Burden of community-acquired pneumonia, predisposing factors and health-care related costs in patients with cancer

Schmedt, Niklas; Heuer, Olivia Denise; Häckl, Dennis; Satō, Reiko; Theilacker, Christian

doi:10.1186/s12913-018-3861-8

Cited by 25 publications

(25 citation statements)

References 20 publications

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“…This study was conducted based on the InGef (former HRI) database with anonymized data from approximately 6.7 million individuals in Germany insured in one of approximately 70 German statutory health insurance providers (SHIs) currently contributing data to this database (mainly company or guild health insurances) [ 4 , 16 ]. For this study, a representative sample of the German SHI population regarding age and sex (approximately five percent of the German population) was created.…”

Section: Methodsmentioning

confidence: 99%

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Population-based incidence and mortality of community-acquired pneumonia in Germany

et al. 2021

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Background Little information on the current burden of community-acquired pneumonia (CAP) in adults in Germany is available. Methods We conducted a retrospective cohort study using a representative healthcare claims database of approx. 4 million adults to estimate the incidence rates (IR) and associated mortality of CAP in 2015. IR and mortality were stratified by treatment setting, age group, and risk group status. A pneumonia coded in the primary diagnosis position or in the second diagnosis position with another pneumonia-related condition coded in the primary position was used as the base cases definition for the study. Sensitivity analyses using broader and more restrictive case definitions were also performed. Results The overall IR of CAP in adults ≥18 years was 1,054 cases per 100,000 person-years of observation. In adults aged 16 to 59 years, IR for overall CAP, hospitalized CAP and outpatient CAP was 551, 96 and 466 (with a hospitalization rate of 17%). In adults aged ≥60 years, the respective IR were 2,032, 1,061 and 1,053 (with a hospitalization rate of 52%). If any pneumonia coded in the primary or secondary diagnosis position was considered for hospitalized patients, the IR increased 1.5-fold to 1,560 in the elderly ≥60 years. The incidence of CAP hospitalizations was substantially higher in adults ≥18 years with at-risk conditions and high-risk conditions (IR of 608 and 1,552, respectively), compared to adults without underlying risk conditions (IR 108). High mortality of hospitalized CAP in adults ≥18 was observed in-hospital (18.5%), at 30 days (22.9%) and at one-year (44.5%) after CAP onset. Mortality was more than double in older adults in comparison to younger patients. Conclusion CAP burden in older adults and individuals with underlying risk conditions was high. Maximizing uptake of existing vaccines for respiratory diseases may help to mitigate the disease burden, especially in times of strained healthcare resources.

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Section: Methodsmentioning

confidence: 99%

“…database (mainly company or guild health insurances) [4,16]. For this study, a representative sample of the German SHI population regarding age and sex (approximately five percent of the German population) was created.…”

Section: Plos Onementioning

confidence: 99%

Population-based incidence and mortality of community-acquired pneumonia in Germany

et al. 2021

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“…This is of particular concern with regard to S. pneumoniae as pneumonia is the most common serious infection found in patients with cancer. 48,49 Further, human infections by S. pneumoniae serotypes 19F, 11A, and 9N, the 3 serotypes with the most significant radiation-induced deficiencies in IgG response, have each been associated with increased mortality. 50 Collectively, the study reported here adds to the growing body of mouse, NHP, and human data indicating that in addition to the dramatic acute effect of radiation exposure, TBI leads to subtle long-term immunologic defects.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Recovery of the Adaptive Immune System in Rhesus Macaques After Total Body Irradiation

