By Debbie Bunch
November 4, 2024
Clinical States Associated with Pneumonia Prognosis and Survival
Pneumonia patients in the ICU are typically relegated to one of three categories based on cause — community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-acquired pneumonia. According to researchers from Northwestern University, none of them really predict a patient’s chance for survival.
In a study published by the Proceedings of the National Academy of Sciences, they identified five different clinical states that they believe do a much better job of predicting disease progression and prognosis and could help clinicians make more informed decisions on treatment.
The team used machine learning tools to cluster patient conditions from two electronic health record sources into different clinical states, integrating a range of data such as body temperature, breathing rate, glucose levels, oxygen levels, and more to establish relationships between the different measures.
Results showed linear combinations of the variables characterizing these five functions — motor response, renal function, heart rate, systolic blood pressure, respiratory rate, and high blood pressure — provided the most pertinent information about the patient’s likelihood of survival.
From there, five distinct clinical states were identified, three associated with mortality and two reflecting disease etiology. One of the clusters was associated with a 7.5% chance of dying within 24 hours and one was found to contain most of the patients in the databases who had developed pneumonia in conjunction with a COVID-19 infection.
The team plans to continue their work on these clusters to find out more about how patients may move from one to another. They are also applying what they have learned during the pneumonia study to an animal study on sepsis. Read Article Read Abstract
Differences in PAIS Symptoms Between COVID and LRTI Patients Who Have Been Hospitalized
Researchers who published their findings in JAMA Network Open are shedding some light on the differences seen between post-acute symptoms suffered by people with COVID and those with other lower respiratory tract infections (LRTIs).
The trial was conducted among 191,710 participants. Among that group 1,153 were hospitalized with COVID-19, 1,304 were hospitalized with other LRTIs, and 189,253 were not infected and served as the reference group.
Results showed —
- COVID patients were significantly more likely to report 23 of 45 post-acute infection syndrome (PAIS) symptoms — which range from ear, nose, and throat symptoms to respiratory, neurological, gastrointestinal, and musculosckeletal problems — than those in the reference group.
- LRTI patients had higher risks for 18 of the 45 symptoms, including lingering cough.
- In a direct comparison, COVID patients were more at risk for seven specific symptoms than those in the LRTI group, including loss of smell, loss of taste, rapid heart rate upon standing, problems with thinking, bone pain, mild fatigue, and severe fatigue.
“Compared with other LRTIs, COVID-19 appeared to impose an extra burden of neurological, cognitive, and fatigue symptoms,” wrote the authors. Discovering the differences between post-COVID and other PAIS symptoms, they continued, “will inform tailored clinical management and offer mechanistic insights into these previously overlooked syndromes.”
E-Cigarettes May be More Dangerous in Older Age Groups
Vaping has been tied to an increase in respiratory symptoms in a number of studies, but a new report from researchers at the City University of New York suggests older people who vape may be at higher risk.
The study looked at data from the Population Assessment of Tobacco and Health study collected between 2016 and 2018. After adjusting for other factors that could influence respiratory health, the investigators found ever use of an e-cigarette product was associated with 1.32 greater odds of developing any respiratory illness when compared to never using an e-cigarette.
However, older adults who reported e-cigarette use had 1.77 greater odds of developing a respiratory condition vs. never users and younger adults. “Only the joint effect of age and e-cigarette use on any respiratory illness was statistically significant, suggesting this effect was greater than expected on the additive and multiplicative scales,” wrote the authors.
They call for interventions and policies to be put into place to reduce the use of vaping. They also suggest additional study to better understand the “modifiers of e-cigarette use, particularly age, in targeted health education programs and policy.”
The study was published by Preventive Medicine. Read Report
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