Based on review and practice of literature search of clinical economic evaluation, We have discussed the source and search strategy of literatures of clinical economic evaluation. A sample on antibiotics in the treatment of community-acquired pneumonia was shown concurrently.
Objective To detect the levels and study the significance of serum soluble intercellular adhension molecule-1(sVCAM-1),soluble vascular cell adhension molecule-1 (sVCAM-1) in patients with community-acquired pneumonia(CAP).Methods sICAM-1 and sVCAM-1 were detected by enzymelinked immunosorbent assy（ELISA）in 25 patients with CAP before and after treatment as well as in 10 healthy controls.Results Before treatment, the levels of serum sICAM-1 and sVCAM-1 in the patients with CAP[（2.658 4±0.259 7）ng/mL,(2.680 9±0.255 4）ng/mL)] were significantly higher than those in controls[(2.472 8±0.077 6)ng/mL,（2.426 3±0.307 2)ng/mL](Plt;0.01,Plt;0.05). After treatment, the levels of serum sICAM-1, sVCAM-1 significantly decreased [(2.518 3±0.205 2)ng/mL,(2.523 0±0.279 4)ng/mL](Plt;0.01,Plt;0.01) and were not different from those in controls（Pgt;0.05）.The levels of sICAM-1 were positively associated with neutrophil counts（r=0.602，Plt;0.001）rather than the levels of sVCAM-1（r＝0.036，Pgt;0.05）.Conclusion The changes of sICAM-1 and sVCAM-1 before and after treatment are predictive to the prognosis in patients with CAP.
Objective To observe the gamma-glutamyltransferase ( GGT) activity and total antioxidant capacity ( T-AOC) in serum and platelet during the course of community-acquired pneumonia ( CAP) . Methods Ninety cases of hospitalized CAP were recruited from the respiratory wards in the Affiliated Hospital of XuzhouMedical College fromSeptember 2010 to September 2011, and 30 healthy cases who underwent physical examination in the same hospital were enrolled as control. GGT activity and T-AOC were compared between the CAP patients and the control subjects, and also between the CAP patients who developed reactive thrombocytosis ( platelet count gt;300 ×109 /L) and those without thrombocytosis ( platelet count ≤300 ×109 /L) . Results Compared with the control subjects, serumand platelet GGT activity of the CAP patients were significantly higher [ ( 45. 6 ±25. 4) U/L vs. ( 17. 9 ±3. 7 ) U/L, ( 179. 9 ±41. 3) mU/109plt vs. ( 49. 5 ±8. 0) mU/109plt, P lt; 0. 05] , serum T-AOC at admission was significantly lower [ ( 12. 6 ±1. 6) U/mL vs. ( 17. 7 ±2. 1) U/mL, P lt; 0. 05] , and platelet T-AOC at admission was significantly higher [ ( 61. 6 ±18. 3) mU/109plt vs. ( 48. 6 ±9. 9) mU/109 plt, P lt; 0. 05] . Platelet T-AOC of the CAP patients at discharge was significantly lower than that of the CAP patients at admission and the control subjects. Compared with the CAP patients without thrombocytosis, serum T-AOC and serum GGT activity of the CAP patients who developed reactive thrombocytosis were significantly higher( P lt;0. 05) , and platelet T-AOC and platelet GGT activity were both significantly lower ( P lt; 0. 05) . There were negative correlations of the platelet count with platelet T-AOC and GGT activity in the CAP patietns( r = - 0. 316,P =0.003; r = - 0. 318, P =0. 002) . Conclusions There is a correlation between the oxidative stress and the platelet function in the inflammatory process of CAP. There might be an indicative role of platelets in resolving the inflammatory process and in maintaining the oxidative-antioxidative balance.
