytes and neutrophils in peripheral blood of rats in PAM high-dose group decreased significantly(P＜0.05); The level of TNF-α, IL-1β and IL-6 in serum and BALF, the protein expression of TLR4 and MyD88 and the phosphorylation level of NF-κB p56 in lung tissue were significantly decreased(P＜0.05). Conclusions The administration of PAM exerts a specific protective effect against Klebsiella pneumoniae-induced pneumonia in rats, potentially suppress inflammatory response through modulation of the TLR4/MyD88/NF-κB signaling pathway.

Despite trials and programs for the prevention of childhood mortality due to pneumonia, Ethiopia is among the top five countries with the highest number of deaths due to pneumonia. Although the prevalence of pneumonia has increased in the above-mentioned trials, little is known about the recovery time from severe pneumonia and its predictors in the study area. Therefore, this study aimed to assess the time to recovery from severe pneumonia and its predictors among pediatric patients admitted to Mizan-Tepi University Teaching Hospital, Ethiopia, in 2022.

Abstract Purpose This study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient. Methods We conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality. Results Multivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission. Conclusions The mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter.

Abstract Background This study aimed to assess the effects of enteral nutrition with different protein concentrations on muscle mass in severe pneumonia patients, providing insights for enteral nutrition practice in intensive care units (ICUs). Methods A total of 120 severe pneumonia patients admitted to Dazhou Central Hospital’s ICU between June 1, 2022, and February 1, 2023, meeting inclusion criteria, were randomly assigned to either a high-protein group (n = 60, 1.8 g/kg/d) or a standard-protein group (n = 60, 1.2 g/kg/d). Changes in relevant indicators were monitored on days 1, 5, and 10 of ICU admission, including quadriceps and diaphragm thickness, nutritional status (prealbumin and albumin), and adverse events such as diarrhea and constipation. Results Autoregressive of order 1 model (AR(1)) analysis revealed a decrease in both quadriceps and diaphragm thickness over time in both groups. A significant group × time interaction was observed in quadriceps thickness. By day 10, compared to baseline, quadriceps thickness decreased in the high-protein (-0.315 cm [95% CI, -0.340 to -0.289]) and standard-protein (-0.429 cm [95% CI, -0.455 to -0.404]) groups. The high-protein group exhibited a lower quadriceps atrophy rate (13.97 ± 2.43%) compared to the standard-protein group (18.96 ± 2.61%), showing a significant difference (P

ObjectiveTo investigate the etiology and epidemiological characteristics of pneumonia in children of different ages, to better characterize the co-infection patterns of pneumonia and their association with severe diseases.MethodsChildren aged 28 days to 13 years with pneumonia who were hospitalized in the Department of Pediatrics, Dongyang People's Hospital, Zhejiang Province from April 1 to December 28, 2023 were selected as the research subjects. Oropharynx swabs were collected from the patients within 24 hours of hospital admission, and PCR tests were conducted for 18 respiratory pathogens. Binary multivariate logistic regression analysis was used to analyze the status of viral and bacterial infection, patterns of co-infection in patients with different ages, and the risk factors for the outcome of severe pneumonia.ResultsA total of 2 191 hospitalized children with pneumonia were enrolled in the study. Severe cases were more common in children aged 5 years and older (53.3%) and in the second quarter of the year (46.5%). An average of (1.31±0.90) pathogens were detected in severe cases. Mycoplasma pneumoniae (44.4%, 973 cases) had the highest detection rate of pathogens. Streptococcus pneumoniae (21.7%, 476 cases) and rhinovirus (10.1%, 222 cases) were the most common bacteria and viruses, respectively, in hospitalized children with pneumonia in Dongyang City. Multivariate logistic regression analysis indicated positive interactions between different viral and bacterial pathogens. The adjusted OR (aOR) values for different respiratory pathogens in children with severe pneumonia varied significantly (all P

