Prediction model for pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and biomarkers

Groeneveld, Geert H.; Wout, J.W. van ’t; Aarts, N. J. M.; Rooden, Cornelis J. van; Verheij, Theo; Cobbaert, Christa; Kuijper, Ed J.; Vries, Jutte J.C. de; Dissel, Jaap T. van

doi:10.1186/s12879-019-4611-1

Cited by 20 publications

(11 citation statements)

References 28 publications

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“…[23] However, some researchers found that the CRP level did not improve the prediction of pneumonia; instead, it can help clinicians make a decision regarding the use of antibiotics. [24,25] In contrast to previous studies [11,20], we found that a hsCRP level of 1.64 mg/L had a negative likelihood ratio of 0.07 in the ROC analysis, which means it was a strong predictor of the absence of pneumonia in patients with normal or low leukocyte counts. Further investigations showed that three patients had a hsCRP level less than 1.64 mg/L in the pneumonia group, two of whom were diagnosed with COVID-19 according to the Chinese management guidelines (version 7.0) [15].…”

Section: Discussioncontrasting

confidence: 91%

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

Wang¹,

Liu²,

Li³

et al. 2020

Preprint

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Background Many patients went to the hospital presenting with acute fever, or respiratory symptoms, most of whom have a normal or low leukocyte counts. The aim of this study was to investigate the clinical characteristics and predictors of pneumonia in those patients. Methods In this retrospective study, adult patients (≥ 18 years old) presenting with acute fever or respiratory symptoms with normal or low leukocyte counts (≤ 9.5 × 109/L) in Peking Union Medical College Hospital between 26 January 2020 and 10 March 2020 were included. Patients were categorized into groups with pneumonia or upper respiratory tract infection (URTI) according to chest CT scans. Logistic regression was used to explore predictors of pneumonia. Results A total of 195 patients were included, 63 of whom were diagnosed with pneumonia. The median maximum body temperature was 38.5 °C (38.0-38.8 °C) in patients with pneumonia and 37.5 °C (37.4–37.8 °C) in the other group. There was a significant difference in high-sensitivity C-reactive protein (hsCRP) levels between the two groups (0.21 (0-3.74) versus 33.4 (15.5–75.5) mg/L, p < 0.001). Multivariable regression showed that the predictive values of pneumonia were older age (OR 1.06, 95% CI 1.02–1.10, p = 0.004), cough (OR 0.18, 95%CI 0.06–0.56; p = 0.003), higher temperature (OR 3.36, 95%CI 1.16–9.71; p = 0.025) and higher hsCRP level (OR 1.05, 95%CI 1.02–1.09; p = 0.003). The optimal cutoff values based on the ROC curve analysis were a temperature of 37.8 °C and a hsCRP level of 1.64 mg/L. Conclusions Patients with older age, cough, higher temperature and higher hsCRP level were more inclined to have pneumonia. Temperatures higher than 37.8 °C were a potential predictor of pneumonia in patients with normal or low leukocyte counts in the early stage. However, a hsCRP level less than 1.64 mg/L could rule out most cases of pneumonia.

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Section: Discussioncontrasting

confidence: 91%

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

Wang¹,

Liu²,

Li³

et al. 2020

Preprint

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show abstract

“…It is a sensitive indicator of inflammation, and the majority of patients with COVID-19 present with increased CRP levels. In patients with severe COVID-19 infection, levels of ≥10 mg/l account for 81.5% ( 49 , 50 ). Patients with severe COVID-19 infection often also present with increased levels of inflammatory factors ( 31 ).…”

Section: Discussionmentioning

confidence: 99%

A pregnant woman with COVID‑19 gives birth to premature triplets: A case report and literature review