Objective To evaluate and select essential medicine for community-acquired pneumonia (CAP) using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Eleven guidelines were included (nine foreign guidelines, two domestic guidelines; nine based on evidence, two based on expert consensus). For CAP, amoxicillin amp; clavulanate potassium had efficiencies of 77.1% and an incidence of 18.8% as to adverse reaction that mainly included gastrointestinal reaction, skin rashes, etc. Piperacillin/tazobactam had an efficiency of 92.1% and a bacterial clearance rate of 88.9%. Cefuroxime had an efficiency of 89% and a bacterial clearance rate of 85.5%. There was no statistical significance between azithromycin and cefuroxime for CAP (RR=0.98, 95%CI 0.9 to 1.06); however, azithromycin was superior to cefuroxime in shortening fever-relief time (MD=–0.98, 95%CI –1.24 to –0.55) and cough-relief time (MD=–1.36, 95%CI –1.94 to –0.78). Efficiencies of ceftriaxone, cefotaxime, moxifloxacin and lavofloxacin were all more than 80% and among the three, moxifloxacin was the most efficient (RR=1.08, 95%CI 1.02 to 1.13, P=0.004). Meropenem had an efficiency of 90%, a bacterial clearance rate of 83.3% and an incidence of 3.33% as to adverse reaction that mainly included diarrhea. Conclusion (1) We offer a b recommendation for antibiotics such as amoxicillin, amoxicillin amp; clavulanate potassium, ampicillin/sulbactam, piperacillin/tazobactam, doxycycline, azithromycin, clarithromycin, cefuroxim, ceftriaxone, cefotaxime, lavofloxacin, moxifloxacin, ertapenem, meropenem, imipenem and vancocin. (2) We offer a weak recommendation for penicillin G, ciprofloxacin and erythromycin. (3) We propose that doctor should choose optimal antibiotics based on commonly-seen pathogenic bacteria that cause CAP, local criteria of antibiotic susceptibility, severity of CAP, and risk factors of patients.
ObjectiveTo investigate the clinical characteristics and predicting factors for death in critically ill patients with severe community-acquired pneumonia (CAP). MethodA total of 143 hospitalized patients with severe CAP between January 2009 and December 2012 were included and their clinical data were retrospectively analyzed. According to the clinical outcome, patients were divided into survival group and death group, and their clinical features and laboratory test results were compared, and multivariate regression analysis was conducted to search for predicting factors for death. ResultsIn this study, a total of 118 patients survived and 25 patients died, and the mortality rate was 17.5%. The number of underlying diseases in the two groups were different, and death group had more patients with 3 kinds of diseases than the survival group[76.0% (19/25) vs. 22.8% (13/57), P<0.05]. The intubation rate in the death group was significantly higher than that in the survival group[84.0% (21/25) vs. 33.1% (39/118), P<0.05], and the arterial blood pH value (7.15±0.52 vs. 7.42±0.17, P<0.05), HCO3- concentration[(18.07±6.25) vs. (25.07±5.44) mmol/L, P<0.05], PaO2[(58.92±35.18) vs. (85.92±32.19) mm Hg (1 mm Hg=0.133 kPa), P<0.05] and PaO2/FiO2[(118.23±98.02) vs. (260.17±151.22) mm Hg, P<0.05)] in the death group were significantly lower than those in the survival group. And multivariate regression analysis indicated that the number of underlying diseases[OR=0.202, 95%CI (0.198, 0.421), P=0.003], PaO2[OR=1.203, 95%CI (1.193, 1.294), P=0.011] and PaO2/FiO2[OR=0.956, 95%CI (0.927, 0.971), P=0.008] were independent predictors of death in the patients with severe pneumonia. ConclusionsPatients who died of severe pneumonia often had severe illnesses before admission, and the number of underlying diseases and PaO2 have highly predictive value for death.
ObjectiveTo investigate the clinical efficacy of low molecular weight heparin on community-acquired pneumonia (CAP). MethodsA total of 78 patients with CAP admitted to hospital between January 2013 and March 2015 were randomly assigned into a conventional treatment group and a heparin treatment group. Both groups received anti-infection and symptomatic treatment, and the patients in heparin treatment group additionally received low molecular weight heparin by abdominal subcutaneous injection once daily for a course with seven days. The age, sex and severity of the disease were recorded. White blood cell (WBC) count and the levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured on and during admission. ResultsThe baseline information including age and sex, severity of illness, CRP, ESR and WBC counts on admission and the first treatment day had no difference between two groups (P > 0.05). CRP and ESR on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significantly more decreased than those in the conventional treatment group (P < 0.05). For the moderate and severe CAP patients, the level of CRP on day 3 after treatment and WBC counts on day 7 after treatment in the heparin treatment group were significant lower than those in the conventional treatment group (P < 0.05). ConclusionCombination therapy of low molecular weight heparin may improve the clinical efficacy of CAP.
