Topics

Assessing Effectiveness of Community Acquired Pneumonia Treatment by Continuous Pneumonia Severity Score

2019-10-28 13:57:19 | BioPortfolio

Summary

Community acquired pneumonia (CAP) is a common respiratory infection and is the main cause of ICU admission and death in adults. Because of most patients were treated empirically against suspected causative microorganism, it is important to assess the effectiveness of treatment after 3 days of anti-infective therapy. However, the criteria for treatment failure is lack of a clear-cut and validated definition from the CAP guidelines.

Pneumonia severity scores is a wide-used severity rating system for treatment selection and outcome prediction for CAP. So far, the pneumonia severity scores only used once before the treatment started. Considering the pneumonia severity scores could reflect the severity of pneumonia, it is reasonable to assume that the change of pneumonia severity scores could reflect the patients' condition and the effectiveness of the treatment. This trail will be designed to validate the feasibility of assessing effectiveness of CAP treatment by using continuous pneumonia severity score.

Description

The applicant has established a CAP patients database and found a new effective pneumonia severity score: Expand-CURB. According to the retrospective study results, applicant found the changes of pneumonia severity score could reflect the patients'condition and was the independent risk factor for 30-day mortality. More specifically, if the patients'Expand-CURB score was not improved after 3-5 days of initial treatment, the odds ratio of 30-day mortality was 5.571 and 5.249 (95%CI 1.831-15.051, P=0.002) by univariate analysis and multivariate analysis (the multivariate was adjusted by the initial severity of pneumonia).

In addition, the applicant found the changes of serum CRP(C reactive protein ) before and after initial treatment also associated the patients'outcomes. If the serum CRP decreased less than 40% or not lower than 20mg/dl after the initial treatment, the odds ratio of 30-day mortality will be 3.692 and 3.806 (95%CI 1.867-7.756, P<0.001) by univariate analysis and multivariate analysis.

In conclusion, the applicant established three criteria for assessing effectiveness of CAP treatment:

1. Effective treatment by PSI: the PSI score decreased after 3-5 days the initial treatment.

2. Effective treatment by Expand-CURB: the Expand-CURB score decreased after 3-5 days the initial treatment.

3. Effective treatment by serum CRP: the serum CRP decreased more than 40% or lower than 20mg/dl after 3-5 days the initial treatment.

Furthermore, the applicant found combined pneumonia severity scores with CRP could predict the 30-day mortality more efficiently. The OR for both CRP and PSI treatment failure was 2.377 (95%CI 1.100-5.136, P=0.028). And the OR for both CRP and Expand-CURB treatment failure was 7.332 (95%CI 1.563-34.385, P=0.012). Therefore, it is reasonable to assume that the change of pneumonia severity scores and CRP could reflect the patients'condition and the effectiveness of the treatment.

To validate the feasibility of assessing effectiveness of CAP treatment by using continuous pneumonia severity score and changes of CRP, applicant intend to randomly allocate the patients into three arms: Comprehensive evaluation group, PSI evaluation group and Expand-CURB evaluation group. Patients who did not agree to participate the randomized controlled study will be asked whether they agree to provide their clinical data for prospective observational studies.

The primary outcomes will be 30-day mortality and ICU admission. The second outcome is length of hospital stay.

Study Design

Conditions

Community-acquired Pneumonia

Intervention

changes of Pneumonia Severity Score

Location

SAHZhejiangU
Hangzhou
Zhejiang
China
310000

Status

Not yet recruiting

Source

Second Affiliated Hospital, School of Medicine, Zhejiang University

Results (where available)

View Results

Links

Published on BioPortfolio: 2019-10-28T13:57:19-0400

Clinical Trials [1812 Associated Clinical Trials listed on BioPortfolio]

Adequate Duration of Antibiotic Treatment in Community-acquired Pneumonia With High Risk Class and Adequate Initial Clinical Response

Non-inferiority, multicenter, prospective double-blind, randomized clinical trial of two parallel groups. The randomization between the 2 study groups will be carried out according to a sc...