Feng

2022

Med Int

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to the best of our knowledge, no case report has been published to date concerning the novel coronavirus disease 2019 treatment plan for pregnant women with triplets, as well as on the possibility of a vertical transmission to triplets delivered prematurely by a pregnant woman with CoVID-19. the present study thus describes such as case. a 29-year-old local resident, a woman with CoVID-19, who was pregnant with triplets, had not moved from her residence for the past 6 months. the main symptoms mentioned by the patient on the day of admission were the following: the patient was in the 28th week of pregnancy, 2019 novel coronavirus (2019-nCoV) nucleic acid positive test 13 h prior to admission. additionally, the patient had a high fever and dyspnea after admission. the patient was treated with convalescent plasma from patients with CoVID-19 and methylprednisolone, at the same time her anemia, anxiety and insomnia were treated. Subsequently, the patient's condition improved, and normal body temperature was restored. Cesarean section was performed due to severe intrahepatic cholestasis of pregnancy (ICP), and due to the fetuses being located in three chorionic and amniotic cavities, and due to the fact that each of the three infants was in a different position (cephalic, breech and transverse position). Following delivery, total bile acid values and liver function improved gradually, and the 2019-nCoV nucleic acid test was negative consecutively for two tests, and the woman was then discharged from the hospital. Each premature infant born by caesarean section was individually transported to a neonatal intensive care unit for isolation treatment, with the neonatal escorts and transport teams wearing secondary protective clothing. all three premature infants were transitioned gradually from parenteral intravenous nutrition to full oral feeding. 2019-nCoV nucleic acid test results were negative for all infants. 2019-nCoV IgM test results were negative and IgG were positive for all infants. the pregnant woman and the three premature infants were successfully treated and discharged after they felt no discomfort and were negative consecutively for two 2019-nCoV nucleic acid tests. the three premature infants were monitored for growth and development until December, 2021, and eye, lung, heart, brain, liver, kidney, intestine and other organ functions were normal. the present study reports on the treatment and delivery outcomes of a woman with CoVID-19, who was pregnant with triplets. the present case report demonstrated that although the pregnant woman with triplets was suffering from CoVID-19, all three premature infants delivered by cesarean section did not present with intrauterine vertical infection, and abnormal growth and development were not observed. the convalescent plasma of patients with CoVID-19 and methylprednisolone were effective for the treatment of a continuously high fever, and the timely treatment of complications is helpful for the treatment of patients with CoVID-19.

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“…As a sensitive indicator of inflammation, CRP is widely used in the evaluation of various infectious diseases alone or in combination with other indicators 20,21 . Increased CRP level was observed in 93.75% (15/16) of the patients in the baseline, and the average CRP level of patients was observed to drop to about 0.63 of the baseline level, suggesting convalescent plasma transfusion may play a role in reducing the body’s inflammatory response rapidly.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Convalescent Plasma for Treatment of COVID-19 Patients

Chen

et al. 2020

Preprint

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Background and objective: The outbreak of COVID-19 has become a global health concern. In this study, we evaluate the effectiveness and safety of convalescent plasma therapy in patients with severe and critically ill COVID-19. Methods: Sixteen COVID-19 patients received transfusion of anti-COVID-19 antibody-positive convalescent plasma. The main outcome was time for viral nucleic acid amplification (NAA) test turning negative. Clinical laboratory parameters were measured at the baseline (d0) before plasma transfusion, and day 1 (d1), day 3 (d3) after transfusion as well. Results: Among the 16 patients, 10 of them had a consistently positive result of viral NAA test before convalescent plasma transfusion. Eight patients (8/10) became negative from day 2 to day 8 after transfusion. Severe patients showed a shorter time for NAA test turning negative after transfusion (mean rank 2.17 vs 5.90, P = 0.036). Two critically ill patients transfused plasma with lower antibody level remained a positive result of NAA test. CRP level demonstrated a decline 1 day after convalescent plasma treatment, compared with the baseline (P = 0.017). No adverse events were observed during convalescent plasma transfusion. Conclusions: Viral NAA test of most patients with COVID-19 who received convalescent plasma transfusion turned negative on the 2nd to 8th days after transfusion, and the negative time of severe patients was shorter than that of critically ill patients.

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Prediction model for pneumonia in primary care patients with an acute respiratory tract infection: role of symptoms, signs, and biomarkers

Cited by 20 publications

References 28 publications

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

Clinical characteristics and predictors of pneumonia in patients presenting fever or respiratory symptoms with normal or low leukocyte counts: a retrospective study

A pregnant woman with COVID‑19 gives birth to premature triplets: A case report and literature review

Effectiveness of Convalescent Plasma for Treatment of COVID-19 Patients

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