Macintyre

French

Sanders

et al. 2021

Advances in Radiation Oncology

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Ionizing radiation causes acute damage to hematopoietic and immune cells, but the long-term immunologic consequences of irradiation are poorly understood. We therefore performed a prospective study of the delayed immune effects of radiation using a rhesus macaque model. Methods and Materials: Ten macaques received 4 Gy high-energy x-ray total body irradiation (TBI) and 6 control animals received sham irradiation. TBI caused transient lymphopenia that resolved over several weeks. Once white blood cell counts recovered, flow cytometry was used to immunophenotype the circulating adaptive immune cell populations 4, 9, and 21 months after TBI. Data were fit using a mixed-effects model to determine age-dependent, radiation-dependent, and interacting effects. T cell receptor (TCR) sequencing and quantification of TCR Excision Circles were used to determine relative contributions of thymopoiesis and peripheral expansion to T cell repopulation. Two years after TBI, the cohort was vaccinated with a 23-valent pneumococcal polysaccharide vaccine and a tetravalent influenza hemagglutinin vaccine. Results: Aging, but not TBI, led to significant changes in the frequencies of dendritic cells, CD4 and CD8 T cells, and B cells. However, irradiated animals exhibited increased frequencies of central memory T cells and decreased frequencies of naïve T cells. These consequences of irradiation were time-dependent and more prolonged in the CD8 T cell population. Irradiation led to transient increases in CD8þ T cell TCR Excision Circles and had no significant effect on TCR sequence entropy, indicating T cell recovery was partially mediated by thymopoiesis. Animals that were irradiated and then vaccinated showed normal immunoglobulin G binding and influenza neutralization titers in response to the 4 protein antigens but weaker immunoglobulin G binding titers to 10 of the 23 polysaccharide antigens.

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“… 6 , 7 Known or potential risk factors for CAP were included in logistic regression to calculate the propensity score. The risk factors included age, 8 – 10 Chinese ethnicity, male gender, 11 smoking status, 9 drinking status, 11 history of psoriasis, history of IBD, use of sulfasalazine, etanercept, infliximab, adalimumab, golimumab, certolizumab, secukinumab, use of steroids for more than ½ year, diabetes, 12 chronic renal impairment, 12 malignancy, 13 , 14 chronic lung disease, 15 chronic heart disease, 12 other immunosuppressants or immune-suppressed states, 11 and cerebrovascular accident. 12 The score was grouped into pentiles with non-overlapping parts trimmed.…”

Section: Methodsmentioning

confidence: 99%

Risk of community-acquired pneumonia requiring hospitalization in patients with spondyloarthritis

Chung

Tam

Chan

et al. 2020

Therapeutic Advances in Musculoskeletal

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Aims: To compare the risk of community-acquired pneumonia (CAP) requiring hospitalization in spondyloarthritis (SpA) and non-specific back pain (NSBP), and to identify the risk factors for CAP in SpA. Methods: A total of 2984 patients with SpA from 11 rheumatology centers and 2526 patients with NSBP from orthopedic units were reviewed from the centralized electronic database in Hong Kong. Incidence of CAP requiring hospitalization and demographic data including age, gender, smoking and drinking status, use of sulfasalazine, individual biological-disease modifying anti-rheumatic drugs (DMARDs) used, micro-organisms, other immunosuppressants or immunosuppressive states, use of steroid for more than ½ year, and co-morbidities were identified. Risks of CAP in SpA were compared with those in NSBP using propensity score regression method. Multivariate Cox regression model was used to identify the risk factors in SpA. Results: CAP requiring hospitalization was found in 183 patients with SpA and 138 patients with NSBP. Increased risk for CAP was found in the following groups with SpA: all subgroups (hazard ratio (HR) 2.14, p < 0.001), without use of DMARDs (HR 2.64, p < 0.001), without psoriasis and not taking DMARDs (HR 2.38, p < 0.001). Infliximab (HR2.55, p = 0.04), smoking (HR 1.68, p = 0.003), comorbid psoriasis (HR 1.67, p = 0.003), and use of steroid for more than ½ year (HR 1.94, p = 0.003) were found to associate with CAP after adjustments for traditional risk factors. Conclusion: Risk of CAP is increased in patients with SpA. Our data favor universal influenza and pneumococcal vaccination programs in the population. Rheumatologists should also advise smoking cessation and avoid long term steroid therapy.

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Burden of community-acquired pneumonia, predisposing factors and health-care related costs in patients with cancer

Cited by 25 publications

References 20 publications

Population-based incidence and mortality of community-acquired pneumonia in Germany

Population-based incidence and mortality of community-acquired pneumonia in Germany

Long-Term Recovery of the Adaptive Immune System in Rhesus Macaques After Total Body Irradiation

Risk of community-acquired pneumonia requiring hospitalization in patients with spondyloarthritis

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