Community Acquired Pneumonia in Telemark and Ostfold

The aim of the study is to investigate the bacterial causes in community acquired pneumonia in adults admitted to hospital in two counties in Norway and to look at possible factors that ma...

Clinical Pathway Based on Procalcitonin Levels for the Management of Community-acquired Pneumonia in Outpatients

A clinical protocol was developed for the management of adult outpatients with community-acquired pneumonia (CAP) and Pneumonia Severity Index risk classes I-II. Patients are assigned to o...

A Molecular Toolkit for the Microbial Investigation of Severe Community Acquired Pneumonia

Severe community acquired pneumonia is common and associated with high mortality. Conventional microbiological diagnostics identify pathogens in approximately half of cases, which is inade...

Bacterial Pneumonia Score (BPS) Guided Antibiotic Use in Children With Community Acquired Pneumonia

The aim of this study is to test if BPS (Bacterial Pneumonia Score) guided antibiotic use in children with non severe community acquired pneumonia (CAP) will reduce antibiotic use as compa...

PubMed Articles [7692 Associated PubMed Articles listed on BioPortfolio]

Community-acquired Pneumonia in the Elderly.

Pneumonia belongs to the most frequent and most deadly infectious diseases worldwide. It represents an increasing problem for the aging population. The incidence and mortality rises with every decade....

Economic evaluation of community acquired pneumonia management strategies: A systematic review of literature.

Community-acquired pneumonia (CAP) is a major cause of mortality and morbidity worldwide. Efficient use of resources is fundamental for best use of money among the available and novel treatment option...

Rapid syndromic molecular testing in Pneumonia: the current landscape and future potential: Rapid syndromic molecular tests for pneumonia.

Community acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and ventilator associated pneumonia (VAP) are all associated with significant mortality and cause huge expense to health care serv...

Emerging antibiotics for Community-Acquired Pneumonia.

: Community-acquired pneumonia is the most common infection leading to hospitalization and death in all age groups, especially in elderly populations. Increasing antibiotic resistance among the common...

The Glycemic Gap and 90-Day Mortality in Community-acquired Pneumonia: A Prospective Cohort Study.

Hyperglycemia is associated with mortality in patients with community-acquired pneumonia (CAP) and hyperglycemia may be a biomarker of severity. However, hyperglycemia has a major disadvantage since t...

Medical and Biotech [MESH] Definitions

Pneumonia due to aspiration or inhalation of various oily or fatty substances.

Pneumonia caused by infection with bacteria of the family RICKETTSIACEAE.

Severe complication of pneumonia characterized by liquefaction of lung tissue.

A species of the genus PNEUMOVIRUS causing pneumonia in mice.

An anatomic severity scale based on the Abbreviated Injury Scale (AIS) and developed specifically to score multiple traumatic injuries. It has been used as a predictor of mortality.

More From BioPortfolio on "Assessing Effectiveness of Community Acquired Pneumonia Treatment by Continuous Pneumonia Severity Score"

Quick Search

Relevant Topics

Pneumonia
Pneumonia (bronchopneumonia, lobar pneumonia and double pneumonia) is inflammation (swelling) of the tissue in one or both of your lungs. It is usually caused by an pneumococcal infection caused by bacteria called Streptococcus pneumoniae.  However,...

Respiratory
Asthma COPD Cystic Fibrosis Pneumonia Pulmonary Medicine Respiratory Respiratory tract infections (RTIs) are any infection of the sinuses, throat, airways or lungs.  They're usually caused by viruses, but they can also ...

Infectious-diseases
Antiretroviral Therapy Clostridium Difficile Ebola HIV & AIDS Infectious Diseases Influenza Malaria Measles Sepsis Swine Flu Tropical Medicine Tuberculosis Infectious diseases are caused by pathogenic...


Searches Linking to this Trial