Thorax
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Multicenter Study
Biomarkers improve mortality prediction by prognostic scales in community-acquired pneumonia.
Prognostic scales provide a useful tool to predict mortality in community-acquired pneumonia (CAP). However, the inflammatory response of the host, crucial in resolution and outcome, is not included in the prognostic scales. ⋯ Adding CRP levels to PSI, CURB65 and CRB65 scales improves the 30-day mortality prediction. The highest predictive value is reached with a combination of two scales and CRP. Further validation of that improvement is needed.
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Multicenter Study
Risk factors for complicated parapneumonic effusion and empyema on presentation to hospital with community-acquired pneumonia.
The aim of this study was to identify key factors on admission predicting the development of complicated parapneumonic effusion or empyema in patients admitted with community-acquired pneumonia. ⋯ This study has identified seven clinical factors predicting the development of complicated parapneumonic effusion or empyema. Independent validation is needed.
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The 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) guidelines defined severe community-acquired pneumonia (CAP) and recommended intensive care unit (ICU) admission when patients fulfilled three out of nine minor criteria. These criteria have not been validated. ⋯ These findings support the use of the IDSA/ATS minor criteria to predict hospital mortality and guide ICU admission in inpatients with CAP who do not require emergency mechanical ventilation or vasopressors.
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Comparative Study
Evaluation of the effect of diagnostic methodology on the reported incidence of ventilator-associated pneumonia.
The optimal method for diagnosing ventilator-associated pneumonia (VAP) is controversial and its effect on reported incidence uncertain. This study aimed to model the impact of using either endotracheal aspirate or bronchoalveolar lavage on the reported incidence of pneumonia and then to test effects suggested from theoretical modelling in clinical practice. ⋯ Diagnostic technique impacts significantly on reported VAP incidence and potentially on antibiotic use.