Yi Shi, Yifan Ren Department of Pediatrics, Shaoxing Keqiao Women and Children’s Hospital, Shaoxing, Zhejiang Province, People’s Republic of ChinaCorrespondence: Yi Shi, Email shiyi111002@163.comBackground: Adenovirus pneumonia progresses rapidly, with a high rate of progression to severe pneumonia, but the early clinical manifestations lack specificity and are not easy to be recognized.Methods: Reviewing the relevant literatures, we studied and summarized the early recognition, clinical features and treatment outlook of severe adenovirus pneumonia Case Presentation: An 11-year-old child with community-acquired pneumonia, with influenza A antigen positive by colloidal gold, which further developed into acute respiratory distress syndrome after hospitalization. Three days later, adenovirus was detected positively by PCR of throat swab and diagnosed as severe adenovirus pneumonia. After aggressive treatment, her condition improved and was discharged from the hospital.Conclusion: Clinically, adenovirus combined with influenza virus infection is uncommon, and adenovirus infection is even rarer in adolescent children.Keywords: adenovirus, influenza virus, severe pneumonia, respiratory failure

Abstract Background Severe pneumonia has consistently been associated with high mortality. We sought to identify risk factors for the mortality of severe pneumonia to assist in reducing mortality for medical treatment. Methods Electronic databases including PubMed, Web of Science, EMBASE, Cochrane Library, and Scopus were systematically searched till June 1, 2023. All human research were incorporated into the analysis, regardless of language, publication date, or geographical location. To pool the estimate, a mixed-effect model was used. The Newcastle–Ottawa Scale (NOS) was employed for assessing the quality of included studies that were included in the analysis. Results In total, 22 studies with a total of 3655 severe pneumonia patients and 1107 cases (30.29%) of death were included in the current meta-analysis. Significant associations were found between age [5.76 years, 95% confidence interval [CI] (3.43, 8.09), P

Dan Ye,1,2 Yuanyuan Li,2 Kangkang Yan,1 Wenzhong Peng2 1Department of Pharmacy, Xi’an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi’an, People’s Republic of China; 2Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of ChinaCorrespondence: Wenzhong Peng, Department of Respiratory Medicine, Xiangya Hospital, Central South University, Xiangya Road No. 87, Kaifu District, Changsha, Hunan, 410008, People’s Republic of China, Tel +86-0731-89753287, Fax +86-89753287, Email pengwenzhong@csu.edu.cnBackground: Chlamydia abortus is a zoonotic pathogen that causes miscarriage, stillbirth, and sepsis of pregnancy in pregnant women when it infects humans. However, it rarely causes pneumonia in humans.Case Presentation: This case reports a case of severe pneumonia characterized by high fever and cough, and the disease rapidly progressed to dyspnea. The patient was treated with moxifloxacin and doxycycline. Chlamydia abortus was detected in bronchoscopy examination and bronchoalveolar lavage fluid (BALF) through metagenomic next-generation sequencing (mNGS)-DNA. A weak positive for influenza A (H1N1) antigen was also found in the throat swab tested. Subsequently, we added mabaloxavir and replaced doxycycline with an intravenous infusion of omadacycline. After effective treatment, the patient developed a urinary tract infection, and the treatment plan was adjusted to meropenem combined with omadacycline. The patient’s condition improved, and she was discharged on the 14th day of admission.Conclusion: This is the first report of cases of non-pregnant female patients with Chlamydia abortus infection pneumonia. Consequently, infections with Chlamydia abortus can result in severe respiratory distress, disturbance of water and electrolyte balance, and abnormal liver function, which requires timely diagnosis and correct use of antibiotics by clinicians. Consequently, the mixed infection of H1N1 and Chlamydia abortus aggravated the complexity of the condition and treatment. Combining tetracycline and quinolone is effective for treating severe pneumonia with Chlamydia abortus infection.Keywords: chlamydia abortus, severe pneumonia, metagenomics next-generation sequencing, case report

