American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Aug 2019
Observational StudyAetiology and Risk Factors for Mortality in an Adult Community-Acquired Pneumonia Cohort in Malawi.
Rationale: In the context of rapid antiretroviral therapy rollout and an increasing burden of noncommunicable diseases, there are few contemporary data describing the etiology and outcome of community-acquired pneumonia (CAP) in sub-Saharan Africa. Objectives: To describe the current etiology of CAP in Malawi and identify risk factors for mortality. Methods: We conducted a prospective observational study of adults hospitalized with CAP to a teaching hospital in Blantyre, Malawi. ⋯ Detection of M. tuberculosis was associated with mortality (adjusted odds ratio, 2.44 [1.19-5.01]). Conclusions: In the antiretroviral therapy era, CAP in Malawi remains predominantly HIV associated, with a large proportion attributable to potentially vaccine-preventable pathogens. Strategies to increase early detection and treatment of tuberculosis and improve supportive care, in particular the correction of hypoxemia, should be evaluated in clinical trials to address CAP-associated mortality.
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Am. J. Respir. Crit. Care Med. · Aug 2019
Identifying Novel Sepsis Subphenotypes Using Temperature Trajectories.
Rationale: Sepsis is a heterogeneous syndrome, and identifying clinically relevant subphenotypes is essential. Objectives: To identify novel subphenotypes in hospitalized patients with infection using longitudinal temperature trajectories. Methods: In the model development cohort, inpatient admissions meeting criteria for infection in the emergency department and receiving antibiotics within 24 hours of presentation were included. ⋯ The hyperthermic, fast resolvers had the lowest mortality rate (2.9%). Similar trajectory groups, patient characteristics, and outcomes were found in the validation cohort. Conclusions: We identified and validated four novel subphenotypes of patients with infection, with significant variability in inflammatory markers and outcomes.