ObjectiveTo systematically review the efficacy and safety of respiratory fluoroquinolones monotherapy versus β-lactams plus macrolides combination therapy for non-ICU hospitalized community acquired pneumonia (CAP) patients. MethodsWe searched databases including PubMed, the Cochrane Library (Issue 3, 2015), EMbase, CNKI, WanFang Data, VIP and CBM to identify randomized controlled trials (RCTs) involving the comparison of fluoroquinolones monotherapy with β-lactams plus macrolides combination treatment for the non-ICU hospitalized patients with CAP up to April 2015. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, assessed the risk bias of included studies, and then meta-analysis was performed using the RevMan 5.0 software. ResultsA total of 17 RCTs involving 5 423 patients were included. The results of meta-analysis showed that there was no significant difference between the two therapy groups on the mortality. For the clinical treatment success rates, no significant differences between the two groups were found based on the data of intention-to-treat (ITT) and per-protocol (PP) analyses. However, respiratory fluoroquinolones monotherapy was associated with higher clinical treatment success rates based on the data that it was unclear whether ITT or PP analysis was used (RR=1.08, 95% CI 1.01 to 1.18, P=0.02), especially in Asians (RR=1.10, 95%CI 1.02 to 1.18, P=0.01). Additionally, respiratory fluoroquinolones monotherapy was associated with less adverse events (RR=0.81, 95%CI 0.73 to 0.90, P<0.000 1), especially in Caucasians (RR=0.64, 95%CI 0.36 to 1.14, P=0.13). ConclusionCurrent evidence shows that the efficacy of respiratory fluoroquinolones monotherapy may be similar to β-lactams plus macrolides combination treatment for non-ICU hospitalized CAP patients. Since the limitation of quantity and quality of included studies, large-scale high-quality RCTs are needed to verify the above conclusion.
Objective To investigate the clinical efficacy of nutritional support with different proportion of fat on the prognosis of patients with severe community-acquired pneumonia (SCAP). Methods Ninety SCAP patients with nutritional risk treated between January 2014 and July 2015 were randomized into high, normal, and low-proportion fat groups with 30 patients in each. The patients in different groups underwent nutritional support with different fat proportion besides the same medication. Data of albumin, pre-albumin and transferrin were collected and analyzed before treatment and 10 days after treatment. The mortality rates were compared between groups. Results Albumin, pre-albumin and transferrin were similar in all groups before intervention (P>0.05); albumin, pre-albumin and transferrin increased significantly 10 days after treatment in each group (P<0.05). Patients in the normal-fat group acquired significantly more obvious improvements on each index (P<0.05). A shorter length of stay in hospital was observed in the normal-proportion fat group compared with the high and low-proportion fat groups, but there was no significant differences among groups (P>0.05). On the 10th day, the normal -proportion fat proportion group had a significantly higher cure rate and a significantly lower mortality rate than the other two groups (P<0.05). The improvement rate was similar in all groups (P>0.05). Conclusion Supportive treatment with normal fat proportion has a promising value in the improvement of albumin, pre-albumin and transferrin for SCAP patients with a shorter length of stay in hospital, which is worthy of clinical promotion.
Objective To investigate the value of procalcitonin (PCT) at admission for severity stratificaton and prognosis prediction of community-acquired pneumonia (CAP), and assess the ability of the combination of PCT and the validated pneumonia risk scores (PSI and CURB-65) for predicting 30-day mortality. Methods A retrospective study was performed in 150 hospitalized CAP patients admitted in the Department of Respiratory Medicine of General Hospital of Tianjin Medical University between March 2015 and March 2016. The primary end point for this study was mortality within 30 days. Sensitivity (SEN), specificity (SPE), positive and negative predictive value (PPV, NPV) of PCT for assessing mortality was calculated and compared to validated pneumonia risk scores. Results In the 150 CAP patients enrolled, there were 77 males and 73 females with an average age of 58.4±16.3 years. Twelve (8%) patients died within 30 days. The non-survivors had significantly higher median PCT level (4.25 ng/mlvs. 0.24 ng/ml) and C-reactive protein (CRP) level (14.60 mg/dlvs. 5.10 mg/dl) compared with the survivors. The median PCT level was significantly higher in the patients with more severe disease assessed by two risk scoring systems. Combination of PCT with risk scores can improve prognostic value for predicting 30-day mortality of CAP. Conclusions The level of PCT at admission is more useful than the traditional biomarkers for the severity stratification and prognosis prediction of CAP. It can well determine patients at low risk of mortality from CAP. There is no advantage of PCT compared to PSI or CURB-65, so we recommend combination of PCT to risk sores to predict 30-day mortality of CAP.