Abstract Background Globally, pneumonia is one of the leading causes of morbidity and mortality as well as hospitalization burden for under-five children. Despite significant initiatives implemented to reduce morbidity and mortality from pneumonia in under-five children, little is known regarding the time to recovery and its predictors among under-five children admitted with severe pneumonia in Ethiopia. Hence, this study intended to estimate the median time to recovery and its predictors among under-five children admitted with severe pneumonia in East Wallaga zone public hospitals, western Ethiopia; 2023. Methods An institution-based retrospective cohort study was conducted among 383 under-five children who were admitted with severe pneumonia in East Wallaga zone public hospitals from January 2017 to December 2022. A systematic sampling method was used to select eligible medical records. EpiData Version 4.6 was used to enter the data and analyzed using STATA Version 17.0. Cox-proportional hazard assumption test and model fitness were checked. Variables with P-value ˂ 0.25 at bivariable Cox regression analysis were selected for the multivariable Cox proportional model. A multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from severe pneumonia at a P-value

Abstract Background Pneumonia is one of the leading causes of infant mortality globally, particularly in sub-Saharan Africa. In Uganda, pneumonia was the fourth leading cause of death in children

Mycoplasma pneumoniae pneumonia （MPP） is a common cause of community-acquired pneumonia in children aged 5 and older in China. Although most affected children have favorable clinical prognosis， some cases can escalate into severe MPP due to risk factors such as pathogen resistance or co-infections， etc. These severe cases significantly jeopardize the lives of children and may lead to diverse long-term sequelae. In response to this challenge， the Children’s Medical Center of the Third Affiliated Hospital of Sun Yat-sen University， integrating current guidelines， expert consensus， and its extensive clinical experience， has devised the “412” cluster treatment strategy. This comprehensive approach encompasses treatments for anti-infection， anti-inflammatory storm， anticoagulation and antioxidant stress. Additionally， it seamlessly integrates traditional Chinese medicine with western therapies， featuring bundled respiratory management and follow-up care. This strategy provides a valuable reference for the diagnosis and treatment of severe MPP in children.

Purpose: This study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient. Methods: We conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality. Results: Multivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission. Conclusions: The mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter. [ABSTRACT FROM AUTHOR]

Objective To explore the application effect of risk management based on nursing quality sensitive indicators in elderly patients with severe pneumonia. Methods A total of 94 elderly patients with severe pneumonia admitted to the Respiratory Department of Zhengzhou Yihe Hospital from May 2021 to May 2023 were selected as the study subjects. The 94 elderly patients with severe pneumonia were divided into the control group and the observation group using a random number table method, with 47 cases in each group. The patients in the control group were given routine nursing care, while the patients in the observation group were given risk management based on sensitive indicators of nursing quality. Both groups continued to receive care until the patients were discharged. The nursing management effects of the two groups were compared. Results The indexes of blood gas analysis in the two groups after nursing were better than those before nursing, and the partial pressure of carbon dioxide in the observation group was lower than that in the control group, with statistical significances（P＜0. 05). The arterial oxygen partial pressure, oxygen and index in the observation group were higher than those in the control group after nursing, but the differences were not statistically significant（P＞0. 05). The duration of mechanical ventilation and hospitalization in the observation group were shorter than those in the control group, and the total incidence of nursing adverse events such as ventilator-associated pneumonia and falling off the bed was lower than that in the control group. The scores of SF-36 and the scores of nursing satisfaction were higher than those in the control group, with statistical significances（P＜0. 05). Conclusion After risk management intervention based on nursing quality sensitive indicators, elderly patients with severe pneumonia can improve their blood gas analysis indicators, further shorten their mechanical ventilation time, reduce hospital stay, reduce nursing adverse events such as ventilator-associated pneumonia and falls, promote the improvement of patient quality of life, and achieve satisfactory nursing outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Basic & Clinical Medicine is the property of Editorial Office of Basic & Clinical Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)